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Vitou V, Gély-Nargeot MC, Jeandel C, Bayard S. The influence of Alzheimer's disease stigma on pain assessment in older persons. DEMENTIA 2022; 21:2418-2441. [PMID: 35976758 DOI: 10.1177/14713012221117907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Pain of nursing homes residents with Alzheimer's disease remains under detected compared to their cognitively intact counterparts. Communication difficulties may partly explain this poor quality of care but the influence of stigmatization on pain assessment has never been explored. RESEARCH QUESTION The objective of this research was to analyze whether a diagnosis label of Alzheimer's disease or the stage of the disease may bias pain assessment scores and empathic reactions of health care staff in nursing homes. METHODS Two studies were conducted based on a similar experimental between-subjects design with a video showing an older adult woman experiencing undefined pain. Different labels and vignettes were manipulated to characterize the subject of the video. In the first study, 84 certified nursing assistants were asked to watch the video and then to assess the pain intensity and their empathic reaction. Participants were randomized in two conditions that varied the disease label (Alzheimer's disease vs no diagnosis). In the second study, 67 certified nursing assistants were enrolled who did not participate in the first study. They watched the same video as in the first study and assessed the pain intensity and their empathic reaction. They were randomized in two conditions that varied the stage of the Alzheimer's disease (mild stage vs severe stage). RESULTS Alzheimer's disease label had no influence on assessment scores. In contrast, the stage of the disease had a significant effect on the health care staff assessments with severe stage associated with lower pain intensity scores and empathic reactions. CONCLUSION These results confirm that the Alzheimer's disease stigma is a real phenomenon that tends to be mainly elicited by the symptoms of the acute phase of the disease. These findings are crucial to better understand the stigma related to Alzheimer's disease and to enhance the pain management of this frail population.
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Affiliation(s)
- Valérie Vitou
- 27038EPSYLON, EA4556, Univ Paul Valéry Montpellier 3, F34000, Montpellier, France.,Fondation Partage et Vie, Montrouge, France
| | | | - Claude Jeandel
- Fondation Partage et Vie, Montrouge, France.,Département de Gériatrie, Université De Montpellier, 26905CHU de Montpellier, Montpellier, France
| | - Sophie Bayard
- 27038EPSYLON, EA4556, Univ Paul Valéry Montpellier 3, F34000, Montpellier, France
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Abstract
Abstract
Personhood has been a key influence on the development of person-centred care models in dementia. However, there is ambiguity around the concept and interpretation of personhood, and what it means in practical terms for the delivery of care to people with dementia. This study examines the conceptualisation of personhood within the formal care system for people with dementia in Ireland. A multiple perspective study design examines the experiences of personhood in dementia from the perspectives of people with dementia, family carers and a range of formal carers. Semi-structured interviews with participants were conducted in both community and long-term care settings. Interpretative phenomenological analysis is used to examine the data. A total of 31 participants were interviewed: eight people with dementia, eight family carers and 15 formal carers. There is general consensus on the core elements of personhood among all participants: interests and preferences; lifecourse experiences; social interaction; family; and place. However, there is ambiguity among family carers and formal carers in the interpretation of changes to personhood as the disease progresses. Interpersonal and structural barriers to supporting personhood are identified by all participants. The findings provide guidance on the traits of personhood-enhancing care, including effective communication skills, and the potential of health and social care reform to support the core elements of personhood among people with dementia.
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Carragher RM, MacLeod E, Camargo-Plazas P. The objectivity and subjectivity of pain practices in older adults with dementia: A critical reflection. Nurs Inq 2020; 28:e12397. [PMID: 33368898 DOI: 10.1111/nin.12397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 11/25/2020] [Accepted: 11/29/2020] [Indexed: 11/30/2022]
Abstract
Providing nursing care for people with dementia residing in long-term care facilities poses specific challenges regarding pain practices. With underlying communication barriers unique to dementia pathologies, this population is often unable to communicate verbal sentiments and descriptions of pain. In turn, nurses caring for older persons with dementia have difficulty assessing, managing and treating pain. Objectivity is an imperative factor in healthcare pain practices; however, it is difficult to objectively evaluate someone who cannot accurately communicate their experience of pain. Therefore, the authors believe that subjectivity is also an essential part of evaluating the person with dementia's experience of pain. In this critical reflection, the authors explore objectivity and subjectivity in relation to pain practices for dementia in long-term care. A historical summary of pain is provided outlining the evolution of objectivity and subjectivity related to pain practices. The authors discuss the complexities of assessing and managing pain and offer a new perspective about the role of objectivity (and co-existence of subjectivity) for nurses treating pain in the older adults with dementia.
