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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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2
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Rutkowski K, Wyszatycki M, Ejdys K, Hawryluk NM, Stompór M. Pain and Its Management in Patients Referred to a Geriatric Outpatient Clinic. J Pers Med 2023; 13:1366. [PMID: 37763134 PMCID: PMC10532457 DOI: 10.3390/jpm13091366] [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: 08/09/2023] [Revised: 08/29/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
(1) Background: A major problem affecting geriatric patients is pain. In addition to pain, a significant problem of old age is dementia and depression, which can hinder the diagnosis and treatment of pain. The aim of this study was to analyse the prevalence of pain in patients treated in a geriatric outpatient clinic and the treatment used. (2) Methods: The analysis was based on the records of 937 patients who visited the Geriatric Outpatient Clinic in Dobre Miasto between 2015 and 2020. Based on records containing data dating back to their first visit to the hospital, patients' experiences of pain, the presence of depressive symptoms and dementia, and the pharmacological treatment used for pain (analgesics and coanalgesics) were analysed. (3) Results: Pain complaints were reported by 311 patients (33.2% of the study group), 76% of the complaints were from females. The mean age of the patients was 78 years (SD = 8.45). At least one analgesic drug was taken by 107 patients (34.4%). The most commonly used analgesics were opioids (63 patients, 58.87%), especially tramadol. Of the potential coanalgesics, the largest number of patients used an antidepressant. (4) Conclusions: Despite the widespread prevalence of pain among the elderly, only about one-third of them were taking pain medication, mainly in the form of weak opioids. Patients with symptoms of dementia were found to report pain less frequently.
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Affiliation(s)
- Krzysztof Rutkowski
- The Nicolaus Copernicus Municipal Polyclinical Hospital in Olsztyn, 10-045 Olsztyn, Poland
| | - Mateusz Wyszatycki
- Marie Sklodowska-Curie Specialist Hospital in Zgierz, 95-100 Zgierz, Poland
| | - Krystian Ejdys
- Students’ Scientific Group, Department of Cardiology, Medical University of Bialystok, 15-089 Białystok, Poland
| | - Natalia Maria Hawryluk
- The Nicolaus Copernicus Municipal Polyclinical Hospital in Olsztyn, 10-045 Olsztyn, Poland
- Department of Family Medicine and Infectious Diseases, Medical Faculty, Collegium Medicum, University of Warmia and Mazury, 10-719 Olsztyn, Poland
| | - Małgorzata Stompór
- Department of Family Medicine and Infectious Diseases, Medical Faculty, Collegium Medicum, University of Warmia and Mazury, 10-719 Olsztyn, Poland
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Seixas-Moizes J, Boerlage A, Lia ÉN, Santos LELE, Zucoloto ML, Dach F, Papassidero PC, Wichert-Ana LAL, Della Pasqua O, Wiesebron ML, Icuma TR, Lanchote VL, Coelho EB, Tibboel D, Wichert-Ana L. Translation, Cross-Cultural Adaptation, and Validation of the Portuguese Version of the Rotterdam Elderly Pain Observation Scale. Dement Geriatr Cogn Dis Extra 2021; 11:314-323. [PMID: 35111191 PMCID: PMC8787539 DOI: 10.1159/000520455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 10/22/2021] [Indexed: 11/19/2022] Open
Abstract
<b><i>Introduction:</i></b> This study reports on the translation, cultural adaptation, and validation of a Portuguese version of the Rotterdam Elderly Pain Observation Scale (REPOS), a Dutch scale to assess pain in patients who cannot communicate, with or without dementia. <b><i>Methods:</i></b> This is a multicenter study in pain and neurological units involving Brazil (clinical phase) and the Netherlands (training phase). We performed a retrospective cross-sectional, 2-staged analysis, translating and culturally adapting the REPOS to a Portuguese version (REPOS-P) and evaluating its psychometric properties. Eight health professionals were trained to observe patients with low back pain. REPOS consists of 10 behavioral items scored as present or absent after a 2-min observation. The REPOS score of ≥3 in combination with the Numerical Rating Scale (NRS) of ≥4 indicated pain. The Content Validity Index (CVI) in all items and instructions showed CVI values at their maximum. According to the higher correlation coefficient found between NRS and REPOS-P, it may be suggested that there was an adequate convergent validity. <b><i>Results:</i></b> The REPOS-P was administered to 80 patients with a mean age of 60 years (SD 11.5). Cronbach’s alpha coefficient showed a moderate internal consistency of REPOS-P (α = 0.62), which is compatible with the original study of REPOS. All health professionals reached high levels of interrater agreement within a median of 10 weeks of training, assuring reproducibility. Cohen’s kappa was 0.96 (SD 0.03), and the intraclass correlation coefficient was 0.98 (SD 0.02), showing high reliability of REPOS-P scores between the trainer (researcher) and the trainees (healthcare professionals). The Pearson correlation coefficient was 0.95 (95% confidence interval 0.94–0.97), showing a significant correlation between the total scores of REPOS-P and NRS. <b><i>Conclusion:</i></b> The REPOS-P was a valuable scale for assessing elderly patients with low back pain by different healthcare professionals. Short application time, ease of use, clear instructions, and the brief training required for application were essential characteristics of REPOS-P.
