Assessing pain in people with profound learning disabilities

Tacit knowledge in dyads of persons with profound intellectual and multiple disabilities and their caregivers: An interpretative literature study

BACKGROUND

Caring for persons with profound intellectual and multiple disabilities (PIMD) demands specific expertise. Tacit knowledge seems to play an important role, but little is known about its nature, including what is necessary for its development and transfer.

AIM

To gain understanding of the nature and development of tacit knowledge between persons with PIMD and their caregivers.

METHOD

We conducted an interpretative synthesis of literature on tacit knowledge in caregiving dyads with persons with PIMD, persons with dementia or infants. Twelve studies were included.

RESULTS

Tacit knowledge is about caregivers and care-recipients becoming sensitive and responsive to each other's cues and together crafting care routines. Learning takes place in a constant process of action and response that transforms those involved.

CONCLUSION

Building tacit knowledge together is necessary for persons with PIMD to learn to recognise and express their needs. Suggestions are made for ways to facilitate its development and transfer.

The recognition, assessment and perceptions of total pain in people with profound intellectual disabilities: A mixed methods systematic review

BACKGROUND

People with profound intellectual disabilities are a population with complex comorbidities. Total pain recognises the interconnectedness of aspects of pain; social, psychological, physical, emotional, spiritual. Pain is under-recognised due to communication challenges and carers perceptions. This review's purpose is to synthesise current literature and provide guidance for future research and care.

METHODS

Five databases were searched in this mixed methods systematic review (Cinahl, Medline, Psycinfo, Web of Science, Scopus). Articles retrieved were reported via a PRISMA flow diagram. Quality appraisal utilised the mixed methods appraisal tool (MMAT). A convergent qualitative design was the method of data synthesis.

RESULTS

Data from 16 included articles generated four themes; Absent voices, reductionist assessment, pain intensity, valuing expertise. Data included physical pain only.

CONCLUSION

Multifaceted pain needs inclusion in research. Assessment must consider the unique expressions of pain by individuals with profound intellectual disabilities. A sharing of expertise may improve pain care.

Palliative care for adults with intellectual disability

Contemporary disability principles and values suggest that adults with intellectual disability should be able to access and participate in any mainstream service rather than having a separate service for them. In the case of healthcare services, achievement of optimal access to and participation in healthcare by adults with intellectual disability requires the presence of both adequate disability supports for the person and reasonable adjustments to generic health systems to enable a person-centred approach to care. Development of an interface between people with lived experience of intellectual disability, disability and health sectors help clarify the required nature of disability supports and types of adjustments to mainstream health services. The article describes a case study of an adult with intellectual disability with a serious illness warranting palliative care, and focusses on the reasonable adjustments to mainstream core palliative care principles for adults with intellectual disability.

The expression and assessment of emotions and internal states in individuals with severe or profound intellectual disabilities

The expression of emotions and internal states by individuals with severe or profound intellectual disabilities is a comparatively under-researched area. Comprehensive or standardized methods of assessing or understanding the emotions and internal states within this population, whose ability to communicate is significantly compromised, do not exist. The literature base will be discussed and compared to that applicable to the general population. Methods of assessing broader internal states, notably depression, anxiety, and pain within severe or profound intellectual disabilities are also addressed. Finally, this review will examine methods of assessing internal states within genetic syndromes, including hunger, social anxiety, and happiness within Prader-Willi, Fragile-X and Angelman syndrome. This will allow for identification of robust methodologies used in assessing the expression of these internal states, some of which may be useful when considering how to assess emotions within individuals with intellectual disabilities.

Detecting pain in people with an intellectual disability

The assessment of pain in a person with an intellectual disability (ID) is often a difficult undertaking complicated by idiosyncratic reactions or vague descriptions. The person with an ID may also be unable to verbally communicate their discomfort. For the carer who knows the individual with an ID, knowing how they respond to painful stimuli assists the carer to detect new instances of pain. The emergency nurse is unlikely to have met the person with an ID and therefore detecting pain by observing behaviour or using self-report measures is unlikely to succeed. There have been some attempts to categorize behavioural responses to pain by people with an ID, however, they have not been developed into a useful assessment tool. Emergency nurses must therefore rely on the person who knows the person with an ID.

Primary health care provision for adults with a learning disability

BACKGROUND

During the last decade, primary care has been designated as the main provider of health care to people with learning disabilities. Practice nurses based in primary care teams are increasingly the first points of contact with health services. They make an important contribution to promoting good health, with health screening and illness prevention work being a significant part of their role. However, little is known about their views or involvement regarding the provision of primary care for people with learning disabilities. There is therefore a need to explore the nursing perspective, from within primary care, on the current provision of care for people with a learning disability.

RESEARCH AIM

To inform the learning disability service of the role of primary care in current service provision for people with learning disabilities.

RESEARCH METHOD

A survey of all practice nurses currently employed by Grampian Health Board in Aberdeen was conducted in June 2001. An initial pilot study was conducted in primary care and learning disability services. Data collection took place during June and July 2001. All practice nurses working in the geographical region of Grampian were invited to participate.

RESULTS

Communication barriers exist, preventing access to health screening and treatment for some people with learning disabilities. Independent living skills, for example dietary management and budgeting, require additional community support. These conditions pose complex problems for practice nurses and other members of the primary care team.

CONCLUSION

This study indicates a need for closer support and partnership with the learning disability service. The factors necessary for providing health care to people with learning disabilities extend beyond the domain of primary care teams. The findings of this survey have important implications for education and support to enable carers and professionals to provide a high standard of care.

Assessment and management of pain in fungating wounds

Pain is a complex phenomenon that affects individuals in different ways. Wound pain is often seen as an inevitable consequence of wound care and many patients may suffer from chronic wound pain. One group of patients that presents a challenge in wound pain management are those with fungating malignant wounds. The effective management of wound pain may be compromised by inappropriate or non-existent pain assessment, the inefficient prescribing of analgesia, and confusion about the appropriate use of dressing products to reduce wound pain. Many healthcare professionals lack knowledge about pain and pain control and hold inappropriate beliefs and attitudes about analgesic medications, in particular relating to opioid drugs. This article aims to address these issues by providing a brief overview of pain physiology followed by strategies for pain assessment and options for the management of pain related to fungating wounds, including pharmacological treatments, wound care techniques and complementary therapies.