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Kodagoda Gamage MW, Pu L, Todorovic M, Moyle W. Factors related to nurses' beliefs regarding pain assessment in people living with dementia. J Clin Nurs 2024; 33:4367-4380. [PMID: 38459722 DOI: 10.1111/jocn.17093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/27/2023] [Accepted: 01/07/2024] [Indexed: 03/10/2024]
Abstract
AIM To evaluate registered nurses' beliefs and related factors regarding pain assessment in people living with dementia. DESIGN A descriptive cross-sectional survey was conducted between July 2022 and April 2023. METHODS An online survey comprised of demographics, knowledge scale, and beliefs scale relating to pain assessment in dementia was distributed to registered nurses (RNs) caring for people living with dementia in Australia. RESULTS RNs (N = 131) completed the survey. Most respondents were females (87.0%) and self-identified as Caucasian (60.3%). The mean beliefs score was 72.60 (±6.39) out of a maximum possible score of 95. RNs' beliefs about pain assessment varied based on their education, dementia pain assessment knowledge, nursing experience, and ethnicity. Hierarchical multiple regression analysis revealed factors significantly related to the beliefs score (i.e. education and dementia pain assessment knowledge). CONCLUSION The relationship between education and knowledge, and the beliefs score indicates the potential to improve RNs' knowledge and overcome their erroneous beliefs about pain assessment in dementia. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Education and training in assessing pain in people living with dementia should be tailored to overcome RNs' misconceived beliefs. These programmes should be integrated into continuous learning programmes. IMPACT Some RNs' beliefs about pain assessment in dementia were not evidence-based, and knowledge and educational status were the strongest factors related to RNs' beliefs. RNs' erroneous beliefs about pain assessment in dementia need to be addressed to improve pain assessment and management. Researchers should explore the potential of educational interventions to overcome RNs' misconceived beliefs about pain assessment in dementia. REPORTING METHOD This study was reported adhering to the Strengthening the Reporting of Observational Studies in Epidemiology checklist. PATIENT OR PUBLIC CONTRIBUTION RNs caring for people living with dementia participated as survey respondents. Additionally, RNs were involved in the pre-testing of the study's survey instrument.
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Affiliation(s)
- Madushika Wishvanie Kodagoda Gamage
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- School of Nursing and Midwifery, Nathan, Griffith University, Brisbane, Queensland, Australia
- Department of Nursing, Faculty of Allied Health Sciences, University of Ruhuna, Matara, Sri Lanka
| | - Lihui Pu
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- School of Nursing and Midwifery, Nathan, Griffith University, Brisbane, Queensland, Australia
| | - Michael Todorovic
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- School of Nursing and Midwifery, Nathan, Griffith University, Brisbane, Queensland, Australia
- Faculty of Health Sciences and Medicine, Bond University, Robina, Australia
| | - Wendy Moyle
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- School of Nursing and Midwifery, Nathan, Griffith University, Brisbane, Queensland, Australia
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Shrestha S, Dahlke S, Butler JI, Hunter K, Fox MT, Davidson S, Chasteen AL, Moody E. Nursing Students' Perceptions on a Pain Management E- Learning Module: An Exploratory Quantitative Study. Pain Manag Nurs 2024; 25:e138-e143. [PMID: 38342704 DOI: 10.1016/j.pmn.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/24/2023] [Accepted: 12/28/2023] [Indexed: 02/13/2024]
Abstract
BACKGROUND Nursing students are graduating ill-prepared to assess and manage pain in older adults. To address this gap, we developed an e-learning module on the topic. AIM To examine nursing students' perceptions on a pain management e-learning module focused on older adults. METHODS Utilizing an exploratory quantitative design, we assessed nursing students' perceptions of the e-learning module. We used a feedback survey (four 5-point, Likert-type items) and one open-ended question to assess students' perceptions. Descriptive statistics were used to summarize students' perceptions and demographic characteristics. Responses to the open-ended question were content analyzed. RESULTS A total of 181 of 249 students completed the module, of whom two-thirds were female. Students perceived that the module enhanced their knowledge, confidence, and perception in working with older people. Students also found the method of instruction interactive and enjoyable. CONCLUSIONS The e-learning module on pain management was viewed by nursing students to be helpful and its interactive method of learning improved their knowledge, confidence, and perceptions of working with older adults in pain.
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Affiliation(s)
- Shovana Shrestha
- Faculty of Nursing, College of Health Sciences, University of Alberta, Alberta, Canada.
| | - Sherry Dahlke
- Faculty of Nursing, College of Health Sciences, University of Alberta, Alberta, Canada
| | - Jeffrey I Butler
- Faculty of Nursing, College of Health Sciences, University of Alberta, Alberta, Canada
| | - Kathleen Hunter
- Faculty of Nursing, College of Health Sciences, University of Alberta, Alberta, Canada
| | - Mary T Fox
- School of Nursing, York University Centre for Aging Research & Education, York University, Ontario, Canada
| | | | | | - Elaine Moody
- School of Nursing, Dalhousie University, Nova Scotia, Canada
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Pu L, Coppieters MW, Smalbrugge M, Jones C, Byrnes J, Todorovic M, Moyle W. Implementing PainChek and PARO to Support Pain Assessment and Management in Residents with Dementia: A Qualitative Study. Pain Manag Nurs 2023; 24:587-594. [PMID: 37105837 DOI: 10.1016/j.pmn.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 02/27/2023] [Accepted: 04/03/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND Pain is a common problem but often undiagnosed and untreated in people with dementia. AIMS This study explored the experiences of residents with dementia, family, andformal carers with (1) pain assessment and management for residents with dementia; (2) the use of the PainChek app for pain assessment, and (3) the use of a social robot PARO for pain management in residents with dementia. DESIGN A qualitative study. SETTINGS/PARTICIPANTS Interviews were conducted with 13 residents withdementia, three family members, and 18 formal carers from a residential aged carefacility. METHOD Residents with dementia interacted with PARO for 15 mins, five days perweek for three weeks. The PainChek app assessed pain levels before and after eachsession. After three-week intervention, individual interviews were conducted withresidents, family, and formal carers who experienced or observed the use of PainChekapp and PARO for residents. Interviews were audio-recorded, transcribed, andanalyzed using thematic analysis. RESULTS Four themes were identified regarding pain in residents with dementia: (1) the impact, challenges and strategies of pain assessment and management; (2) benefits and barriers of using PainChek app to assess pain; (3) benefits of interacting with PARO to manage pain and behavioral symptoms; and (4) implementing PainChek app and PARO to support pain assessment and management in dementia care. CONCLUSIONS Technology, such as PainChek and PARO, is promising to improve painassessment and reduce pain for people with dementia. Barriers to using technologyinclude limited staff training and the implementation of person-centered care.
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Affiliation(s)
- Lihui Pu
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Australia.
| | - Michel W Coppieters
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia; Amsterdam Movement Sciences - Program Musculoskeletal Health, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; School of Health Sciences and Social Work, Griffith University, Brisbane, Australia
| | - Martin Smalbrugge
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Medicine for Older People, Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, Aging & Later Life, Amsterdam, The Netherlands
| | - Cindy Jones
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia; Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Australia
| | - Joshua Byrnes
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia; Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Brisbane, Australia
| | - Michael Todorovic
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Australia
| | - Wendy Moyle
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Australia
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Kodagoda Gamage MW, Todorovic M, Moyle W, Pu L. Cultural Influence on Nurses' Pain Observations Related to Dementia: An Integrative Review. Pain Manag Nurs 2023:S1524-9042(23)00028-0. [PMID: 36907689 DOI: 10.1016/j.pmn.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 01/17/2023] [Accepted: 01/29/2023] [Indexed: 03/13/2023]
Abstract
BACKGROUND Nurses play a pivotal role in pain observation in people living with dementia. However, currently, there is little understanding of the influence culture may have on the way nurses observe pain experienced by people living with dementia. AIM This review explores the influence of culture on nurses... pain observations experienced by people living with dementia. SETTINGS Studies were included regardless of the setting (e.g., acute medical care, long-term care, community). DESIGN An integrative review. PARTICIPANTS/SUBJECTS PubMed, Medline, Psychological Information Database, Cochrane Library, Scopus, Web of Science, Cumulative Index of Nursing and Allied Health Literature, and ProQuest were included in the search. METHODS Electronic databases were searched using synonyms for "dementia," "nurse," "culture," and "pain observation." The review included ten primary research papers following the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. RESULTS Nurses reported that pain observation in people living with dementia is challenging. Four themes were identified by data synthesis: (1) using behaviors for pain observation; (2) information from carers for pain observation; (3) pain assessment tools for pain observation; and (4) role of knowledge, experience, and intuition in pain observation. CONCLUSIONS There is a limited understanding of the role of culture on nurses' pain observations. However, nurses take a multifaceted approach to observing pain using behaviors, information from carers, pain assessment tools, and their knowledge, experience, and intuition.