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Affiliation(s)
| | - Emily MacLeod
- School of Nursing, Queen's University, Kingston, Ontario, Canada
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Walsh S, O'Shea E, Pierse T, Kennelly B, Keogh F, Doherty E. Public preferences for home care services for people with dementia: A discrete choice experiment on personhood. Soc Sci Med 2020; 245:112675. [DOI: 10.1016/j.socscimed.2019.112675] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 11/04/2019] [Accepted: 11/08/2019] [Indexed: 11/16/2022]
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Personhood and Dementia Care: A Qualitative Evidence Synthesis of the Perspectives of People With Dementia. THE GERONTOLOGIST 2019; 61:e85-e100. [DOI: 10.1093/geront/gnz159] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Indexed: 12/23/2022] Open
Abstract
Abstract
Background and Objectives
Personhood is considered the cornerstone of person-centered care for people with dementia. However, there is little research on personhood in dementia care from the perspective of the person with dementia themselves. This article presents a qualitative evidence synthesis of the experiences and perceptions of people with dementia on personhood in dementia care.
Research Design and Methods
A systematic search of nine databases was conducted. In addition to initial screening, CART analysis was used to determine the most relevant papers. Thematic synthesis was conducted on 20 papers. The CASP tool was used to examine the quality of the included papers. GRADE CERQual analysis examined confidence in the review findings.
Results
People with dementia experience many changes due to the disease and the experience of being cared for in different settings. Personhood is affirmed through personal interactions with family, friends, other care recipients, and formal caregivers, as well as through continued engagement in social and occupational roles.
Discussion and Implications
The review has important implications for practice, regulation, and policy. The person and their personhood should be protected rather than undermined, and relationships should be enhanced not diminished by the formal care process. The focus should be on creating and amplifying opportunities for people with dementia to affirm the self through interactions with others and engaging in occupational and social roles to ensure continuity of self.
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Abstract
AbstractDementia, a term that describes a variety of brain conditions marked by gradual, persistent and progressive cognitive decline, affects a significant proportion of older adults. Older adults with dementia are sometimes perceived less favourably than those without dementia. Furthermore, compared to persons without dementia, those with dementia are often perceived by others as having reduced personhood. This study was aimed at investigating whether differences in attitudes towards dementia and personhood perceptions vary as a function of age group, care-giver status, attitudes towards ageing, dementia knowledge, gender and education. In total 196 younger, middle-aged and older adults were recruited. Findings revealed that being a care-giver as well as having less ageist attitudes were predictive of being more comfortable around persons with dementia, having more knowledge about dementia and ascribing greater personhood to people with dementia. Those with more dementia knowledge (prior to the study) were less comfortable around people with dementia. Finally, when controlling this prior dementia knowledge, older adults were more comfortable around people with dementia compared to younger and middle-aged adults. Gender and education were not associated with any of the variables under study. Findings contribute to a better understanding of the role of age- and care-giver-related factors in the determination of attitudes towards dementia.
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Haeusermann T. Forced continuity: Explorations of biographical narratives in dementia care. J Aging Stud 2019; 49:1-8. [PMID: 31229213 DOI: 10.1016/j.jaging.2019.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 02/10/2019] [Accepted: 02/21/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Tobias Haeusermann
- Memory and Aging Center, UCSF, 1500 Owens St #320, San Francisco, CA 94158, USA; University of Cambridge, PPSIS Faculty, Department of Sociology, Free School Lane, Cambridge CB2 3, UK.
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Abstract
Personhood and its realisation in person-centred care is part of the narrative, if not always the reality, of care for people with dementia. This paper examines how personhood is conceptualised and actualised in Ireland through a content analysis of organisational and individual submissions from stakeholders in the development of the Irish National Dementia Strategy, followed by an examination of the Strategy itself. The organisational submissions are further categorised into dementia care models. A structural analysis of the Strategy examines its principles, actions and outcomes in relation to personhood. Of the 72 organisational and individual submissions received in the formulation of the Strategy, 61% contained references to personhood and its synonyms. Of the 35 organisational submissions, 40% fit a biomedical model, 31% a social model and 29% a biopsychosocial model. The Strategy contains one direct reference to personhood and 33 to personhood synonyms. Half of these references were contained within its key principles and objectives; none were associated with priority actions or outcomes. While stakeholders value personhood and the Strategy identifies personhood as an overarching principle, clearer direction on how personhood and person-centred care can be supported in practice and through regulation is necessary in Ireland. The challenge, therefore, is to provide the information, knowledge, incentives and resources for personhood to take hold in dementia care in Ireland.