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Affiliation(s)
- Julieta Seixas-Moizes
- Department of Radiology, Hematology, and Oncology, University of São Paulo, Ribeirão Preto, Brazil
| | - Anneke Boerlage
- Department of Pediatric Surgery, Erasmus Medical Center, Sophia Children's Hospital, Erasmus University, Rotterdam, The Netherlands
| | - Érica Negrini Lia
- Department of Radiology, Hematology, and Oncology, University of São Paulo, Ribeirão Preto, Brazil
- Department of Dentistry, Health Sciences School, University of Brasília (UNB), Brasília, Brazil
| | | | | | - Fabíola Dach
- Department of Neurosciences and Behavioral Sciences, University of São Paulo, Ribeirão Preto, Brazil
| | | | | | - Oscar Della Pasqua
- Division of Pharmacology, Leiden Academic Centre for Drug Research, University of Leiden, Leiden, The Netherlands
- Clinical Pharmacology & Therapeutics, School of Life and Medical Sciences, University College London, London, United Kingdom
| | | | - Tatiana Reis Icuma
- Department of Social Medicine, University of São Paulo, Ribeirão Preto, Brazil
| | - Vera Lucia Lanchote
- Department of Clinical Analysis, Food Science and Toxicology, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Eduardo Barbosa Coelho
- Internal Medicine of the Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Dick Tibboel
- Department of Pediatric Surgery, Erasmus Medical Center, Sophia Children's Hospital, Erasmus University, Rotterdam, The Netherlands
| | - Lauro Wichert-Ana
- Department of Radiology, Hematology, and Oncology, University of São Paulo, Ribeirão Preto, Brazil
- *Lauro Wichert-Ana,
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4
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Felton N, Lewis JS, Cockburn SJ, Hodgson M, Dawson S. Pain Assessment for Individuals with Advanced Dementia in Care Homes: A Systematic Review. Geriatrics (Basel) 2021; 6:geriatrics6040101. [PMID: 34698157 PMCID: PMC8544573 DOI: 10.3390/geriatrics6040101] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/12/2021] [Accepted: 10/14/2021] [Indexed: 11/20/2022] Open
Abstract
Pain is prevalent in older people, especially in those with advanced dementia who have communication impairments. Although pain is recognised to be present in this population, it is often under-assessed and ineffectively managed. The assessment of pain in advanced dementia is extremely challenging and complex, particularly in institutional settings such as care homes. This study systematically reviews the literature to examine and characterise the evidence for the use of pain assessment tools in care homes with individuals living with advanced dementia. Relevant publications were sourced from electronic bibliometric medical databases including AMED, CINAHL Plus, Medline, PsycINFO, EMBASE, TRIP Pro, Google Scholar, and HINARI. The database search was supplemented by screening citations and reference lists, in addition to a grey literature searches. The search identified 2221 studies, among which 26 were included in the review. The majority of the studies were observational, which created a rich source of data to create four major themes. The findings were informed and shaped by working with key stakeholders to develop a conceptual model that can contribute to developing evidence-based practice. This highlights the importance of a comprehensive, multi-disciplinary approach to pain assessment in this population, which is beyond the use of tools.
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Affiliation(s)
- Nansi Felton
- Avon and Wiltshire Mental Health Partnership NHS Trust, Bath NHS House, Newbridge Hill, Bath BA1 3QE, UK; (S.-J.C.); (M.H.)
- Correspondence:
| | - Jennifer S. Lewis
- School for Health and Social Wellbeing, University of the West of England, Bristol BS16 1DD, UK;
- National Complex Regional Pain Syndrome Service, Pain Specialty, Royal United Hospitals NHS Trust, Bath BA1 3NG, UK
| | - Sarah-Jane Cockburn
- Avon and Wiltshire Mental Health Partnership NHS Trust, Bath NHS House, Newbridge Hill, Bath BA1 3QE, UK; (S.-J.C.); (M.H.)
- Doctoral College, Department of Psychology, University of Southampton, Building 44, Highfield Campus, Southampton SO17 1BJ, UK
| | - Margot Hodgson
- Avon and Wiltshire Mental Health Partnership NHS Trust, Bath NHS House, Newbridge Hill, Bath BA1 3QE, UK; (S.-J.C.); (M.H.)
| | - Shoba Dawson
- Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK;
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5
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Towers AM, Smith N, Allan S, Vadean F, Collins G, Rand S, Bostock J, Ramsbottom H, Forder J, Lanza S, Cassell J. Care home residents’ quality of life and its association with CQC ratings and workforce issues: the MiCareHQ mixed-methods study. HEALTH SERVICES AND DELIVERY RESEARCH 2021. [DOI: 10.3310/hsdr09190] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background
Care home staff have a critical bearing on quality. The staff employed, the training they receive and how well they identify and manage residents’ needs are likely to influence outcomes. The Care Act 2014 (Great Britain. The Care Act 2014. London: The Stationery Office; 2014) requires services to improve ‘well-being’, but many residents cannot self-report and are at risk of exclusion from giving their views. The Adult Social Care Outcomes Toolkit enables social care-related quality of life to be measured using a mixed-methods approach. There is currently no equivalent way of measuring aspects of residents’ health-related quality of life. We developed new tools for measuring pain, anxiety and depression using a mixed-methods approach. We also explored the relationship between care home quality, residents’ outcomes, and the skill mix and employment conditions of the workforce who support them.
Objectives
The objectives were to develop and test measures of pain, anxiety and depression for residents unable to self-report; to assess the extent to which regulator quality ratings reflect residents’ care-related quality of life; and to assess the relationship between aspects of the staffing of care homes and the quality of care homes.
Design
This was a mixed-methods study.
Setting
The setting was care homes for older adults in England.
Participants
Care home residents participated.
Results
Three measures of pain, anxiety and low mood were developed and tested, using a mixed-methods approach, with 182 care home residents in 20 care homes (nursing and residential). Psychometric testing found that the measures had good construct validity. The mixed-methods approach was both feasible and necessary with this population, as the majority of residents could not self-report. Using a combined data set (n = 475 residents in 54 homes) from this study and the Measuring Outcomes in Care Homes study (Towers AM, Palmer S, Smith N, Collins G, Allan S. A cross-sectional study exploring the relationship between regulator quality ratings and care home residents’ quality of life in England. Health Qual Life Outcomes 2019;17:22) we found a significant positive association between residents’ social care-related quality of life and regulator (i.e. Care Quality Commission) quality ratings. Multivariate regression revealed that homes rated ‘good/outstanding’ are associated with a 12% improvement in mean current social care-related quality of life among residents who have higher levels of dependency. Secondary data analysis of a large, national sample of care homes over time assessed the impact of staffing and employment conditions on Care Quality Commission quality ratings. Higher wages and a higher prevalence of training in both dementia and dignity-/person-centred care were positively associated with care quality, whereas high staff turnover and job vacancy rates had a significant negative association. A 10% increase in the average care worker wage increased the likelihood of a ‘good/outstanding’ rating by 7%.
Limitations
No care homes rated as inadequate were recruited to the study.