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Affiliation(s)
- Madushika Wishvanie Kodagoda Gamage
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Nathan, Griffith University, Brisbane, Queensland, Australia; Department of Nursing, Faculty of Allied Health Sciences, University of Ruhuna, Sri Lanka.
| | - Michael Todorovic
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Nathan, Griffith University, Brisbane, Queensland, Australia
| | - Wendy Moyle
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Nathan, Griffith University, Brisbane, Queensland, Australia
| | - Lihui Pu
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Nathan, Griffith University, Brisbane, Queensland, Australia
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Smith TO, Lockey D, Johnson H, Rice L, Heard J, Irving L. Pain management for people with dementia: a cross-setting systematic review and meta-ethnography. Br J Pain 2023; 17:6-22. [PMID: 36815066 PMCID: PMC9940246 DOI: 10.1177/20494637221119588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Pain management for people with dementia is challenging. There is limited understanding on the experiences of pain management from people with dementia, but also from those who support them. This study synthesised the qualitative evidence to explore the perspectives of people with dementia, their family, friends, carers and healthcare professionals to pain management. Methods A systematic literature review was undertaken of published and unpublished literature databases (to 01 November 2021). All qualitative research studies reporting the perspectives of people with dementia, their family, friends, carers and healthcare professionals to managing pain were included. Eligible studies were appraised using the Critical Appraisal Skills Programme (CASP) qualitative appraisal tool. A meta-ethnography analysis approach was adopted, with findings assessed against the GRADE-CERQual framework. Results Of the 3994 citations screened, 33 studies were eligible. Seven themes were identified from the data. There was moderate evidence from six studies indicating inequity of pain management for people with dementia. There was moderate evidence from 22 studies regarding anxieties on cascading pain information. There was moderate evidence from nine studies that familiarisation of the person with pain, their preferences, routines and behaviours were key factors to better pain management. Consistently, carers and healthcare professionals had a low opinion of the management of pain for people with dementia, with tensions over the 'best' treatment options to offer. This was associated with poor training and understanding on how pain 'should' be managed. Conclusion The findings highlight the challenges faced by people with dementia and pain, and those who support them. Improvements in education for people who support these individuals would be valuable across health and social care pathways. Supporting family members and relatives on pain experiences and treatment options could improve awareness to improve quality of life for people with dementia and pain and those who support them.
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Affiliation(s)
- Toby O Smith
- School of Health Sciences, University of East Anglia, Norwich, UK,Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Dawn Lockey
- Physiotherapy Department, South Tyneside and Sunderland NHS Foundation Trust, Sunderland Royal Hospital, Sunderland, UK
| | - Helen Johnson
- Physiotherapy Department, South Tyneside and Sunderland NHS Foundation Trust, Sunderland Royal Hospital, Sunderland, UK
| | - Lauren Rice
- Physiotherapy Department, South Tyneside and Sunderland NHS Foundation Trust, Sunderland Royal Hospital, Sunderland, UK
| | - Jay Heard
- Physiotherapy Department, Lewisham and Greenwich NHS Trust, Lewisham, University Hospital Lewisham, London, UK
| | - Lisa Irving
- Physiotherapy Department, South Tyneside and Sunderland NHS Foundation Trust, Sunderland Royal Hospital, Sunderland, UK
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Liao YJ, Jao YL, Berish D, Hin AS, Wangi K, Kitko L, Mogle J, Boltz M. A Systematic Review of Barriers and Facilitators of Pain Management in Persons with Dementia. THE JOURNAL OF PAIN 2023; 24:730-741. [PMID: 36634886 DOI: 10.1016/j.jpain.2022.12.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 12/07/2022] [Accepted: 12/24/2022] [Indexed: 01/10/2023]
Abstract
Approximately 50% of persons living with dementia experience pain, yet it is frequently undetected and inadequately managed resulting in adverse consequences. This review aims to synthesize evidence on the barriers and facilitators of pain management in persons living with dementia. PubMed, CINAHL, PsycINFO, and Web of Science datasets were used for article searching. Inclusion criteria were peer-reviewed original articles written in English that examined the barriers and facilitators of pain management for persons living with dementia. The Mixed Methods Appraisal Tool was used to evaluate the quality of the studies. A total of 26 studies were selected, including 18 qualitative and 3 quantitative (all high quality), as well as 5 mixed methods studies (low-to-high quality). Results were categorized into intrapersonal, interpersonal, environmental, and policy categories. Factors that impact pain management in dementia include cognitive and functional impairment, healthcare workers' knowledge, collaboration and communication, healthcare workers' understanding of patients' baseline behaviors, observation of behaviors, pain assessment tool use, pain management consistency, staffing level, pain guideline/policy, and training. Overall, pain management is challenging in persons living with dementia. The results indicate that there is a need for multi-component interventions that involves multidisciplinary teams to improve pain management in persons living with dementia at the intrapersonal, interpersonal, environmental, and policy levels. PERSPECTIVES: This review systematically synthesized barriers and facilitators of providing pain management in persons living with dementia. Results were presented in intrapersonal, interpersonal, environmental, and policy categories and suggests that multicomponent interventions involving multidisciplinary teams are needed to systematically improve pain management in persons living with dementia.
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Affiliation(s)
- Yo-Jen Liao
- Pennsylvania State University, Nese College of Nursing, University Park, Pennsylvania.
| | - Ying-Ling Jao
- Pennsylvania State University, Nese College of Nursing, University Park, Pennsylvania
| | - Diane Berish
- Pennsylvania State University, Nese College of Nursing, University Park, Pennsylvania
| | - Angelina Seda Hin
- Pennsylvania State University, College of Health and Human Development, University Park, Pennsylvania
| | - Karolus Wangi
- Pennsylvania State University, Nese College of Nursing, University Park, Pennsylvania
| | - Lisa Kitko
- Pennsylvania State University, Nese College of Nursing, University Park, Pennsylvania
| | - Jacqueline Mogle
- Clemson University, Department of Psychology, Clemson, South Carolina
| | - Marie Boltz
- Pennsylvania State University, Nese College of Nursing, University Park, Pennsylvania
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Are nurse`s needs assessment methods robust enough to recognise palliative care needs in people with dementia? A scoping review. BMC Nurs 2022; 21:194. [PMID: 35854261 PMCID: PMC9297617 DOI: 10.1186/s12912-022-00947-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 06/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People with dementia are most at risk of experiencing serious health related suffering, if they do not have a palliative care approach introduced early enough in the illness. It can be challenging for nurses to assess experienced needs of people, who are thought no longer able to self-report such as people with dementia. Assessment help to understand the care the patient and their family need promptly. It is unknown how nurses recognise holistic palliative care needs in people with dementia during routine care. METHODS Scoping review where EMBASE, MEDLINE, CINAHL, PsycInfo databases, and references were searched with an advanced search strategy, which was built on three concepts (nurses, dementia, and nursing assessment) using corresponding Medical Subject Headings. Data were charted in a piloted extraction form, based on the assessment domains within the nursing process followed by summarise and synthesise results narratively. RESULTS 37 out of 2,028 qualitative and quantitative articles published between 2000 and 2021, and relating to 2600 + nurses, were identified. Pain was sole focus of assessment in 29 articles, leaving 8 articles to describe assessment of additional needs (e.g., discomfort). Nurses working in a nursing home assess pain and other needs by observing the persons with dementia behaviour during routine care. Nurses in the acute care setting are more likely to assess symptoms with standard assessment tools at admission and evaluate symptoms by observational methods. Across settings, about one third of pain assessments are supported by person-centred pain assessment tools. Assessments were mostly triggered when the person with dementia vocalised discomfort or a change in usual behaviour was observed. Nurses rely on family members and colleagues to gain more information about needs experienced by people with dementia. CONCLUSION There is a scarcity of evidence about techniques and methods used by nurses to assess needs other than pain experienced by people with dementia. A holistic, person-centred screening tool to aid real-time observations at the bedside and used in conversations with health care professionals and families/friends, may improve need recognition other than pain, to ensure holistic needs could then be addressed timely to improve care in people with dementia.
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Parveen S, Mehra A, Kumar K, Grover S. Knowledge and attitude of caregivers of people with dementia. Geriatr Gerontol Int 2021; 22:19-25. [PMID: 34755432 DOI: 10.1111/ggi.14304] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 09/21/2021] [Accepted: 10/18/2021] [Indexed: 11/30/2022]
Abstract
AIM This study aimed to evaluate the knowledge and attitude of caregivers of people with dementia towards the disease (Alzheimer disease). The secondary objective of the study was to assess the association of attitude and knowledge towards dementia. METHODS In total, 50 patients with dementia and their caregivers were included in the present study. Caregivers were evaluated on the Dementia Attitude Scale and Alzheimer's Disease Knowledge Scale (ADKS) to assess the level of knowledge and attitude. RESULTS The mean age of patients was 72.2 years, and the majority of them were men, married, from joint/extended family setup, urban background, and upper or upper-middle socioeconomic status. The mean age of the caregivers was 48.04 years, and the majority was educated more than the matric level. Nearly half of the caregivers were children, and about one-third were the spouse of the person with dementia. The mean duration of the caregiver role was 3.6 ± 3.0 years, while the average time spent in caregiving was 7.4 ± 2.9 h/day. Using the Alzheimer's Disease Knowledge Scale, the mean knowledge score for the caregivers was 16.9 ± 2.7. In terms of individual items on the knowledge scale, most of the caregivers were aware of most aspects of dementia. In terms of the mean weighted score, the maximum score was for the domains of course and symptoms and this was followed by the domain of "treatment and management." The lowest score was obtained for the domain of assessment and diagnosis on ADKS. On the Dementia Attitude Scale, the mean total score was 76.4 ± 18.4. The mean total score for the knowledge domain was higher than the support domain. CONCLUSION The current study suggests that most caregivers with dementia have a reasonable level of knowledge about dementia. However, in terms of attitude, caregivers of people with dementia have a less positive attitude towards dementia. The study's finding suggests that there is a need to evaluate the knowledge and attitude of the caregivers of people with dementia and the gaps must be addressed to improve the outcome, both for the people with dementia and their caregivers. Geriatr Gerontol Int 2021; ••: ••-••.