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A life history intervention for individuals with dementia: a randomised controlled trial examining nursing staff empathy, perceived patient personhood and aggressive behaviours. AGEING & SOCIETY 2015. [DOI: 10.1017/s0144686x15000902] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
ABSTRACTBehaviours of concern (e.g.aggression) are often present in residents of long-term care (LTC) facilities diagnosed with dementia and may impact quality of life. Prior uncontrolled research has shown that an intervention involving sharing resident life histories may be effective in reducing aggressive behaviours and improving quality of life, perhaps by increasing staff empathy. We used a randomised controlled design, involving a considerably larger sample than previous investigations. We also examined staff perceptions of LTC resident personhood in relation to aggressive behaviour. Seventy-three residents were randomised to either a life history intervention (N = 38) or a control condition (N = 35). Ninety-nine nurses and care aides answered questionnaires about their own attitudes and the residents' behaviours and quality of life at baseline, post-intervention and at follow-up. Results of mixed-effects modelling indicated significant differences between groups in personhood perception and resident quality of life. Personhood perception mediated the relationship between the intervention and improved quality of life. We identified significant negative correlations between resident cognitive impairment and staff perceptions of resident personhood. Qualitative findings suggested that staff primarily changed their verbal interactions with residents following the intervention, which may be particularly helpful for residents with the most severe dementia. Our results indicate that LTC residents benefit when life histories are constructed with their families and shared with nursing staff.
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Hodgson N, Gitlin LN, Winter L, Hauck WW. Caregiver's perceptions of the relationship of pain to behavioral and psychiatric symptoms in older community-residing adults with dementia. Clin J Pain 2014; 30:421-7. [PMID: 24281271 PMCID: PMC3995132 DOI: 10.1097/ajp.0000000000000018] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Pain is underrecognized and undermanaged in older adults with dementia. Because dementia patients have a diminished capacity to communicate discomfort, untreated pain may be expressed in the form of behavioral and psychiatric symptoms. The goal of the present study was to examine the relationship between pain and behavioral and psychiatric symptoms of dementia in community-residing older adults from the perspective of the family caregiver. MATERIALS AND METHODS Dyads composed of 272 dementia patients, and their family caregivers were assessed to determine dementia patient's mental status; family caregiver's assessment of care recipient's pain, functional dependence, and number of behavioral symptoms; analgesic use; and demographic information. RESULTS Hierarchical multiple regression analysis controlling for age, marital status, race, functional disability, and analgesic use showed that pain explained a small but significant percent of variance in the number of behavioral symptoms (3%, P<0.001). Pain had a stronger influence on the number of behavioral and psychiatric symptoms of dementia among those with severe cognitive impairment (F1,69=11.75, P<0.001) compared with those with low to moderate cognitive impairment (F1,199=4.543, P=0.034.). DISCUSSION The findings indicate that pain is a risk factor for behavioral symptoms in individuals with dementia and suggest that pain is a more significant predictor of behavior for individuals with severe dementia, compared with those with mild/moderate stage dementia. These results reinforce the importance of proper pain assessment and its management as part of dementia care planning.
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Development and mixed-methods evaluation of a pain assessment video training program for long-term care staff. Pain Res Manag 2013; 18:307-12. [PMID: 23957021 DOI: 10.1155/2013/659320] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Inadequacies in pain assessment and management in long-term care have been well documented. Insufficient pain education and inaccurate beliefs about the nature of pain and aging have been identified as possible contributors. The present study addresses the need for improved, efficient and feasible continuing pain education through the use of an assessment training video. METHODS A total of 148 long-term care staff viewed and evaluated the training video. Knowledge changes and pain beliefs were assessed postvideo and at a four-week follow-up. Beliefs about pain, as well as pain and aging, were also examined using multivariate procedures to determine whether these variables influenced participants' evaluation of the video. Focus groups were also conducted, and transcripts were analyzed using thematic content analysis. RESULTS Pain assessment knowledge improved postvideo and at the four-week follow-up. Participants positively evaluated the content and quality of the video. Individuals who held stronger beliefs (at baseline) about the organic nature of pain provided more positive evaluations. Barriers to implementation of practices in the video identified by the focus groups (and qualitative analysis) included time, workload and resistance to change. Facilitators to implementation included continued management support and observing the benefits to implementation. DISCUSSION The present study provides support for the use of video training. However, based on the focus group results, top-down implementation approaches with ongoing management involvement throughout the implementation process may be needed to achieve sustained changes in pain assessment practices. A model useful for sustained implementation was proposed and discussed, and is hoped to facilitate future research.
