Table 5 Results from the group interviews (T1 and T2) presented in nine subcategories and three categories

Group interview (T1)

‘X: The facial expressions and the sleep X: The facial expression is the best, then you can see that wrinkle there and the whole thing, the first physical symptoms’.

The scale works well but is not always necessary

A new way of working to identify pain

‘For temporary fill in personnel it is another thing entirely, the temporary staff barely know them [the residents]’.

‘X Maybe get the staff’s interest going, so that everyone strives towards the same goal. X: What can it be when she does like that or is looking like that? When they don’t hear, or they don’t see, they can’t make themselves understood even if it’s not dementia, just as difficult’.

Helps to put a focus on pain

‘X: Says that it’s not good today. X: It seems that he may have pain, but there is nothing you can put your finger on’.

Pain assessments can help bring about an improvement in documentation and evaluation

‘Can’t make an evaluation after such a short time. Assessing pain can still feel like a problem because doing that is still so new to us, a person needs to train a bit more’.

A longer trial period is needed to evaluate the usefulness of the scale

Group interviews (T2)

‘X: What do you mean, a little headache, one’s own personal views are incredibly important. X: If one accesses pain for every person, so to say, then you’ll get quite a few different responses. X: Some of the older ones have a high pain threshold, they don’t complain much’.

Be observant of pain indicators and your personal views regarding pain

A systematic method of working and better communication facilitates better pain management

‘X: We have had several doctors…then there was a summer substitute and then we had a new one again. X: Feels very confusing. X: Now, we have a doctor from the local medical care centre here and he is very dedicated and good to talk to’.

Pain assessments facilitate more effective teamwork and drug treatments

‘If a person has made an assessment and it says that someone is likely to have pain, then you have evidence with the pain assessment’.

‘It is easier to get the staff to understand that you try other things [acetaminophen] first, it can be pain but it can also be something else that is causing the uneasiness, try something like that, to begin with before some sedative’.

‘X: Very different, doing this pain assessment. X: It has taken a lot of time but that will probably get better, it should be easy and there are benefits with it, but of course we don’t get more time either, instead we’ll have to make time to do it’.

Usability of the scale and items and work practices

We have considered it to be extremely interesting and thought it was great fun’.

Planning phase, lectures and pain assessment use

‘There are staff members that have questioned this, I could also say so, otherwise I would be lying but most of them are positive’.

Possibilities and obstacles with the intervention

‘X: Really good dialogue, she checks how it’s going, knows exactly how it is’. ‘X: Has not shown interest, but I hope that they [managers] will be interested.’

Manager support