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Affiliation(s)
- Shaheena Parveen
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aseem Mehra
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Krishan Kumar
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Pringle J, Mellado ASAV, Haraldsdottir E, Kelly F, Hockley J. Pain assessment and management in care homes: understanding the context through a scoping review. BMC Geriatr 2021; 21:431. [PMID: 34275442 PMCID: PMC8286436 DOI: 10.1186/s12877-021-02333-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 06/07/2021] [Indexed: 11/10/2022] Open
Abstract
Background Internationally, 2–5% of people live in residential or nursing homes, many with multi-morbidities, including severe cognitive impairment. Pain is frequently considered an expected part of old age and morbidity, and may often be either under-reported by care home residents, or go unrecognized by care staff. We conducted a systematic scoping review to explore the complexity of pain recognition, assessment and treatment for residents living in care homes, and to understand the contexts that might influence its management. Methods Scoping review using the methodological framework of Levac and colleagues. Articles were included if they examined pain assessment and/or management, for care or nursing home residents. We searched Medline, CINAHL, ASSIA, PsycINFO, EMBASE, Cochrane Library, and Google Scholar; reference lists were also screened, and website searches carried out of key organisations. Conversations with 16 local care home managers were included to gain an understanding of their perspective. Results Inclusion criteria were met by 109 studies. Three overarching themes were identified: Staff factors and beliefs - in relation to pain assessment and management (e.g. experience, qualifications) and beliefs and perceptions relating to pain. Pain assessment – including use of pain assessment tools and assessment/management for residents with cognitive impairment. Interventions - including efficacy/effects (pharmaceutical/non pharmaceutical), and pain training interventions and their outcomes. Overall findings from the review indicated a lack of training and staff confidence in relation to pain assessment and management. This was particularly the case for residents with dementia. Conclusions Further training and detailed guidelines for the appropriate assessment and treatment of pain are required by care home staff. Professionals external to the care home environment need to be aware of the issues facing care homes staff and residents in order to target their input in the most appropriate way. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02333-4.
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Affiliation(s)
- Jan Pringle
- Scottish Collaboration for Public Health Research and Policy, University of Edinburgh, Edinburgh, UK.
| | | | | | - Fiona Kelly
- School of Health Sciences, Queen Margaret University, Edinburgh, East Lothian, UK
| | - Jo Hockley
- Usher Institute, University of Edinburgh, Edinburgh, UK
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Al Nazly EK, Al Khatib H. The Knowledge and Educational Needs of Nurses Regarding Pain Management of Patients on Maintenance Hemodialysis: A Qualitative Study. Open Nurs J 2021. [DOI: 10.2174/1874434602115010093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Nurses are the first to encounter a patient in pain. A nurse’s knowledge of pain management in patients receiving hemodialysis allows them to provide optimal pain management.
Objective:
The aim of this qualitative study is to explore the experiences, perceptions, and beliefs of nurses in the hemodialysis unit regarding pain management practices and identify nurses’ educational needs to improve nurses’ pain management in practice.
Methods:
A purposive sample of 16 nurses working in four out-patient hemodialysis units in Amman, Jordan, was recruited. The data was collected through semi-structured interviews. The interviews were audio-recorded and transcribed manually for the following content analysis scheme.
Results:
The five themes and fifteen sub-categories were extracted from the nurses' experiences regarding nurses’ knowledge of pain management. The five categories that emerged from the analysis were (1) nurses’ knowledge of pain management, (2) nurses’ self-learning pain management strategy, (3) nurses’ approach to pain management, (4) patients continue to suffer unrelieved pain, (5) nurses’ educational needs.
Relevance to Clinical Practice:
This data will prove to be useful for evaluating pain management practices for patients on maintenance hemodialysis, developing educational programs for nurses working in hemodialysis units with a focus on improving pain management, and providing knowledge regarding these issues. More research is recommended among nurses for understanding pain knowledge in patients on maintenance hemodialysis.
Conclusion:
This qualitative analysis indicated that nurses are not fully aware of various strategies for pain management. Nurses’ perception of pain and pain management was found to be limited to pain assessment and some non-pharmacological management strategies. It has been revealed that nurses require educational interventions regarding pain management in practice.
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Ando C, Kanno Y, Uchida O, Nashiki E, Kosuge N, Ogawa A. Pain management in community-dwelling older adults with moderate-to-severe dementia. Int J Palliat Nurs 2021; 27:158-166. [PMID: 34038176 DOI: 10.12968/ijpn.2021.27.3.158] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND This study explored visiting nurses' knowledge and beliefs regarding pain management in community-dwelling older adults with moderate-to-severe dementia. METHODS A cross-sectional study design was used to collect data in 2019. A questionnaire was mailed to nursing managers at 1037 home-visiting nursing stations in Japan. FINDINGS The final analysis included 230 responses. The mean score on the knowledge and belief statements was 14 out of a possible 18, and respondents with more pain management training obtained a higher total score on knowledge than those without such training (p<.001). More than 95% indicated that they needed training on pain management for older adults with dementia. CONCLUSION Visiting nurses in Japan require training in pain management for older adults with moderate-to-severe dementia. Despite its usefulness, the current pain management training programme should be improved to enable visiting nurses to manage dementia patients' pain more confidently.
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Affiliation(s)
- Chiaki Ando
- Associate Professor, Nayoro City University, Hokkaido, Japan
| | - Yusuke Kanno
- Assistant Professor, Yokohama City University, Yokohama, Japan
| | - Osamu Uchida
- Associate Professor, University of Information Sciences, Chiba, Japan
| | - Emiko Nashiki
- Certified Nurse Specialist In Gerontological Nursing; Assistant Professor, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Noriko Kosuge
- Deputy Director of Nursing, Kenwakai Medical Corporation, Tokyo, Japan
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Chang AK, Edwards RR, Morrison RS, Argoff C, Ata A, Holt C, Bijur PE. Disparities in Acute Pain Treatment by Cognitive Status in Older Adults With Hip Fracture. J Gerontol A Biol Sci Med Sci 2021; 75:2003-2007. [PMID: 31560758 DOI: 10.1093/gerona/glz216] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND We examined the disparities in emergency department (ED) pain treatment based on cognitive status in older adults with an acute hip fracture. METHODS Observational study in an academic ED in the Bronx, New York. One hundred forty-four adults aged 65 years and older with acute hip fracture were administered the Telephone Interview for Cognitive Status (TICS) while in the ED. The primary outcome was receipt of any parenteral analgesic. The risk factor of interest was cognitive impairment (TICS ≤ 25). Secondary outcomes included receipt of any opioid, receipt of any analgesic, total dose of analgesics in intravenous morphine equivalent units (MEQ), and time to receiving first analgesic. RESULTS Of the 87 (60%) study patients who were cognitively impaired, 60% received a parenteral analgesic compared to 79% of the 57 cognitively unimpaired patients (RR 0.76 [95% CI 0.61, 0.94]). The effect of cognitive impairment on receiving any opioids (RR: 0.81, 95% CI 0.67, 0.98) and any analgesic (RR: 0.85; 95% CI: 0.71, 1.01) was similar. The median analgesic dose in cognitively impaired patients was significantly lower than in cognitively unimpaired patients (4 MEQ vs 8 MEQ, p = .003). CONCLUSION Among older adults presenting to the ED with acute hip fracture, cognitive impairment was independently associated with lower likelihood of receiving analgesia and lower amount of opioid analgesia.
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Affiliation(s)
- Andrew K Chang
- Department of Emergency Medicine, Albany Medical College, New York
| | - Robert R Edwards
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - R Sean Morrison
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Charles Argoff
- Department of Neurology, Albany Medical College, New York
| | - Ashar Ata
- Department of Emergency Medicine, Albany Medical College, New York
| | - Christian Holt
- Department of Emergency Medicine, Albany Medical College, New York
| | - Polly E Bijur
- Department of Emergency Medicine, Albert Einstein College of Medicine, Bronx, New York
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Jonsdottir T, Gunnarsson EC. Understanding Nurses' Knowledge and Attitudes Toward Pain Assessment in Dementia: A Literature Review. Pain Manag Nurs 2020; 22:281-292. [PMID: 33334680 DOI: 10.1016/j.pmn.2020.11.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 10/28/2020] [Accepted: 11/03/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pain is underrecognized and undertreated in patients with dementia. It has been suggested that nurses' attitudinal barriers may contribute to the challenges surrounding pain assessment and management in dementia. AIMS This integrative literature review aims to identify and explore nurses' knowledge and attitudes towards pain assessment in older people with dementia and how it may affect pain management in this patient group. METHOD Electronic searches were conducted in Web of Science, MEDLINE, Scopus, ProQuest, PubMed, and EBSCOhost from January 2008 to December 2018 for articles specifically focusing on nurses' knowledge and attitudes towards pain assessment in older patients with dementia. RESULTS Ten studies were included in the review after meeting the inclusion criteria. Data extracted from each study included study design, aims and objectives, setting/sample, findings, and limitations. Patients with dementia are at greater risk of experiencing underassessment, undertreatment, and delayed treatment of pain due to nurses' knowledge deficits and uncertainty in the decision-making process. Nurses see providing comfort and reducing pain as ethical obligation. However, they find pain assessment a challenge due to the complexity of recognizing painful behaviors, and difficulty differentiating between pain and behavioral disturbances in dementia. Poor multidisciplinary communication, time constraints, and workload pressure, as well as uncertainty about opioid use, are important barriers to effective pain assessment and management among patients with dementia. CONCLUSION It is essential that nurses gain confidence in distinguishing signs and symptoms of pain from behavioral changes in dementia. It is important to improve interdisciplinary communication and to get physicians to listen and prioritize pain assessment and management.