Conclusions
The most dependent residents gain the most from homes rated ‘good/outstanding’. However, measuring the needs and outcomes of these residents is challenging, as many cannot self-report. A mixed-methods approach can reduce methodological exclusion and an over-reliance on proxies. Improving working conditions and reducing staff turnover may be associated with better outcomes for residents.
Future work
Further work is required to explore the relationship between pain, anxiety and low mood and other indicators of care homes quality and to examine the relationship between wages, training and social care outcomes.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 19. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Ann-Marie Towers
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | - Nick Smith
- Personal Social Services Research Unit, University of Kent, Canterbury, UK
| | - Stephen Allan
- Personal Social Services Research Unit, University of Kent, Canterbury, UK
| | - Florin Vadean
- Personal Social Services Research Unit, University of Kent, Canterbury, UK
| | - Grace Collins
- Personal Social Services Research Unit, University of Kent, Canterbury, UK
| | - Stacey Rand
- Personal Social Services Research Unit, University of Kent, Canterbury, UK
| | | | | | - Julien Forder
- Personal Social Services Research Unit, University of Kent, Canterbury, UK
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6
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Association between Self-Reported Pain, Cognition, and Neuropathology in Older Adults Admitted to an Outpatient Memory Clinic-A Cross-Sectional Study. Brain Sci 2021; 11:brainsci11091156. [PMID: 34573177 PMCID: PMC8465123 DOI: 10.3390/brainsci11091156] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/19/2021] [Accepted: 08/27/2021] [Indexed: 12/14/2022] Open
Abstract
Cognitive impairment has been linked to reduced self-reporting of pain. However, it is unclear whether the various cognitive functions are similarly and/or independently associated with such pain report measures. In the present study, we explored how executive functioning (EF), memory, and global cognition relate to self-reported pain and investigated whether underlying neuropathology partially accounts for these results. We used Lasso categorical regression to analyze data from 179 individuals visiting a memory clinic. The data included the self-reported pain occurrence, intensity, severity and frequency, clinical diagnoses, neuropsychological scores, white matter hyperintensities, medial temporal lobe atrophy, depressive symptoms, and demographics. Our results showed that worse memory and EF performance predicted a lower pain occurrence. In those individuals who did report pain, worse memory predicted lower pain intensity, severity, and frequency levels, but for EF reversed effects were found, with worse EF predicting higher pain scores. These relationships were only partially explained by reductions in white matter and medial temporal lobe integrity. Similar effects were found for depressive symptoms. Our findings highlight the distinct associations of EF and memory with self-reported pain. A similar pattern of relationships found for both self-reported pain and depressive symptoms may reflect shared latent affective components.
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7
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van der Steen JT, Westzaan A, Hanemaayer K, Muhamad M, de Waal MWM, Achterberg WP. Probable Pain on the Pain Assessment in Impaired Cognition (PAIC15) Instrument: Assessing Sensitivity and Specificity of Cut-Offs against Three Standards. Brain Sci 2021; 11:brainsci11070869. [PMID: 34210018 PMCID: PMC8301856 DOI: 10.3390/brainsci11070869] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/16/2021] [Accepted: 06/26/2021] [Indexed: 11/25/2022] Open
Abstract
Observational pain scales can help to identify pain in persons with dementia who may have difficulty expressing pain verbally. The Pain Assessment in Impaired Cognition-15 (PAIC15) covers 15 items that indicate pain, but it is unclear how probable pain is, for each summed score (range 0–45). We aimed to determine sensitivity and specificity of cut-offs for probable pain on the PAIC15 against three standards: (1) self-report when able, (2) the established Pain Assessment in Advanced Dementia (PAINAD) cut-off of 2, and (3) observer’s overall estimate based on a series of systematic observations. We used data of 238 nursing home residents with dementia who were observed by their physician in training or nursing staff in the context of an evidence-based medicine (EBM) training study, with re-assessment after 2 months in 137 residents. The area under the ROC curve was excellent against the PAINAD cut-off (≥0.8) but acceptable or less than acceptable for the other two standards. Across standards and criteria for optimal sensitivity and specificity, PAIC15 scores of 3 and higher represent possible pain for screening in practice, with sensitivity and specificity against self-report in the 0.5 to 0.7 range. While sensitivity for screening in practice may be too low, a cut-off of 4 is reasonable to indicate probable pain in research.
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Affiliation(s)
- Jenny T. van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center (LUMC), P.O. Box 9600, 2300 RC Leiden, The Netherlands; (A.W.); (K.H.); (M.M.); (M.W.M.d.W.); (W.P.A.)
- Department of Primary and Community Care, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
- Correspondence:
| | - Andrew Westzaan
- Department of Public Health and Primary Care, Leiden University Medical Center (LUMC), P.O. Box 9600, 2300 RC Leiden, The Netherlands; (A.W.); (K.H.); (M.M.); (M.W.M.d.W.); (W.P.A.)
- Aafje Thuiszorg, Huizen en Zorghotels, Pietersdijk 60, 3079 TD Rotterdam, The Netherlands
| | - Kimberley Hanemaayer
- Department of Public Health and Primary Care, Leiden University Medical Center (LUMC), P.O. Box 9600, 2300 RC Leiden, The Netherlands; (A.W.); (K.H.); (M.M.); (M.W.M.d.W.); (W.P.A.)
- Franciscus Vlietland Hospital, Vlietlandplein 2, 3118 JH Schiedam, The Netherlands
| | - Muhamad Muhamad
- Department of Public Health and Primary Care, Leiden University Medical Center (LUMC), P.O. Box 9600, 2300 RC Leiden, The Netherlands; (A.W.); (K.H.); (M.M.); (M.W.M.d.W.); (W.P.A.)
- Stichting Voor Regionale Zorgverlening (Nursing Home), Prins Clauslaan 1, 4691 ZA Tholen, The Netherlands
| | - Margot W. M. de Waal
- Department of Public Health and Primary Care, Leiden University Medical Center (LUMC), P.O. Box 9600, 2300 RC Leiden, The Netherlands; (A.W.); (K.H.); (M.M.); (M.W.M.d.W.); (W.P.A.)
| | - Wilco P. Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center (LUMC), P.O. Box 9600, 2300 RC Leiden, The Netherlands; (A.W.); (K.H.); (M.M.); (M.W.M.d.W.); (W.P.A.)