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The Personhood in Dementia Questionnaire (PDQ): Establishing an association between beliefs about personhood and health providers' approaches to person-centred care. J Aging Stud 2013; 27:276-87. [DOI: 10.1016/j.jaging.2013.05.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 05/04/2013] [Accepted: 05/21/2013] [Indexed: 11/23/2022]
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Lukas A, Mayer B, Fialová D, Topinkova E, Gindin J, Onder G, Bernabei R, Nikolaus T, Denkinger MD. Treatment of pain in European nursing homes: results from the Services and Health for Elderly in Long TERm Care (SHELTER) study. J Am Med Dir Assoc 2013; 14:821-31. [PMID: 23746948 DOI: 10.1016/j.jamda.2013.04.009] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 04/18/2013] [Accepted: 04/23/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To identify pharmacological and nonpharmacological pain management approaches and associated factors in nursing home residents across Europe. SETTING, PARTICIPANTS, AND MEASUREMENTS Cross-sectional study with 4156 residents who were assessed using the interRAI instrument for Long Term Care Facilities (interRAI LTCF), including pharmacological and nonpharmacological pain management modalities. Those reporting pain were included in the analyses (n = 1900). A deeper analysis was performed for the subsample of residents who reported "current pain," defined as pain at least 1 day within the past 3 days (n = 838), and those who reported "current pain of moderate to severe intensity" (n = 590). RESULTS Up to 24% of residents who reported pain did not receive any pain medication and up to 11% received it only PRN (as-needed basis), independent of current pain-intensity levels; 61% did not receive any nonpharmacological treatment and 21% received neither pharmacological nor nonpharmacological pain modalities. Considerable differences could be demonstrated across European countries. Factors positively associated with pharmacological pain management were being of female gender, reporting cancer, and having moderate or severe pain. High turnover rates of regular staff and low-to-moderate physicians' availability were negatively associated. Factors positively associated with nonpharmacological treatment were fractures and need of assistance in activities of daily living. Dementia, large nursing home facilities, above-average and high turnover rates of nursing staff, a low physicians' availability, and severe pain intensity were negatively associated. CONCLUSION Despite some advances in recent years, pain treatment in European nursing home residents remains to be suboptimal and requires further improvement.
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Affiliation(s)
- Albert Lukas
- Agaplesion Bethesda Clinic, Competence Center of Geriatrics and Aging Research, University of Ulm, Ulm, Germany.
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Abstract
The study describes how relationships are created with persons with moderate to severe dementia. The material comprises 24 video sequences of Relational Time (RT) sessions, 24 interviews with persons with dementia and eight interviews with professional caregivers. The study method was Constructivist Grounded Theory. The categories of 'Assigning time', 'Establishing security and trust' and 'Communicating equality' were strategies for arriving at the core category, 'Opening up', which was the process that led to creating relationships. Both parties had to contribute to create a relationship; the professional caregiver controlled the process, but the person with dementia permitted the caregiver's overtures and opened up, thus making the relationship possible. Interpersonal relationships are significant to enhancing the well-being of persons with dementia. Small measures like RT that do not require major resources can open paths to creating relationships.