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Affiliation(s)
- Thorbjorg Jonsdottir
- Faculty of Nursing, School of Health Sciences, University of Akureyri, Akureyri, Iceland; School of Health Sciences, Faculty of Nursing, University of Akureyriv/Nordurslod, Akureyri, Iceland.
| | - Esther Christina Gunnarsson
- Faculty of Nursing, School of Health Sciences, University of Akureyri, Akureyri, Iceland; The National University Hospital of Iceland, Eiriksgata, Reykjavik, Iceland
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Bullock L, Chew-Graham CA, Bedson J, Bartlam B, Campbell P. The challenge of pain identification, assessment, and management in people with dementia: a qualitative study. BJGP Open 2020; 4:bjgpopen20X101040. [PMID: 32457099 PMCID: PMC7330220 DOI: 10.3399/bjgpopen20x101040] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 01/10/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Painful conditions are common in older adults, including people with dementia. The symptoms associated with dementia (for example, diminished language capacity, memory impairment, and behavioural changes), however, may lead to the suboptimal identification, assessment, and management of pain. Research has yet to qualitatively explore pain management for community-dwelling people with dementia. AIM To explore pain identification, assessment, and management for community-dwelling people with dementia. DESIGN & SETTING A qualitative study was undertaken, set in England. METHOD Semi-structured interviews took place with people with dementia, family caregivers, GPs, and old-age psychiatrists. Data were analysed thematically. RESULTS Interviews were conducted with eight people with dementia, nine family caregivers, nine GPs, and five old-age psychiatrists. Three themes were identified that related to pain identification and assessment: gathering information to identify pain; the importance of knowing the person; and the use of pain assessment tools. A further three themes were identified that related to pain management: non-drug strategies; concerns related to analgesic medications; and responsibility of the caregiver to manage pain. CONCLUSION Identifying and assessing the pain experienced by people with dementia was challenging. Most people with dementia, family caregivers, and healthcare professionals supported non-drug strategies to manage pain. The minimal concerns associated with non-drug strategies contrasted the multifactorial concerns associated with analgesic treatment for people with dementia. Given the complexity of pain identification, assessment, and management, primary care should work together with family caregivers and community services, with case finding for pain being considered in all assessment and management plans.
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Affiliation(s)
- Laurna Bullock
- School of Primary Community and Social Care, Keele University, Keele, UK
| | - Carolyn A Chew-Graham
- School of Primary Community and Social Care, Keele University, Keele, UK
- Midlands Partnership NHS Foundation Trust, St Georges' Hospital, Stafford, UK
| | - John Bedson
- School of Primary Community and Social Care, Keele University, Keele, UK
| | - Bernadette Bartlam
- School of Primary Community and Social Care, Keele University, Keele, UK
- Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technical University Singapore, Singapore, UK
| | - Paul Campbell
- School of Primary Community and Social Care, Keele University, Keele, UK
- Midlands Partnership NHS Foundation Trust, St Georges' Hospital, Stafford, UK
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Kwon SH, Kim H, Park S, Jeon W. Development of Knowledge and Attitudes Survey on Pain Management for Korean Long-term Care Professionals. Asian Nurs Res (Korean Soc Nurs Sci) 2020; 14:105-113. [DOI: 10.1016/j.anr.2020.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 03/02/2020] [Accepted: 04/06/2020] [Indexed: 01/29/2023] Open
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May K, Scammell J. Nurses' experiences of pain management in end-of-life dementia care: a literature review. Int J Palliat Nurs 2020; 26:110-118. [PMID: 32275475 DOI: 10.12968/ijpn.2020.26.3.110] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Nurses play an important role in assessing and managing pain. However, this is often poorly managed for people living with dementia. AIM To explore nurses' experiences of pain management in end-of-life dementia care. METHODS Using the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, a systematic narrative review of research papers published in English between 2008 and 2018 was conducted. Data sources were CINAHL, Medline, PsycINFO, ScienceDirect and SocIndex. Articles focused on nursing at the end of life and pain management in people with dementia. FINDINGS Eight articles were retrieved that met the search criteria. Four studies used qualitative methodology, two quantitative and two mixed methods. Studies from the UK dominated (n=5), the remainder were from Sweden, Norway and the US. Following thematic analysis, three themes were identified: training and education in pain management at the end of life for people with dementia, challenges in identifying pain and pain assessment tool use. CONCLUSION The review revealed inadequate education for nurses concerning end-of-life care for people living with dementia, notably concerning pain recognition and use of assessment tools. It is recommended that specialist education is mandated for all nurses working with this client group to improve care delivery.
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Affiliation(s)
- Kerry May
- Registered nurse, Department of Nursing and Clinical Sciences, Faculty of Health and Social Sciences, Bournemouth University
| | - Janet Scammell
- Associate Professor (Nursing), Department of Nursing and Clinical Sciences, Faculty of Health and Social Sciences, Bournemouth University
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Zwakhalen S, Docking RE, Gnass I, Sirsch E, Stewart C, Allcock N, Schofield P. Pain in older adults with dementia : A survey across Europe on current practices, use of assessment tools, guidelines and policies. Schmerz 2019; 32:364-373. [PMID: 29931391 DOI: 10.1007/s00482-018-0290-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND We aimed to explore the existing use of pain assessment tools and guidelines, and develop understanding of the practical considerations required to facilitate their use within the nursing home, hospital and community settings. METHODS A self-administered web-based survey was conducted with nurses, health and social care workers with an interest in the assessment of pain in older adults with cognitive impairment. The survey was distributed to participants in Austria, Belgium, Denmark, Germany, The Netherlands, Switzerland and United Kingdom. RESULTS Only a minority of staff reported use of (inter-)national or local standards or specific pain assessment tools in daily practice. A range of tools were reported as being used, which varied across country. While participants generally reported that these pain assessment tools were easy/very easy to use, many participants reported that they were difficult to interpret. Assessment is generally performed whilst providing nursing care. This was highlighted in 70-80% of all participating countries. While many of these tools rely on facial expression of pain, facial expressions were considered to be the least useful in comparison to other items. Furthermore findings showed that nurses employed in long-term care settings did not feel that they were educated enough in pain assessment and management. CONCLUSION Our findings suggest that pain education is required across all countries surveyed. This should include a focus on guidelines and standards for assessment and subsequent management of pain. Findings suggest that clinical staff find interpreting facial expressions in relation to pain more difficult.
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Affiliation(s)
- S Zwakhalen
- School for Public Health and Primary Care (CAPHRI), Department of Health Services Research, Maastricht University, Maastricht, The Netherlands.,Faculty of Education and Health, Department of Adult Nursing and Paramedic Sciences, University of Greenwich, London, UK
| | - R E Docking
- Faculty of Education and Health, Department of Adult Nursing and Paramedic Sciences, University of Greenwich, London, UK
| | - I Gnass
- Institute of Nursing Science and Practice, Paracelsus Medical University, Strubergasse 21, 5020, Salzburg, Austria.
| | - E Sirsch
- Faculty of Nursing Science, Philosophisch-Theologische Hochschule Vallendar (Catholic University), Vallendar, Germany
| | - C Stewart
- NHS Research Scotland, The Golden Jubilee National Hospital, Clydebank, UK
| | - N Allcock
- Professional and Clinical Development Lead, InHealth Pain Management Solutions Limited, Barnsley, UK
| | - P Schofield
- Faculty of Education and Health, Department of Adult Nursing and Paramedic Sciences, University of Greenwich, London, UK
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Knopp-Sihota JA, Dirk KL, Rachor GS. Factors Associated With Pain Assessment for Nursing Home Residents: A Systematic Review and Meta-Synthesis. J Am Med Dir Assoc 2019; 20:884-892.e3. [DOI: 10.1016/j.jamda.2019.01.156] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 01/28/2019] [Accepted: 01/29/2019] [Indexed: 11/15/2022]
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Pain in Advanced Stages of Dementia: The Perspective of Medical Students. ACTA ACUST UNITED AC 2019; 55:medicina55050116. [PMID: 31035451 PMCID: PMC6572279 DOI: 10.3390/medicina55050116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 04/19/2019] [Accepted: 04/24/2019] [Indexed: 11/17/2022]
Abstract
Background and objective: The number of studies related to medical students' attitude toward pain is limited. The aim of our study was, thus, to assess the medical students' knowledge of pain assessment and treatment in advanced stages of dementia in order to improve the existing curriculum in this area. Material and methods: We analyzed the medical students' knowledge about pain in advanced dementia based on a short questionnaire. The research was anonymous. The questionnaire was completed by 147 students. Results: The students most often suggested that pain in patients with advanced dementia could be manifested via body language and facial expression (107 students-72.8% and 100 students-68.0%, respectively). Vocalization was the third most frequently reported pain manifestation (84-57.1%). Other groups of pain symptoms (changes in activity patterns, changes in interpersonal interactions, and mental status changes) were indicated less often (p < 0.0001). Only five students (3.4%) listed the DOLOPLUS behavioral pain scale as an assessment tool for patients with advanced dementia, and 16 (10.9%) indicated observational scale elements or a necessity to observe the patient. Still, 110 students (74.5%) correctly characterized pain treatment in patients with advanced dementia. Conclusions: To the best of our knowledge, our study is pioneering in defining the deficits of medical students' knowledge on pain assessment and treatment in patients with advanced dementia. We highlighted knowledge gaps in the area of pain assessment which might make medical students incapable of proper pain treatment. Following the International Association for the Study of Pain considerations regarding the need for excellence in pain education, these results can contribute to the improvement of existing medical curricula in Poznan University of Medical Sciences to include pain management in dementia in a more "patient-centered" way in order to increase future staff's competency and to assure a better quality of care.