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8
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Iversen WL, Cowan RL, Atalla S, Englehart SS, Gure TR, Moss KO, Ryan CM, Scharre DW, Wright KD, Monroe TB. Treating the most vulnerable: A discursive review of experimental pain in Alzheimer's disease. Nurs Open 2021; 9:942-949. [PMID: 34165251 PMCID: PMC8859087 DOI: 10.1002/nop2.922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 03/18/2021] [Accepted: 03/29/2021] [Indexed: 11/10/2022] Open
Abstract
AIM The purpose of this manuscript is to summarize research on how experimental pain is experienced by adults with Alzheimer's disease (AD) and to translate results into implications for nurses. DESIGN This discursive review synthesizes the results of three previous research studies exploring experimental pain in adults with AD. METHODS Using a series of fictional clinical vignettes, the authors discuss how the results from three previous papers using acute experimental pain can potentially be translated into clinical practice. The authors also introduce the reader to the concept of research-related psychophysics using introductory definitions and concepts with the impetus to encourage other nurses to consider this research methodology. RESULTS Pain characteristics in AD that differ from cognitively intact controls must be explored to properly address pain in this population. Nurses are well positioned to address these issues in order to provide a high quality of care to adults with AD.
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Affiliation(s)
- Wm Larkin Iversen
- The Ohio State University College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Ronald L Cowan
- Department of Psychiatry, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Sebastian Atalla
- The Ohio State University College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Sydney S Englehart
- The Ohio State University College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Tanya R Gure
- Division of General Internal Medicine and Geriatrics, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Karen O Moss
- The Ohio State University College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Claire M Ryan
- Vanderbilt Department of Psychiatry and Behavioral Sciences, Nashville, TN, USA
| | - Douglas W Scharre
- Department of Neurology, Division of Cognitive Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Kathy D Wright
- The Ohio State University College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Todd B Monroe
- The Ohio State University College of Nursing, The Ohio State University, Columbus, OH, USA
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9
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Kosmadakis G, Amara I, Costel G. Pain on arteriovenous fistula cannulation: A narrative review. Semin Dial 2021; 34:275-284. [PMID: 33962481 DOI: 10.1111/sdi.12979] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Pain on arteriovenous fistula (AVF) cannulation is a rather persistent problem in the daily hemodialysis practice. Its prevalence varies from 12% to even 80% depending on the definition and the pain-assessment tools and it affects the quality of life of hemodialysis patients. It is associated with fear of the cannulation process, the decision of hemodialysis from an AVF and sometimes the hemodialysis itself. In this narrative review, we tried to tackle the extent of the problem and to present the available published solutions. The literature suggests a large array of methods based on the application of local anesthetic creams, application of cold or hot directly on the cannulation sites or on the contralateral arm, cannulation techniques and AVF localization, distraction as well as alternative treatments. All of them have shown a relative success. There is a serious lack of large multicenter randomized trials and a gap concerning work groups and guidelines or recommendations from national or international societies on this matter. Complementary training starting from the predialysis patient education programs may be useful. Alternative prophylactic measures including counseling, hypnosis, or other physicochemical interventions could also improve our knowledge on the treatment of this seriously uncomfortable condition.
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Vader K, Bostick GP, Carlesso LC, Hunter J, Mesaroli G, Perreault K, Tousignant-Laflamme Y, Tupper S, Walton DM, Wideman TH, Miller J. The Revised IASP Definition of Pain and Accompanying Notes: Considerations for the Physiotherapy Profession. Physiother Can 2021; 73:103-106. [PMID: 34456418 PMCID: PMC8370731 DOI: 10.3138/ptc-2020-0124-gee] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Kyle Vader
- School of Rehabilitation Therapy, Queen’s University
- Chronic Pain Clinic, Kingston Health Sciences Centre, Kingston
| | - Geoff P. Bostick
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alta
| | | | - Judith Hunter
- Department of Physical Therapy, University of Toronto
| | - Giulia Mesaroli
- Department of Physical Therapy, University of Toronto
- Department of Rehabilitation Services, Hospital for Sick Children, Toronto
| | - Kadija Perreault
- Department of Rehabilitation
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Université Laval, Quebec City
| | | | - Susan Tupper
- Saskatchewan Health Authority
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, Sask
| | | | - Timothy H. Wideman
- School of Physical and Occupational Therapy, McGill University, Montreal
| | - Jordan Miller
- School of Rehabilitation Therapy, Queen’s University
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11
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Vader K, Bostick GP, Carlesso LC, Hunter J, Mesaroli G, Perreault K, Tousignant-Laflamme Y, Tupper S, Walton DM, Wideman TH, Miller J. La définition révisée de la douleur de l’IASP et les notes complémentaires : les considérations pour la profession de la physiothérapie. Physiother Can 2021; 73:106-109. [PMID: 34456419 PMCID: PMC8370722 DOI: 10.3138/ptc-2020-0124-gef] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Kyle Vader
- École de thérapie de réadaptation, Queen’s University
- Clinique de douleur chronique, Kingston Health Sciences Centre, Kingston
| | - Geoff P. Bostick
- Faculté de médecine de réadaptation, University of Alberta, Edmonton (Alberta)
| | - Lisa C. Carlesso
- École des sciences de la réadaptation, McMaster University, Hamilton
| | - Judith Hunter
- Département de physiothérapie, University of Toronto
| | - Giulia Mesaroli
- Département de physiothérapie, University of Toronto
- Département des services de réadaptation, The Hospital for Sick Children, Toronto
| | - Kadija Perreault
- Département de réadaptation
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Université Laval, Québec
| | | | - Susan Tupper
- Autorité sanitaire de la Saskatchewan
- École des sciences de la réadaptation, University of Saskatchewan, Saskatoon (Saskatchewan)
| | - David M. Walton
- École de physiothérapie, Western University, London (Ontario)
| | | | - Jordan Miller
- École de thérapie de réadaptation, Queen’s University
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12