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Lokon E, Kinney JM, Kunkel S. Building Bridges Across Age and Cognitive Barriers Through Art: College Students' Reflections on an Intergenerational Program With Elders who Have Dementia. JOURNAL OF INTERGENERATIONAL RELATIONSHIPS 2012. [DOI: 10.1080/15350770.2012.724318] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Karlsson C, Sidenvall B, Bergh I, Ernsth-Bravell M. Registered Nurses´ View of Performing Pain Assessment among Persons with Dementia as Consultant Advisors. Open Nurs J 2012; 6:62-70. [PMID: 22655002 PMCID: PMC3362856 DOI: 10.2174/1874434601206010062] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Revised: 03/08/2012] [Accepted: 03/12/2012] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Pain assessment in persons with dementia is well known as a challenging issue to professional caregivers, because of these patients´ difficulties in verbalising pain problems. Within municipal dementia care in Sweden, pain assessment has become problematic for registered nurses, as they have entered a new role in their nursing profession, from being clinical practitioners to becoming consultant advisers to other health care staff. AIM To present municipal registered nurses´ view of pain assessment in persons with dementia in relation to their nursing profession as consultant advisers. METHODS Purposive sampling was undertaken with 11 nurses invited to participate. Data were collected by focus groups. Qualitative content analysis was used to analyse the data. FINDINGS Four categories were identified to describe registered nurses´ view of pain assessment: estrangement from practical nursing care, time consuming and unsafe pain documentation, unfulfilled needs of reflection possibilities, and collaboration and coordination. CONCLUSIONS The performance of pain assessment through a consultant advising function is experienced as frustrating and as an uncomfortable nursing situation. The nurses feel resistance to providing nursing in this way. They view nursing as a clinical task demanding daily presence among patients to enable them to make accurate and safe assessments. However, due to the consultative model, setting aside enough time for the presence seems difficult to accomplish. It is necessary to promote the quality of systematic routines in pain assessment and reflection, as well as developing professional knowledge of how pain can be expressed by dementia patients, especially those with communication difficulties.
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Affiliation(s)
- Christina Karlsson
- Department of Nursing Science, School of Health Sciences, Jönköping University, Box 1026, SE-551 11 Jönköping, Sweden
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Jordan A, Hughes J, Pakresi M, Hepburn S, O'Brien JT. The utility of PAINAD in assessing pain in a UK population with severe dementia. Int J Geriatr Psychiatry 2011; 26:118-26. [PMID: 20652872 DOI: 10.1002/gps.2489] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Studies suggest that pain is under-recognized and under-treated in those with severe dementia. Identifying pain is the first step in its effective management. Few studies have investigated the utility of behavioural pain tools in those with advanced dementia. METHODS Participants were nursing home residents with advanced dementia who were observed on three occasions using a pain assessment tool (PAINAD). Following further assessment, an appropriate management plan was formulated for those thought to be in pain. Participants who scored above the cutoff (two) on the PAINAD scale, but were felt not to be in pain, formed the false positive group. The pain and false positive groups were reassessed at 1 and 3 months. RESULTS Seventy-nine participants completed the study, with 39 participants scoring above two on the PAINAD. Of these, only 13 were assessed as being in pain. The other 26 participants who scored above the cutoff on PAINAD were not felt to be in pain. Instead, their behaviour had a psychosocial explanation, often to do with a lack of understanding as to what was happening to them. The sensitivity of PAINAD was 92%. In those with pain, a significant decrease was demonstrated in the PAINAD scores on intervention following treatment for pain (p=0.008). CONCLUSIONS PAINAD is a sensitive tool for detecting pain in people with advanced dementia, but has a high false positive rate, frequently detecting psychosocial distress rather than pain. PAINAD can be used to assess whether pain management strategies have been successful.
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Affiliation(s)
- Alice Jordan
- Northumbria Healthcare NHS Foundation Trust, UK.
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Promoting the Concept of Personhood in Practice, Hamilton, Ontario: McMaster Centre for Gerontological Studies, 2009.*. Can J Aging 2010. [DOI: 10.1017/s0714980810000619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Nurse-patient encounters in the hospital ward, from the perspectives of older persons: an analysis using the Authentic Consciousness Framework. Int J Older People Nurs 2010; 7:95-104. [DOI: 10.1111/j.1748-3743.2010.00233.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Slaughter S, Bankes J. The Functional Transitions Model: Maximizing Ability in the Context of Progressive Disability Associated with Alzheimer's Disease. Can J Aging 2010; 26:39-47. [PMID: 17430803 DOI: 10.3138/q62v-1558-4653-p0hx] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
ABSTRACTThe Functional Transitions Model (FTM) integrates the theoretical notions of progressive functional decline associated with Alzheimer's disease (AD), excess disability, and transitions occurring intermittently along the trajectory of functional decline. Application of the Functional Transitions Model to clinical practice encompasses the paradox of attempting to minimize excess disability while anticipating the progressive functional decline associated with AD. It is suggested that times of functional transition are times of decision making and opportunities for interdisciplinary collaboration to identify and minimize excess disability, for revision of goals and expectations, and for provision of support to patients and caregivers. The model also is applicable as a conceptual framework for education and research.
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Affiliation(s)
- Susan Slaughter
- Primary Care Research and Development Group, Department of Family Medicine, University of Calgary, Calgary, AB.