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Gilmore-Bykovskyi AL, Block L, Hovanes M, Mirr J, Kolanowski A. Analgesic Use Patterns Among Patients With Dementia During Transitions From Hospitals to Skilled Nursing Facilities. Res Gerontol Nurs 2019; 12:61-69. [PMID: 30703217 DOI: 10.3928/19404921-20190122-01] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 11/28/2018] [Indexed: 01/09/2023]
Abstract
Gaps in pain management, including discontinuity in analgesic medication prescribing, frequently complicate transitions from hospital to skilled nursing facilities (SNFs) for patients with dementia. The objective of the current study was to examine analgesic medication use and prescribing patterns in the last 48 hours of hospitalization and upon discharge to SNF among stroke and hip fracture patients with dementia. Of 318 patients who received an analgesic medication within the last 48 hours of hospitalization, 23% experienced potentially abrupt discontinuations upon discharge. These rates varied by medication, with acetaminophen with codeine (27%), hydromorphone (19%), and acetaminophen with hydrocodone (19%) having the highest rates of potentially abrupt discontinuations. Conversely, 38% of patients experienced potentially abrupt additions of an analgesic medication upon discharge. Findings suggest that changes to analgesic regimens prior to and upon discharge may be common practice, potentially hindering care continuity and pain control during transitions. [Res Gerontol Nurs. 2019; 12(2):61-69.].
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21
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Jennings AA, Linehan M, Foley T. The knowledge and attitudes of general practitioners to the assessment and management of pain in people with dementia. BMC FAMILY PRACTICE 2018; 19:166. [PMID: 30301471 PMCID: PMC6178252 DOI: 10.1186/s12875-018-0853-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 09/26/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Pain in people with dementia is underdiagnosed and undertreated. General practitioners (GPs) play a pivotal role in dementia care but their perspectives on pain in people with dementia remains under-researched. The aim of this study was to explore GPs' knowledge and attitudes towards pain assessment and management in people with dementia. METHODS This was a descriptive cross-sectional study. A questionnaire was adapted from a previous study and piloted with 5 GPs. The questionnaire was posted to a census sample of all GPs in Cork city and county in the southern region of Ireland. The questionnaire collected demographic information, responses to a series of Likert-type statements assessing GPs' knowledge and attitudes, and provided an opportunity for the GP to give qualitative feedback on their experiences of managing pain in dementia. SPSS v25 was used for statistical analysis. Qualitative responses were thematically analysed. RESULTS Of the 320 questionnaires posted, 157 completed questionnaires were returned (response rate of 49%). The sample was representative of GPs nationally in terms of years in GP practice and practice location. Over two-thirds (108/157) of respondents had a nursing home commitment. Only 10% of respondents (16/157) were aware of any dementia-specific pain assessment tools. The larger the nursing home commitment of the GP the more likely they were to be familiar with these tools (p = 0.048). The majority of respondents (113/157) believed people with dementia could not self-report pain. Respondents were uncertain about the safety of using opioid medications to treat pain in people with dementia with only 51.6% agreeing that they were safe. The qualitative comments highlighted the importance the GPs placed on surrogate reports of pain, GPs' uncertainty regarding the value of formal pain assessment tools and the challenges caused by under-resourcing in general practice. CONCLUSION This study has highlighted aspects of pain assessment and management in dementia that GPs find challenging. Guidance on pain assessment and management in people with dementia do not appear to be translating into clinical practice. The findings will inform educational interventions being developed by our research team as part of the implementation of the Irish national dementia strategy. The knowledge and attitudes of general practitioners to the assessment and management of pain in people with dementia.
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Affiliation(s)
- Aisling A Jennings
- Department of General Practice, Western Gateway Building, University College Cork, Cork, Ireland
| | - Maura Linehan
- Department of General Practice, Western Gateway Building, University College Cork, Cork, Ireland
| | - Tony Foley
- Department of General Practice, Western Gateway Building, University College Cork, Cork, Ireland
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De Witt Jansen B, Brazil K, Passmore P, Buchanan H, Maxwell D, McIlfatrick S, Morgan SM, Watson M, Parsons C. "A tool doesn't add anything". The importance of added value: Use of observational pain tools with patients with advanced dementia approaching the end of life-a qualitative study of physician and nurse experiences and perspectives. Int J Geriatr Psychiatry 2018; 33:1346-1354. [PMID: 29961948 DOI: 10.1002/gps.4931] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 05/31/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND Observational pain tools (OPTs) are widely recommended in health care policies, clinical guidelines, and recommendations for pain assessment and management. However, it is unclear whether and how these tools are used for patients with advanced dementia approaching the end of life. AIM To explore hospice, secondary, and primary care physicians' and nurses' use of OPTs with patients dying with advanced dementia and their perspectives on practice development and training needs. METHODS Twenty-three physicians and 24 nurses with experience of caring for people dying with advanced dementia were recruited from primary care surgeries (n = 5), hospitals (n = 6), hospices (n = 4), and nursing homes (n = 10). Semistructured, face-to-face interviews were conducted. Interviews were digitally recorded, transcribed verbatim, and thematic analysis applied to identify core themes. RESULTS Three key themes emerged: (1) use of OPTs in this vulnerable patient population, (2) barriers to the use of OPTs and lack of perceived "added value", and (3) perspectives on practice development and training in pain assessment in advanced dementia at end of life. Just over one-quarter of participants (n = 13) routinely used OPTs. Reasons for nonuse included perceived limitations of such tools, difficulties with their use and integration with existing practice, and lack of perceived added value. Most participants strongly emphasised a need for ongoing training and development which facilitated transfer of knowledge and multidisciplinary skills across professions and specialties. CONCLUSIONS Health professionals require ongoing support in developing and integrating change to existing pain assessment protocols and approaches. These findings have important implications for health education, practice, and policy.
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Affiliation(s)
| | | | - Peter Passmore
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Belfast, UK
| | - Hilary Buchanan
- Patient and Public Involvement, Carer for person living with dementia, Belfast, UK
| | | | - Sonja McIlfatrick
- Institute of Nursing and Health Research, Ulster University, Jordanstown, UK
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24
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Rostad HM, Utne I, Grov EK, Småstuen MC, Puts M, Halvorsrud L. The impact of a pain assessment intervention on pain score and analgesic use in older nursing home residents with severe dementia: A cluster randomised controlled trial. Int J Nurs Stud 2018; 84:52-60. [PMID: 29763832 DOI: 10.1016/j.ijnurstu.2018.04.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 04/08/2018] [Accepted: 04/26/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Pain is highly prevalent in older adults, especially those in institutional settings such as nursing homes. The presence of dementia may increase the risk of underdiagnosed and undertreated pain. Pain assessment tools are not regularly used in clinical practice, however, there are indications that the regular use of pain assessments tools may influence the recognition of pain by nursing staff and thereby affect pain management. OBJECTIVES To assess whether regular pain assessment using a pain assessment tool is associated with changes in i) pain scores and ii) analgesic use in nursing home residents with severe dementia. DESIGN Cluster-randomised controlled trial. SETTING The study was conducted in 16 nursing homes in four counties in Norway. PARTICIPANTS A total of 112 nursing home residents aged 65 years and older with dementia who lacked the capacity for self-reporting pain or were non-verbal. METHODS The experimental group were regularly assessed pain with a standardised pain scale (the Doloplus-2) twice a week for a 12-week intervention period. The control group received usual care. The primary outcome was pain score measured with the Doloplus-2, and the secondary outcome was analgesic use (oral morphine equivalents and milligram/day paracetamol). Data on the outcomes were collected at baseline and at the end of week 12. The nursing staff in both the experimental and the control groups received training to collect the data. Linear mixed models were used to assess possible between-group difference over time. RESULTS No overall effect of regular pain assessment was found on pain score or analgesic use. The mean score of Doloplus-2 and analgesic use remained unchanged and above the established cut-off in both groups. CONCLUSION The current intervention did not change analgesic use or pain score compared with the control condition. However, there is not sufficient evidence to conclude that regular pain assessment using a pain assessment tool is not clinically relevant. Furthermore, our results indicated that pain continued to be inadequately treated in nursing home residents with severe dementia. Therefore, further research on how standardised pain assessment can be used to support effective pain management in this population is needed.