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Natavio T, McQuillen E, Dietrich MS, Wells N, Rhoten BA, Vallerand AH, Monroe TB. A Comparison of the Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC) and Pain Assessment in Advanced Dementia Scale (PAINAD). Pain Manag Nurs 2020; 21:502-509. [DOI: 10.1016/j.pmn.2020.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 03/16/2020] [Accepted: 04/13/2020] [Indexed: 11/26/2022]
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13
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Gallant NL, Peckham A, Marchildon G, Hadjistavropoulos T, Roblin B, Stopyn RJN. Provincial legislative and regulatory standards for pain assessment and management in long-term care homes: a scoping review and in-depth case analysis. BMC Geriatr 2020; 20:458. [PMID: 33167897 PMCID: PMC7650170 DOI: 10.1186/s12877-020-01758-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 09/08/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Among Canadian residents living in long-term care (LTC) facilities, and especially among those with limited ability to communicate due to dementia, pain remains underassessed and undermanaged. Although evidence-based clinical guidelines for the assessment and management of pain exist, these clinical guidelines are not widely implemented in LTC facilities. A relatively unexplored avenue for change is the influence that statutes and regulations could exert on pain practices within LTC. This review is therefore aimed at identifying the current landscape of policy levers used across Canada to assess and manage pain among LTC residents and to evaluate the extent to which they are concordant with evidence-based clinical guidelines proposed by an international consensus group consisting of both geriatric pain and public policy experts. METHODS Using scoping review methodology, a search for peer-reviewed journal articles and government documents pertaining to pain in Canadian LTC facilities was carried out. This scoping review was complemented by an in-depth case analysis of Alberta, Saskatchewan, and Ontario statutes and regulations. RESULTS Across provinces, pain was highly prevalent and was associated with adverse consequences among LTC residents. The considerable benefits of using a standardized pain assessment protocol, along with the barriers in implementing such a protocol, were identified. For most provinces, pain assessment and management in LTC residents was not specifically addressed in their statutes or regulations. In Alberta, Saskatchewan, and Ontario, regulations mandate the use of the interRAI suite of assessment tools for the assessment and reporting of pain. CONCLUSION The prevalence of pain and the benefits of implementing standardized pain assessment protocols has been reported in the research literature. Despite occasional references to pain, however, existing regulations do not recommend assessments of pain at the frequency specified by experts. Insufficient direction on the use of specialized pain assessment tools (especially in the case of those with limited ability to communicate) that minimize reliance on subjective judgements was also identified in current regulations. Existing policies therefore fail to adequately address the underassessment and undermanagement of pain in older adults residing in LTC facilities in ways that are aligned with expert consensus.
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Affiliation(s)
- Natasha L. Gallant
- Department of Psychology and Center on Aging and Health, University of Regina, 3737 Wascana Parkway, Regina, Saskatchewan S4S 0A2 Canada
| | - Allie Peckham
- Edson College of Nursing and Health Innovation, Arizona State University, 550 N 3rd Street, Phoenix, AZ 85004 USA
- Institute of Health Policy, Management and Evaluation, University of Toronto, 425–155 College Street, Toronto, Ontario M5T 3M6 Canada
| | - Gregory Marchildon
- Institute of Health Policy, Management and Evaluation, University of Toronto, 425–155 College Street, Toronto, Ontario M5T 3M6 Canada
| | - Thomas Hadjistavropoulos
- Department of Psychology and Center on Aging and Health, University of Regina, 3737 Wascana Parkway, Regina, Saskatchewan S4S 0A2 Canada
| | - Blair Roblin
- Institute of Health Policy, Management and Evaluation, University of Toronto, 425–155 College Street, Toronto, Ontario M5T 3M6 Canada
| | - Rhonda J. N. Stopyn
- Department of Psychology and Center on Aging and Health, University of Regina, 3737 Wascana Parkway, Regina, Saskatchewan S4S 0A2 Canada
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Delwel S, Maier AB, Parvaneh D, Meijers J, Scherder EJA, Lobbezoo F. Chewing Efficiency, Global Cognitive Functioning, and Dentition: A Cross-sectional Observational Study in Older People With Mild Cognitive Impairment or Mild to Moderate Dementia. Front Aging Neurosci 2020; 12:225. [PMID: 33033478 PMCID: PMC7510165 DOI: 10.3389/fnagi.2020.00225] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 06/25/2020] [Indexed: 12/29/2022] Open
Abstract
Introduction: Previous studies suggest an association between poor mastication and cognitive impairment. The role of chewing efficiency and dentition in this relation is unclear. The aim was to examine global cognitive functioning and dentition as predictors for chewing efficiency, in older people with mild cognitive impairment (MCI) or dementia. Methods: In this observational cross-sectional study, 136 people with MCI or dementia were included. The chewing efficiency was assessed with a two-colored chewing gum and analyzed with the Chewing Efficiency Analysis software. The level of global cognitive functioning was measured with the Mini Mental State Examination (MMSE) by trained clinical staff. An oral examination was performed by a dentist and included the number of present teeth, the number of occluding pairs, and the presence of prostheses. Age, gender, and educational years were derived from the medical records. Univariate and multivariate backward stepwise linear regression analyses were used to evaluate global cognitive functioning and dentition as predictors for chewing efficiency. Results: The mean age of the participants was 82.1 (SD 5.8) years, and 74 (54.4%) were female. The participants had a median MMSE score of 22.4 (IQR 18.0–26.0) and a median Chewing Efficiency Analysis score of 0.46 (IQR 0.14–0.59). The median number of teeth was 13.0 (IQR 0.0–23.0), and the median number of occluding pairs was 0.0 (IQR 0.0–7.0). Sixty-four (47.4%) of the participants wore full prosthesis in the upper jaw. In univariate linear regression analyses, predictive factors for the Chewing Efficiency Analysis score were age, MMSE score, full prosthesis in the upper jaw, number of present teeth, and number of occluding pairs. In the multivariate model, full prosthesis in the upper jaw and number of occluding pairs were significant predictors for the Chewing Efficiency Analysis score. Participants with full prosthesis in the upper jaw had a lower Chewing Efficiency Analysis score than participants with natural dentition in the upper jaw. Conclusion: Better mastication is associated with a higher number of occluding pairs. Full prosthesis in the upper jaw is related to a lower chewing efficiency. Global cognitive functioning is not associated with mastication in older people with MCI or mild-to-moderate dementia. This might be explained by sufficient capacity for compensation of reduced mastication in this group.