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Malloy DC, Hadjistavropoulos T, McCarthy EF, Evans RJ, Zakus DH, Park I, Lee Y, Williams J. Culture and Organizational Climate: Nurses’ Insights Into Their Relationship With Physicians. Nurs Ethics 2009; 16:719-33. [DOI: 10.1177/0969733009342636] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Within any organization (e.g. a hospital or clinic) the perception of the way things operate may vary dramatically as a function of one’s location in the organizational hierarchy as well as one’s professional discipline. Interorganizational variability depends on organizational coherence, safety, and stability. In this four-nation (Canada, Ireland, Australia, and Korea) qualitative study of 42 nurses, we explored their perception of how ethical decisions are made, the nurses’ hospital role, and the extent to which their voices were heard. These nurses suggested that their voices were silenced (often voluntarily) or were not expressed in terms of ethical decision making. Finally, they perceived that their approach to ethical decision making differed from physicians.
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Levels of Personhood: A Model for Dementia Care. Geriatr Nurs 2008; 29:324-32. [DOI: 10.1016/j.gerinurse.2007.11.001] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2007] [Revised: 11/05/2007] [Accepted: 11/11/2007] [Indexed: 11/19/2022]
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Bartlett R, O'Connor D. From personhood to citizenship: Broadening the lens for dementia practice and research. J Aging Stud 2007. [DOI: 10.1016/j.jaging.2006.09.002] [Citation(s) in RCA: 183] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Penrod J, Yu F, Kolanowski A, Fick DM, Loeb SJ, Hupcey JE. Reframing Person-Centered Nursing Care for Persons With Dementia. Res Theory Nurs Pract 2007; 21:57-72. [PMID: 17378465 PMCID: PMC2844333 DOI: 10.1891/rtnpij-v21i1a007] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Alzheimer’s dementia manifests in a complex clinical presentation that has been addressed from both biomedical and phenomenological perspectives. Although each of these paradigmatic perspectives has contributed to advancement of the science, neither is adequate for theoretically framing a person-centered approach to nursing care. The need-driven dementia-compromised behavior (NDB) model is discussed as an exemplar of midrange nursing theory that promotes the integration of these paradigmatic views to promote a new level of excellence in person-centered dementia care. Clinical application of the NDB promotes a new level of praxis, or thoughtful action, in the care of persons with dementia.
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Affiliation(s)
- Janice Penrod
- The Pennsylvania State University, University Park, PA 16802, USA.
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Van den Block L, Bilsen J, Deschepper R, Van der Kelen G, Bernheim JL, Deliens L. End-of-life decisions among cancer patients compared with noncancer patients in Flanders, Belgium. J Clin Oncol 2006; 24:2842-8. [PMID: 16782923 DOI: 10.1200/jco.2005.03.7531] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Incidence studies reported more end-of-life decisions with possible/certain life-shortening effect (ELDs) among cancer patients than among noncancer patients. These studies did not correct for the different proportions of sudden/unexpected deaths of cancer versus noncancer patients, which could have biased the results. We investigated incidences and characteristics of ELDs among nonsudden cancer and noncancer deaths. METHODS We sampled 5,005 certificates of all deaths in 2001 (Flanders, Belgium) stratified for ELD likelihood. Questionnaires were mailed to the certifying physicians. Data were corrected for stratification and nonresponse. RESULTS The response rate was 59%. Among 2,128 nonsudden deaths included, ELDs occurred in 74% of cancer versus 50% of noncancer patients (P < .001). Symptom alleviation with possible life-shortening effect occurred more frequently among cancer patients (P < .001); nontreatment decisions occurred less frequently (P < .001). The higher incidence of lethal drug use among cancer patients did not hold after correcting for patient age. Half of the cancer patients who died after an ELD were incompetent to make decisions compared with 76% of noncancer patients (P < .001). Discussion with patients and relatives was similar in both groups. In one fifth of all patients the ELD was not discussed. CONCLUSION ELDs are common in nonsudden deaths. The different incidences for symptom alleviation with possible life-shortening effect and nontreatment decisions among cancer versus noncancer patients may be related to differences in dying trajectories and in timely recognition of patient needs. The end-of-life decision-making process is similar for both groups: consultation of patients and relatives can be improved in a significant minority of patients.
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Affiliation(s)
- Lieve Van den Block
- Vrije Universiteit Brussel, End-of-Life Care Research Group, Brussels, Belgium.
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Affiliation(s)
- Patricia O'Malley
- Center of Nursing Excellence, Miami Valley Hospital, Dayton, Ohio 45409, USA.
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