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Affiliation(s)
| | - Inger Utne
- OsloMet - Oslo Metropolitan University, Oslo, Norway
| | | | | | - Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
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Choy KLT, Siu KYP, Ho TSG, Wu C, Lam HY, Tang V, Tsang YP. An intelligent case-based knowledge management system for quality improvement in nursing homes. VINE JOURNAL OF INFORMATION AND KNOWLEDGE MANAGEMENT SYSTEMS 2018. [DOI: 10.1108/vjikms-01-2017-0001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This paper aims to maintain the high service quality of the long-term care service providers by establishing a knowledge-based system so as to enhance the service quality of nursing homes and the performance of its nursing staff continually.
Design/methodology/approach
An intelligent case-based knowledge management system (ICKMS) is developed with the integration of two artificial intelligence techniques, i.e. fuzzy logic and case-based reasoning (CBR). In the system, fuzzy logic is adopted to assess the performance through the analysis of the long-term care services provided, nurse performance and elderly satisfaction, whereas CBR is used to formulate a customized re-training program for quality improvement. A case study is conducted to validate the feasibility of the proposed system.
Findings
The empirical findings indicate that the ICKMS helps in identification of those nursing staff who cannot meet the essential service standard. Through the customized re-training program, the performance of the nursing staff can be greatly enhanced, whereas the medical errors and complaints can be considerably reduced. Furthermore, the proposed methodology provides a cost-saving approach in the administrative work.
Practical implications
The findings and results of the study facilitate decision-making using the ICKMS for the long-term service providers to improve their performance and service quality by providing a customized re-training program to the nursing staff.
Originality/value
This study contributes to establishing a knowledge-based system for the long-term service providers for maintaining the high service quality in the health-care industry.
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Veal F, Williams M, Bereznicki L, Cummings E, Thompson A, Peterson G, Winzenberg T. Barriers to Optimal Pain Management in Aged Care Facilities: An Australian Qualitative Study. Pain Manag Nurs 2017; 19:177-185. [PMID: 29153298 DOI: 10.1016/j.pmn.2017.10.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 08/22/2017] [Accepted: 10/02/2017] [Indexed: 02/03/2023]
Abstract
Up to 80% of residents in aged care facilities (ACFs) experience pain, which is often suboptimally managed. The purpose of this study was to characterize pain management in ACFs and identify the barriers to optimal pain management. This exploratory descriptive qualitative study used semistructured interviews in five Southern Tasmania, Australian ACFs. Interviewees included 23 staff members (18 nurses and 5 facility managers) and were conducted from September to November 2015. Interviews included questions about how pain was measured or assessed, what happened if pain was identified, barriers to pain management, and potential ways to overcome these barriers. Interviewees noted that there were no formal requirements regarding pain assessment at the ACFs reviewed; however, pain was often informally assessed. Staff noted the importance of adequate pain management for the residents' quality of life and employed both nonpharmacologic and pharmacologic techniques to reduce pain when identified. The barriers to optimal pain management included difficulty identifying and assessing pain, residents' resistance to reporting pain and/or taking medications, and communication barriers between the nursing staff and GPs. Staff interviewed were dedicated to managing residents' pain effectively; however, actions in a number of areas could improve resident outcomes. These include a more consistent approach to documenting pain in residents' progress notes and improving nurse-GP communications to ensure that new or escalating pain is identified and expedient changes can be made to the resident's management. Additionally, resident, family, nurse, and carer education, conducted within the facilities on a regular basis, could help improve the pain management of residents.
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Affiliation(s)
- Felicity Veal
- Unit for Medication Outcomes Research & Education (UMORE), Pharmacy, School of Medicine, University of Tasmania, Hobart, Australia.
| | - Mackenzie Williams
- Unit for Medication Outcomes Research & Education (UMORE), Pharmacy, School of Medicine, University of Tasmania, Hobart, Australia
| | - Luke Bereznicki
- Unit for Medication Outcomes Research & Education (UMORE), Pharmacy, School of Medicine, University of Tasmania, Hobart, Australia
| | - Elizabeth Cummings
- Nursing and Midwifery Department, School of Health Sciences, University of Tasmania, Hobart, Australia
| | - Angus Thompson
- Unit for Medication Outcomes Research & Education (UMORE), Pharmacy, School of Medicine, University of Tasmania, Hobart, Australia
| | - Gregory Peterson
- Unit for Medication Outcomes Research & Education (UMORE), Pharmacy, School of Medicine, University of Tasmania, Hobart, Australia
| | - Tania Winzenberg
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
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De Witt Jansen B, Brazil K, Passmore P, Buchanan H, Maxwell D, McIlfactrick SJ, Morgan SM, Watson M, Parsons C. Nurses' experiences of pain management for people with advanced dementia approaching the end of life: a qualitative study. J Clin Nurs 2017; 26:1234-1244. [PMID: 27324751 DOI: 10.1111/jocn.13442] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2016] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To explore hospice, acute care and nursing home nurses' experiences of pain management for people with advanced dementia in the final month of life. To identify the challenges, facilitators and practice areas requiring further support. BACKGROUND Pain management in end-stage dementia is a fundamental aspect of end-of-life care; however, it is unclear what challenges and facilitators nurses experience in practice, whether these differ across care settings, and whether training needs to be tailored to the context of care. DESIGN A qualitative study using semi-structured interviews and thematic analysis to examine data. METHODS Twenty-four registered nurses caring for people dying with advanced dementia were recruited from 10 nursing homes, three hospices and two acute hospitals across a region of the UK. Interviews were conducted between June 2014-September 2015. RESULTS Three core themes were identified: challenges administering analgesia, the nurse-physician relationship, and interactive learning and practice development. Patient-related challenges to pain management were universal across care settings; nurse- and organisation-related barriers differed between settings. A need for interactive learning and practice development, particularly in pharmacology, was identified. CONCLUSIONS Achieving pain management in practice was highly challenging. A number of barriers were identified; however, the manner and extent to which these impacted on nurses differed across hospice, nursing home and acute care settings. Needs-based training to support and promote practice development in pain management in end-stage dementia is required. RELEVANCE TO CLINICAL PRACTICE Nurses considered pain management fundamental to end-of-life care provision; however, nurses working in acute care and nursing home settings may be undersupported and under-resourced to adequately manage pain in people dying with advanced dementia. Nurse-to-nurse mentoring and ongoing needs-assessed interactive case-based learning could help promote practice development in this area. Nurses require continuing professional development in pharmacology.
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Affiliation(s)
| | - Kevin Brazil
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Peter Passmore
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | | | | | - Sonja J McIlfactrick
- Institute of Nursing and Health Research, Ulster University, Ulster, UK.,All Ireland Institute of Hospice and Palliative Care, Dublin, Ireland
| | | | | | - Carole Parsons
- School of Pharmacy, Queen's University Belfast, Belfast, UK
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Myers DR, Rogers R, LeCrone HH, Kelley K, Scott JH. Work Life Stress and Career Resilience of Licensed Nursing Facility Administrators. J Appl Gerontol 2016; 37:435-463. [PMID: 27572341 DOI: 10.1177/0733464816665207] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Career resilience provided a frame for understanding how Licensed Nursing Facility Administrators (LNFAs) sustain role performance and even thrive in stressful skilled nursing facility work environments. Quantitative and qualitative analyses of in-depth interviews with18 LNFAs, averaging 24 years of experience were conducted by a five-member research team. Analysis was informed by evidence-based frameworks for career resilience in the health professions as well as the National Association of Long-Term Care Administrator Boards' (NAB) five domains of competent administrative practice. Findings included six sources of work stressors and six sources of professional satisfaction. Also, participants identified seven strategic principles and 10 administrative practices for addressing major sources of stress. Recommendations are provided for research and evidence-based application of the career resilience perspective to LNFA practice aimed at reducing role abandonment and energizing the delivery of the quality of care that each resident deserves.
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Malotte KL, McPherson ML. Identification, assessment, and management of pain in patients with advanced dementia. Ment Health Clin 2016; 6:89-94. [PMID: 29955453 PMCID: PMC6007582 DOI: 10.9740/mhc.2016.03.89] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Patients with advanced dementia have a high symptom burden at end of life. Many of those with dementia have reports of symptoms similar to those without dementia, yet are treated less frequently. Pain is a prevalent symptom that can be underrecognized because of the ability of the patient to self-report. Several tools are available to help with the identification of pain, but they should only be one aspect in the overall assessment. Health care providers must anticipate this and screen for and treat potential pain. This includes obtaining a self-report, searching for potential causes for pain, observing patient behavior, gaining proxy reporting of pain, and attempting an appropriate analgesic trial. It is beneficial for all those involved with a patient's care to screen for pain because of the potential benefits in decreasing behaviors and subsequent antipsychotic use.