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Affiliation(s)
- Suzanne Delwel
- Department of Clinical Neuropsychology, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Andrea B Maier
- Department of Medicine and Aged Care, The Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia.,Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Donya Parvaneh
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | - Erik J A Scherder
- Department of Clinical Neuropsychology, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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15
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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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16
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Zahid M, Gallant NL, Hadjistavropoulos T, Stroulia E. Behavioral Pain Assessment Implementation in Long-Term Care Using a Tablet App: Case Series and Quasi-Experimental Design. JMIR Mhealth Uhealth 2020; 8:e17108. [PMID: 32319955 PMCID: PMC7203621 DOI: 10.2196/17108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 02/05/2020] [Accepted: 02/10/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Pain is often underassessed and undertreated among long-term care (LTC) residents living with dementia. When used regularly, the Pain Assessment Checklist for Seniors With Limited Ability to Communicate (PACSLAC) scales have been shown to have beneficial effects on pain assessment and management practices and stress and burnout levels in frontline staff in LTC facilities. Such scales, however, are not utilized as often as recommended, which is likely to be related to additional record-keeping and tracking over time involved with their paper-and-pencil administration. OBJECTIVE Using implementation science principles, we assessed the introduction of the PACSLAC-II scale by comparing two methods of administration-a newly developed tablet app version and the original paper-and-pencil version-with respect to the frequency of pain assessment and facility staff feedback. METHODS Using a case series approach, we tracked pain-related quality indicators at baseline, implementation, and follow-up periods. A quasi-experimental design was used to evaluate the effect of the method of administration (ie, paper-and-pencil only [n=18], tablet only [n=12], paper-and-pencil followed by tablet app [n=31], and tablet app followed by paper-and-pencil [n=31]) on pain assessment frequency and frontline staff stress and burnout levels. Finally, semistructured interviews were conducted with frontline staff to obtain perspectives on each method of administration. RESULTS The implementation effort resulted in a great increase in pain assessment frequency across 7 independent LTC units, although these increases were not maintained during the follow-up period. Frontline staff reported lower levels of workload in the paper-and-pencil followed by tablet app condition than those in the paper-and-pencil only (P<.001) and tablet app followed by paper-and-pencil (P<.001) conditions. Frontline staff also reported lower levels of workload in the tablet-only condition than those in the paper-and-pencil only condition (P=.05). Similarly, lower levels of emotional exhaustion were reported by frontline staff in the paper-and-pencil followed by tablet app condition than those in the paper-and-pencil only (P=.002) and tablet app followed by paper-and-pencil (P=.002) conditions. Finally, frontline staff reported higher levels of depersonalization in the paper-and-pencil only condition than those in the tablet app only (P=.008), paper-and-pencil followed by tablet app (P<.001), and tablet app followed by paper-and-pencil (P<.001) conditions. Furthermore, narrative data from individual interviews with frontline staff revealed a preference for the tablet app over the paper-and-pencil method of administration. CONCLUSIONS This study provides support for the use of either the tablet app or the paper-and-pencil version of the PACSLAC-II to improve pain-related quality indicators, but a reported preference for and lower levels of stress and burnout with the use of the tablet app method of administration suggests that the use of the tablet app may have more advantages compared with the paper-and-pencil method of administration.
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Affiliation(s)
- Mahnoor Zahid
- Department of Psychology and Centre on Aging and Health, University of Regina, Regina, SK, Canada
| | - Natasha L Gallant
- Department of Psychology and Centre on Aging and Health, University of Regina, Regina, SK, Canada
| | - Thomas Hadjistavropoulos
- Department of Psychology and Centre on Aging and Health, University of Regina, Regina, SK, Canada
| | - Eleni Stroulia
- Department of Computing Science, University of Alberta, Edmonton, AB, Canada
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Kutschar P, Berger S, Brandauer A, Freywald N, Osterbrink J, Seidenspinner D, Gnass I. Nursing Education Intervention Effects on Pain Intensity of Nursing Home Residents with Different Levels of Cognitive Impairment: A Cluster-Randomized Controlled Trial. J Pain Res 2020; 13:633-648. [PMID: 32273749 PMCID: PMC7105359 DOI: 10.2147/jpr.s237056] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 03/07/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Pain management in nursing homes is challenging and pain prevalence remains high. The objective of this study was to improve the pain situation of nursing home residents following a nursing-related educational intervention within a cluster-randomized controlled trial (2016-2018). PARTICIPANTS Clusters were nursing homes from one nursing home operator in Bavaria, Germany. Nursing home residents who were permanently registered in the facilities, at least 60 years of age, and who themselves or their legal guardians provided informed consent were included. INTERVENTION In addition to the implementation of pain nurses and pain care assistants, staff of the intervention group received an educational intervention in pain management, containing classroom (quality circles) and web-based training for nurses. METHODS Based on the Mini-Mental State Examination (MMSE), residents were either interviewed (MMSE 10-30) using self-report instruments or observed (MMSE 0-9) by proxy assessment. The primary outcome in residents able to self-report was maximum pain intensity according to Brief Pain Inventory (BPI); in those not able to self-report treatment-relevant pain above cut-off (≥2) on the Pain Assessment in Advanced Dementia (PAINAD). RESULTS Out of 20 randomly selected clusters, 9 nursing homes from the control, and 6 nursing homes from the intervention group participated. Multilevel linear (n=347 residents, MMSE 10-30) and logistic regression (n=222 residents, MMSE 0-9) analyses were conducted. Maximum pain intensity was higher after intervention (B=1.32, p<0.01), decreased with a better quality of life (B=-0.07, p<0.001), and was lower when dementia diagnoses were present (B=-1.12, p<0.01). PAINAD scores before and after intervention did not differ significantly (OR=0.89, p=0.724), but chances to exhibit treatment-related pain were higher with decreasing MMSE (OR=0.94, p<0.05). CONCLUSION While no significant positive intervention effect was measured, findings suggest nurses' raised awareness towards pain management. Overall results indicate that large-scale educational interventions seem to be less effective in complex nursing home settings without also including specific individual-based intervention measures.