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Affiliation(s)
- Kasey L Malotte
- Palliative Care Resident, School of Pharmacy, University of Maryland, Baltimore, Baltimore, Maryland; Palliative Care Clinical Pharmacist, MedStar Franklin Square Medical Center, Rosedale, Maryland,
| | - Mary Lynn McPherson
- Professor and Vice Chair for Education, Department of Pharmacy Practice and Science, School of Pharmacy, University of Maryland, Baltimore, Baltimore, Maryland
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Analgesic Use and Daytime Sleepiness in Residents With and Without Dementia in Residential Aged Care Facilities. Drugs Aging 2015; 32:1045-53. [DOI: 10.1007/s40266-015-0325-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Burns M, McIlfatrick S. Nurses' knowledge and attitudes towards pain assessment for people with dementia in a nursing home setting. Int J Palliat Nurs 2015; 21:479-87. [PMID: 26505082 DOI: 10.12968/ijpn.2015.21.10.479] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM The aim of this study was to determine nurses' knowledge and attitudes towards pain assessment for people with dementia in a nursing home setting. BACKGROUND Pain is highly prevalent among older people, yet is often under-recognised and undertreated in people with dementia. People with dementia can lose the ability to report pain and it is the role of the nurse to identify and appropriately assess pain, to provide effective treatment. This requires nurses to have sufficient knowledge and training in the assessment and management of pain in residents with dementia; however, research suggests deficits in this area. METHODS A cross-sectional survey design was used to determine nurses' knowledge and attitudes to pain assessment in dementia. A questionnaire comprising three sections was distributed to 96 registered nurses across 17 nursing homes in a health-care trust in a UK region. RESULTS A total of 32 responses were obtained (response rate 33%). The majority of nurses had a good knowledge in relation to the assessment and management of pain in residents with dementia. There was, however, some uncertainty among nurses over analgesic choice, the safety of opioid use in dementia, and the use of dementia-specific pain assessment tools for residents with no cognitive impairment. The main barriers to effective pain assessment for older people with dementia were workload pressures, poor staffing and lack of medical support. CONCLUSION This study highlights the need to develop pain education programmes and clear guidance specifically designed for nurses caring for older people with dementia. It also emphasises the need for better communication and co-ordination of pain treatment for nursing home residents with dementia.
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Affiliation(s)
- Michelle Burns
- Macmillan Clinical Nurse Specialist, Belfast Health and Social Care Trust
| | - Sonja McIlfatrick
- Reader, Institute of Nursing and Health Research, University of Ulster, UK
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32
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Beach PA, Huck JT, Miranda MM, Bozoki AC. Autonomic, Behavioral, and Subjective Pain Responses in Alzheimer's Disease. PAIN MEDICINE 2015; 16:1930-42. [DOI: 10.1111/pme.12769] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 03/11/2015] [Accepted: 03/25/2015] [Indexed: 12/31/2022]
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van Almenkerk S, Depla MFIA, Smalbrugge M, Eefsting JA, Hertogh CMPM. Pain among institutionalized stroke patients and its relation to emotional distress and social engagement. Int J Geriatr Psychiatry 2015; 30:1023-31. [PMID: 25581472 DOI: 10.1002/gps.4256] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 12/03/2014] [Accepted: 12/09/2014] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Pain is a frequent long-term consequence of stroke, but its relation to emotional and social well-being is poorly studied in stroke populations. We aimed to identify the prevalence of substantial pain among institutionalized stroke patients and to explore its relation to emotional distress (ED) and low social engagement (SE). METHODS In a cross-sectional design, we collected data of 274 chronic stroke patients in Dutch nursing homes. Observation lists were filled out in structured interviews with qualified nurse assistants who knew the residents well. Pain and SE were measured with the Resident Assessment Instrument for Long-term Care Facilities, and ED was measured with the Neuropsychiatric Inventory Questionnaire (NPIQ). RESULTS Substantial pain was present in 28% of the residents, mostly located in the affected body side (68%). Multilevel regression analyses revealed that this pain was independently related to a 60% increase in NPIQ score (β 3.18 [1.84-4.53]) and to clinically relevant symptoms of delusions (odds ratio [OR] 8.45 [1.82-39.05]), agitation/aggression (OR 3.82 [1.76-8.29]), depression (OR 3.49 [1.75-6.98]), and anxiety (OR 2.32 [1.08-4.97]). Substantial pain was associated with low SE when adjusted for clinical covariates (OR 4.25 [1.72-10.53]), but only in residents with no/mild or severe cognitive impairment. This relation disappeared when additionally corrected for NPIQ score (OR 1.95 [0.71-5.39]). CONCLUSIONS Pain is a serious and multidimensional problem among institutionalized stroke patients. It is related to increased ED, which in turn can be a pathway to low SE as an indicator of social vulnerability. Future research should reveal how pain management in nursing homes can be tailored to the needs of this patient group.
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Affiliation(s)
- Suzanne van Almenkerk
- Department of General Practice and Elderly Care Medicine and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Marja F I A Depla
- Department of General Practice and Elderly Care Medicine and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Martin Smalbrugge
- Department of General Practice and Elderly Care Medicine and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Jan A Eefsting
- Department of General Practice and Elderly Care Medicine and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Cees M P M Hertogh
- Department of General Practice and Elderly Care Medicine and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
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Burns M, McIlfatrick S. Palliative care in dementia: literature review of nurses' knowledge and attitudes towards pain assessment. Int J Palliat Nurs 2015; 21:400-7. [DOI: 10.12968/ijpn.2015.21.8.400] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Michelle Burns
- Macmillan Clinical Nurse Specialist, Belfast Health and Social Care Trust
| | - Sonja McIlfatrick
- Reader, Institute of Nursing and Health Research, University of Ulster, UK
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Abstract
Pain may adversely affect cognition through its effects on mood and sleep, and chronic pain has been associated with brain atrophy. Studies suggest that chronic pain is undertreated in cognitively impaired people. Pain assessment should involve direct enquiry with the patient; where this is not possible, a proxy history from a caregiver or nurse should be obtained, and observational scales may also be useful. This report is adapted from paineurope 2014; Issue 1, Haymarket Medical Publications Ltd., and is presented with permission. paineurope is provided as a service to pain management by Mundipharma International, Ltd., and is distributed free of charge to health care professionals in Europe. Archival issues can be accessed via the Web site: http://www.paineurope.com, at which European health professionals can register online to receive copies of the quarterly publication.
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36
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Adherence of pain assessment to the German national standard for pain management in 12 nursing homes. Pain Res Manag 2015; 19:133-40. [PMID: 24851238 DOI: 10.1155/2014/785765] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Pain is very common among nursing home residents. The assessment of pain is a prerequisite for effective multiprofessional pain management. Within the framework of the German health services research project, 'Action Alliance Pain-Free City Muenster', the authors investigated pain assessment adherence according to the German national Expert Standard for Pain Management in Nursing, which is a general standard applicable to all chronic⁄acute pain-affected persons and highly recommended for practice. OBJECTIVES To evaluate the state of pain assessment and to identify need for improvement in 12 nursing homes in a German city. METHODS In the present study, the authors used an ex-post-facto design (survey methodology). Available written policies for routine pain assessment in residents ≥65 years of age were reviewed and a standardized online survey completed by 151 of 349 nurses in 12 nursing home facilities was conducted between September 2010 and April 2011. RESULTS Most of the included nursing homes provided written policies for pain assessment, and the majority of nurses reported that they assess and regularly reassess pain. However, observational tools for residents with severe cognitive impairment and written reassessment schedules were lacking in many facilities or were inconsistent. CONCLUSIONS Essentially, pain assessment appeared to be feasible in the majority of the German nursing homes studied. However, the absence or inconsistency of reassessment schedules indicate that pain management guidelines should include a detailed and explicit reassessment schedule for the heterogenic needs of nursing home residents. For residents with severe cognitive impairment, assessment tools are needed that are simple to use and clearly indicate the presence or absence of pain.
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Barry HE, Parsons C, Passmore AP, Hughes CM. Pain in care home residents with dementia: an exploration of frequency, prescribing and relatives' perspectives. Int J Geriatr Psychiatry 2015; 30:55-63. [PMID: 24733695 DOI: 10.1002/gps.4111] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 03/04/2014] [Indexed: 11/10/2022]
Abstract
OBJECTIVES This study aims to determine pain frequency amongst care home residents with dementia, to investigate variables associated with pain, to explore analgesic use among residents and to seek residents' relatives' views on provision of care and management of pain by the care home. METHODS Structured face-to-face interviews were conducted with residents, nursing staff and relatives from nine dementia care homes in Northern Ireland, between May 2010 and March 2012. Demographic information was collected from participants, neuropsychiatric tests were used to assess residents' cognitive functioning, medication use was determined from care home records and residents' pain was assessed using a verbal descriptor scale. Relatives' views were sought on care provision and management of pain. RESULTS Forty-two residents, 16 nurses/care assistants and 35 relatives participated; the participation rate of residents was low (27.6%). Most residents were suffering moderate-severe dementia, and some residents (26.2%) were unable to provide a self-report of pain. A significantly higher proportion of relatives (57.1%) deemed residents to be experiencing pain at the time of the interview, compared with residents (23.8%, p = 0.005) and nurses/care assistants (42.9%, p = 0.035). Most residents (88.1%) were prescribed with analgesia; non-opioid analgesics were most commonly prescribed. High proportions of residents were prescribed with psychoactive medications. Antipsychotic drug use was associated with presence of pain (p = 0.046). CONCLUSIONS This study has reinforced the challenge of assessing and managing pain in this resident population and highlighted issues to be addressed by long-term care providers and clinicians. Participation of people with dementia, and their families, in healthcare research needs to be improved.