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Affiliation(s)
- P Kutschar
- Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria
| | - S Berger
- Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria
| | - A Brandauer
- Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria
| | - N Freywald
- Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria
| | - J Osterbrink
- Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria
- Brooks College of Health, University of North Florida, Jacksonville, FL, USA
| | - D Seidenspinner
- Nursing Science and Practice Development, University Hospital of Munich-Großhadern (LMU), Munich, Germany
| | - I Gnass
- Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria
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18
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Sirsch E, Lukas A, Drebenstedt C, Gnass I, Laekeman M, Kopke K, Fischer T. Pain Assessment for Older Persons in Nursing Home Care: An Evidence-Based Practice Guideline. J Am Med Dir Assoc 2020; 21:149-163. [DOI: 10.1016/j.jamda.2019.08.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 07/29/2019] [Accepted: 08/05/2019] [Indexed: 10/25/2022]
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Lee SJ, Park MS, Choi YR, Chang SO. Concept Development of Identification of Discomfort for Nursing Home Patients With Advanced Dementia. Int J Nurs Knowl 2020; 32:274-285. [PMID: 31957245 DOI: 10.1111/2047-3095.12277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 12/31/2019] [Accepted: 01/09/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE The aim of this study is to clarify the concept of discomfort identification by concept development in the nursing home. METHODS The Schwartz-Barcott and Kim's hybrid model was used. FINDINGS The identification of discomfort can be explained as an interactive and confirmative process of sympathetically responding to patients with dementia's problem behavior expressions that communicate unmet needs. CONCLUSIONS The identification of discomfort has the potential to improve the detection of multidimensional discomfort related to nursing diagnosis as a holistic and patient-centered approach. IMPLICATION FOR NURSING PRACTICE The findings could help nursing home nurses have a better understanding of identification of discomfort and can improve nurses and interdisciplinary caregivers' knowledge for developing appropriate comfort caring activities.
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Affiliation(s)
- Su Jung Lee
- Korea University College of Nursing, Seoul, Republic of Korea
| | - Min Sun Park
- Korea University College of Nursing, Seoul, Republic of Korea
| | - Young-Rim Choi
- Korea University College of Nursing, Seoul, Republic of Korea
| | - Sung Ok Chang
- Korea University College of Nursing, Seoul, Republic of Korea
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20
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Fischer T, Hosie A, Luckett T, Agar M, Phillips J. Strategies for Pain Assessment in Adult Patients With Delirium: A Scoping Review. J Pain Symptom Manage 2019; 58:487-502.e11. [PMID: 31195076 DOI: 10.1016/j.jpainsymman.2019.05.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 05/31/2019] [Accepted: 05/31/2019] [Indexed: 01/19/2023]
Abstract
CONTEXT Pain and delirium are highly prevalent in the same patient groups. Disturbances in attention, awareness, and cognition are characteristics for delirium and can compromise pain assessment. OBJECTIVES The aim of this review was to examine and map models and understandings of pain and delirium as well as pain assessment instruments and strategies for adult patients with delirium. METHODS A scoping review of all publications that reported on pain assessment in adult patients with delirium was conducted with no time and language constraints, searching Medline, CINAHL, Scopus, Embase, and PsycINFO and systematically assessing for inclusion. Standardized data extraction and a narrative synthesis followed. RESULTS A total of 90 publications were included in the final analysis. Despite being recommended for practice, no evidence for the use of self-report or behavioral pain assessment instruments in patients with delirium was identified, with the exception of limited evidence for the validity of the Critical Care Pain Observation Tool and Behavioral Pain Scale in delirious intensive care patients. Proxy ratings of pain and comprehensive pain assessment hierarchies were also recommended, but not supported by evidence. Current models and/or understandings of pain and delirium were not applied in most publications. CONCLUSION The current literature is insufficient to guide clinical practice in pain assessment in patients with delirium. Future research will be needed to address the validity of existing pain assessment instruments, apply theoretical and conceptual understandings of pain and delirium, and build on prior studies to close evidence gaps.
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Affiliation(s)
| | - Annmarie Hosie
- IMPACCT-Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - Tim Luckett
- IMPACCT-Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - Meera Agar
- IMPACCT-Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - Jane Phillips
- IMPACCT-Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, Faculty of Health, University of Technology Sydney, Ultimo, Australia
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21
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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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22
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Iaboni A, Campitelli MA, Bronskill SE, Diong C, Kumar M, Maclagan LC, Gomes T, Tadrous M, Maxwell CJ. Time trends in opioid prescribing among Ontario long-term care residents: a repeated cross-sectional study. CMAJ Open 2019; 7:E582-E589. [PMID: 31551235 PMCID: PMC6759016 DOI: 10.9778/cmajo.20190052] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Opioids are an important pain therapy, but their use may be associated with adverse events in frail and cognitively impaired long-term care residents. The objective of this study was to investigate trends in opioid prescribing among Ontario long-term care residents over time, given the paucity of data for this setting. METHODS We used linked clinical and health administrative databases to conduct a population-based, repeated cross-sectional study of opioid use among Ontario long-term care residents between Apr. 1, 2009, and Mar. 31, 2017. We identified prevalent opioid use by drug type, dosage and coprescription with benzodiazepines, and within certain vulnerable subgroups. We used log-binomial regression to quantify the percent change between 2009/10 and 2016/17. RESULTS Among an average of 76 147 long-term care residents per year, the prevalence of opioid use increased from 15.8% in 2009/10 to 19.6% in 2016/17 (p < 0.001). Over the study period, the use of hydromorphone increased by 233.2%, whereas the use of all other opioid agents decreased. The use of high-dose opioids (> 90 mg of morphine equivalents) and the coprescription of opioids with benzodiazepines decreased significantly, by 17.7% (p < 0.001) and 23.8% (p < 0.001), respectively. Increases in opioid prevalence were more notable among frail residents (37.6% v. 18.8% among nonfrail residents, p < 0.001) and those with dementia (38.6% v. 21.6% among those without dementia, p < 0.001). INTERPRETATION Within Ontario long-term care, trends suggest a shift toward increased use of hydromorphone but reduced prevalence of use of other opioid agents and potentially inappropriate opioid prescribing. Further investigation is needed on the impact of these trends on resident outcomes.