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Affiliation(s)
- Heather E Barry
- Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast, UK
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de Souto Barreto P, Lapeyre-Mestre M, Vellas B, Rolland Y. Indicators of influenza and pneumococcal vaccination in French nursing home residents in 2011. Vaccine 2013; 32:846-51. [PMID: 24370710 DOI: 10.1016/j.vaccine.2013.12.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 12/06/2013] [Accepted: 12/10/2013] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Older adults living in nursing homes (NH) are at high risk of developing influenza and pneumococcal infections. The objectives of this study were to describe vaccination coverage for influenza and pneumococcal among French NH residents and to investigate which NH structure- and organisation-related aspects could impact on vaccination in this population. METHODS This study is based on cross-sectional data from 175 French NHs (N=6275 residents), collected in May-July 2011. Residents' vaccination status (yes vs. no) against pneumococcal infection and seasonal influenza was recorded by the NH staff (on the basis of the resident's medical chart). Residents' health-related variables (e.g., co-morbidities) and information on NH structure and internal organisation were recorded by the NH staff. Mixed-effects logistic regressions were performed on influenza and pneumococcal vaccination separately. RESULTS Influenza vaccination coverage was high (n=5071, i.e., 80.8% of residents) and relatively well-distributed across NHs, whereas pneumococcal vaccination was low (n=1758, i.e., 28%) and highly variable across facilities. Mixed-effects logistic regressions confirmed that structural and organisational aspects related to the NH functioning impacted vaccination coverage. More precisely, living in a private for profit NH, living in NHs located in low-urban areas, and coordinating physician training increased the odds of receiving pneumococcal vaccine, whereas living in NHs located at high-urban areas decreased this odds. Moreover, the time spent by the coordinating physician in the NH increased the odds of receiving influenza vaccine. Prescriptions re-examination since resident's admission at the NH and the presence of an individualised health care project increased the odds of receiving both influenza and pneumococcal vaccines. CONCLUSIONS Our findings suggest that a more standardised approach is needed to improve vaccination coverage against pneumococcal infection in French NH residents.
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Affiliation(s)
- Philipe de Souto Barreto
- Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse (CHU Toulouse), Toulouse, France; UMR7268 ADES, Aix-Marseille Univ., Marseille, France.
| | - Maryse Lapeyre-Mestre
- UMR INSERM 1027, University of Toulouse III, Toulouse, France; Service de Pharmacologie Clinique, CHU de Toulouse, Toulouse, France
| | - Bruno Vellas
- Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse (CHU Toulouse), Toulouse, France; UMR INSERM 1027, University of Toulouse III, Toulouse, France
| | - Yves Rolland
- Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse (CHU Toulouse), Toulouse, France; UMR INSERM 1027, University of Toulouse III, Toulouse, France
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de Souto Barreto P, Lapeyre-Mestre M, Vellas B, Rolland Y. Potential underuse of analgesics for recognized pain in nursing home residents with dementia: A cross-sectional study. Pain 2013; 154:2427-2431. [DOI: 10.1016/j.pain.2013.07.017] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 07/11/2013] [Accepted: 07/15/2013] [Indexed: 11/30/2022]
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Achterberg WP, Pieper MJC, van Dalen-Kok AH, de Waal MWM, Husebo BS, Lautenbacher S, Kunz M, Scherder EJA, Corbett A. Pain management in patients with dementia. Clin Interv Aging 2013; 8:1471-82. [PMID: 24204133 PMCID: PMC3817007 DOI: 10.2147/cia.s36739] [Citation(s) in RCA: 204] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
There are an estimated 35 million people with dementia across the world, of whom 50% experience regular pain. Despite this, current assessment and treatment of pain in this patient group are inadequate. In addition to the discomfort and distress caused by pain, it is frequently the underlying cause of behavioral symptoms, which can lead to inappropriate treatment with antipsychotic medications. Pain also contributes to further complications in treatment and care. This review explores four key perspectives of pain management in dementia and makes recommendations for practice and research. The first perspective discussed is the considerable uncertainty within the literature on the impact of dementia neuropathology on pain perception and processing in Alzheimer's disease and other dementias, where white matter lesions and brain atrophy appear to influence the neurobiology of pain. The second perspective considers the assessment of pain in dementia. This is challenging, particularly because of the limited capacity of self-report by these individuals, which means that assessment relies in large part on observational methods. A number of tools are available but the psychometric quality and clinical utility of these are uncertain. The evidence for efficient treatment (the third perspective) with analgesics is also limited, with few statistically well-powered trials. The most promising evidence supports the use of stepped treatment approaches, and indicates the benefit of pain and behavioral interventions on both these important symptoms. The fourth perspective debates further difficulties in pain management due to the lack of sufficient training and education for health care professionals at all levels, where evidence-based guidance is urgently needed. To address the current inadequate management of pain in dementia, a comprehensive approach is needed. This would include an accurate, validated assessment tool that is sensitive to different types of pain and therapeutic effects, supported by better training and support for care staff across all settings.
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Affiliation(s)
- Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Marjoleine JC Pieper
- Department of General Practice and Elderly Care Medicine, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Annelore H van Dalen-Kok
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Margot WM de Waal
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Bettina S Husebo
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Stefan Lautenbacher
- Physiological Psychology, Otto Friedrich University Bamberg, Bamberg, Germany
| | - Miriam Kunz
- Physiological Psychology, Otto Friedrich University Bamberg, Bamberg, Germany
| | - Erik JA Scherder
- Department of Clinical Neuropsychology, VU University Amsterdam, Amsterdam, The Netherlands
| | - Anne Corbett
- Wolfson Centre for Age-Related Diseases, King’s College London, London, UK
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Barry HE, Parsons C, Passmore AP, Hughes CM. Community pharmacists and people with dementia: a cross-sectional survey exploring experiences, attitudes, and knowledge of pain and its management. Int J Geriatr Psychiatry 2013; 28:1077-85. [PMID: 23348866 DOI: 10.1002/gps.3931] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2012] [Accepted: 12/19/2012] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To explore community pharmacists' experiences with and attitudes towards people with dementia, and to determine the knowledge they have about pain and its management in this patient population. METHODS A questionnaire comprising five sections, including the Approaches to Dementia Questionnaire, was mailed, on two occasions, during February and March 2011, to all community pharmacies in Northern Ireland (n = 530). RESULTS The response rate was 34.3%. A greater proportion of pharmacists provided pharmaceutical care to people with dementia living at home (91.2%) than those living in care homes (40.1%). Respondents most frequently encountered queries relating to starting and stopping medications, compliance with medication, and availability of formulation types. The mean total score for the Approaches to Dementia Questionnaire measure was 72.8, indicating a positive attitude towards people with dementia, and respondents demonstrated a strong person-centred approach towards this patient population. The majority of respondents recognised the difficulty of assessing pain in people with dementia; however, younger pharmacists (p = 0.041) and pharmacists who provided pharmaceutical care to people with dementia (p = 0.012) were more likely to be aware of the pain assessment tools for use in people with dementia. Pharmacists appeared uncertain about how to appropriately manage pain in people with dementia. CONCLUSIONS The study has revealed that community pharmacists often encounter people with dementia, especially those living in their own homes, and they have positive attitudes towards the patient population. However, training in the assessment and management of pain in people with dementia must be developed to further improve their knowledge in this area.
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Affiliation(s)
- Heather E Barry
- Clinical and Practice Research Group, School of Pharmacy, Queen's University, Belfast, UK
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Calvó-Perxas L, López-Pousa S, Turró-Garriga O, de Eugenio R, Linares M, Fernández MDM, Castellanos M, Casas I, Turón-Estrada A, Casadevall T, Coromina J, Vilalta-Franch J, Garre-Olmo J. Pain treatment and its cost in old people with dementia: a descriptive analysis from the Registry of Dementias of Girona (ReDeGi). Int J Neurosci 2013; 123:339-46. [PMID: 23270366 DOI: 10.3109/00207454.2012.761216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Pain prevalence is high among elderly people, and equally prevalent in those with dementia. The aim of this study was to describe the use analgesics, as well as the cost of these treatments in old people with dementia. METHODS We used a cross-sectional design using 1186 cases registered by the Registry of Dementias of Girona from 2007 to 2008. All drugs were categorized following the Anatomic Therapeutic Chemical classification and grouped according to the World Health Organization (WHO) analgesic ladder steps. Descriptive statistical methods were used. RESULTS Analgesics were prescribed to 78.6% (95% CI, 76.2-81.0) of the registered cases. Of them, 80.6% (95% CI, 78.0-83.2) were treated following step 1 of the WHO analgesic ladder, 16.8% (95% CI, 14.4-19.3) following step 2 and 2.6% (95% CI, 1.5-3.6) following step 3. Pain treatment in old people with dementia had a cost of 42.1 € per patient and year, with no significant differences depending on the subtype of dementia. CONCLUSIONS The use of analgesics in our sample was not associated to age or to dementia severity, which are themselves risk factors for increased pain. Moreover, no differences were detected depending on the subtype of dementia.
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