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Affiliation(s)
- Andrea Iaboni
- Toronto Rehabilitation Institute (Iaboni), University Health Network; Department of Psychiatry (Iaboni), University of Toronto; ICES (Campitelli, Bronskill, Diong, Kumar, Maclagan, Gomes, Tadrous, Maxwell); Institute of Health Policy, Management and Evaluation (Bronskill, Gomes), University of Toronto; Sunnybrook Research Institute (Bronskill), Sunnybrook Health Sciences Centre; Women's College Research Institute (Bronskill, Tadrous), Women's College Hospital; Li Ka Shing Knowledge Institute (Gomes, Tadrous), St. Michael's Hospital; Leslie Dan Faculty of Pharmacy (Gomes, Tadrous), University of Toronto, Toronto, Ont.; Schools of Pharmacy and of Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont
| | - Michael A Campitelli
- Toronto Rehabilitation Institute (Iaboni), University Health Network; Department of Psychiatry (Iaboni), University of Toronto; ICES (Campitelli, Bronskill, Diong, Kumar, Maclagan, Gomes, Tadrous, Maxwell); Institute of Health Policy, Management and Evaluation (Bronskill, Gomes), University of Toronto; Sunnybrook Research Institute (Bronskill), Sunnybrook Health Sciences Centre; Women's College Research Institute (Bronskill, Tadrous), Women's College Hospital; Li Ka Shing Knowledge Institute (Gomes, Tadrous), St. Michael's Hospital; Leslie Dan Faculty of Pharmacy (Gomes, Tadrous), University of Toronto, Toronto, Ont.; Schools of Pharmacy and of Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont
| | - Susan E Bronskill
- Toronto Rehabilitation Institute (Iaboni), University Health Network; Department of Psychiatry (Iaboni), University of Toronto; ICES (Campitelli, Bronskill, Diong, Kumar, Maclagan, Gomes, Tadrous, Maxwell); Institute of Health Policy, Management and Evaluation (Bronskill, Gomes), University of Toronto; Sunnybrook Research Institute (Bronskill), Sunnybrook Health Sciences Centre; Women's College Research Institute (Bronskill, Tadrous), Women's College Hospital; Li Ka Shing Knowledge Institute (Gomes, Tadrous), St. Michael's Hospital; Leslie Dan Faculty of Pharmacy (Gomes, Tadrous), University of Toronto, Toronto, Ont.; Schools of Pharmacy and of Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont
| | - Christina Diong
- Toronto Rehabilitation Institute (Iaboni), University Health Network; Department of Psychiatry (Iaboni), University of Toronto; ICES (Campitelli, Bronskill, Diong, Kumar, Maclagan, Gomes, Tadrous, Maxwell); Institute of Health Policy, Management and Evaluation (Bronskill, Gomes), University of Toronto; Sunnybrook Research Institute (Bronskill), Sunnybrook Health Sciences Centre; Women's College Research Institute (Bronskill, Tadrous), Women's College Hospital; Li Ka Shing Knowledge Institute (Gomes, Tadrous), St. Michael's Hospital; Leslie Dan Faculty of Pharmacy (Gomes, Tadrous), University of Toronto, Toronto, Ont.; Schools of Pharmacy and of Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont
| | - Matthew Kumar
- Toronto Rehabilitation Institute (Iaboni), University Health Network; Department of Psychiatry (Iaboni), University of Toronto; ICES (Campitelli, Bronskill, Diong, Kumar, Maclagan, Gomes, Tadrous, Maxwell); Institute of Health Policy, Management and Evaluation (Bronskill, Gomes), University of Toronto; Sunnybrook Research Institute (Bronskill), Sunnybrook Health Sciences Centre; Women's College Research Institute (Bronskill, Tadrous), Women's College Hospital; Li Ka Shing Knowledge Institute (Gomes, Tadrous), St. Michael's Hospital; Leslie Dan Faculty of Pharmacy (Gomes, Tadrous), University of Toronto, Toronto, Ont.; Schools of Pharmacy and of Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont
| | - Laura C Maclagan
- Toronto Rehabilitation Institute (Iaboni), University Health Network; Department of Psychiatry (Iaboni), University of Toronto; ICES (Campitelli, Bronskill, Diong, Kumar, Maclagan, Gomes, Tadrous, Maxwell); Institute of Health Policy, Management and Evaluation (Bronskill, Gomes), University of Toronto; Sunnybrook Research Institute (Bronskill), Sunnybrook Health Sciences Centre; Women's College Research Institute (Bronskill, Tadrous), Women's College Hospital; Li Ka Shing Knowledge Institute (Gomes, Tadrous), St. Michael's Hospital; Leslie Dan Faculty of Pharmacy (Gomes, Tadrous), University of Toronto, Toronto, Ont.; Schools of Pharmacy and of Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont
| | - Tara Gomes
- Toronto Rehabilitation Institute (Iaboni), University Health Network; Department of Psychiatry (Iaboni), University of Toronto; ICES (Campitelli, Bronskill, Diong, Kumar, Maclagan, Gomes, Tadrous, Maxwell); Institute of Health Policy, Management and Evaluation (Bronskill, Gomes), University of Toronto; Sunnybrook Research Institute (Bronskill), Sunnybrook Health Sciences Centre; Women's College Research Institute (Bronskill, Tadrous), Women's College Hospital; Li Ka Shing Knowledge Institute (Gomes, Tadrous), St. Michael's Hospital; Leslie Dan Faculty of Pharmacy (Gomes, Tadrous), University of Toronto, Toronto, Ont.; Schools of Pharmacy and of Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont
| | - Mina Tadrous
- Toronto Rehabilitation Institute (Iaboni), University Health Network; Department of Psychiatry (Iaboni), University of Toronto; ICES (Campitelli, Bronskill, Diong, Kumar, Maclagan, Gomes, Tadrous, Maxwell); Institute of Health Policy, Management and Evaluation (Bronskill, Gomes), University of Toronto; Sunnybrook Research Institute (Bronskill), Sunnybrook Health Sciences Centre; Women's College Research Institute (Bronskill, Tadrous), Women's College Hospital; Li Ka Shing Knowledge Institute (Gomes, Tadrous), St. Michael's Hospital; Leslie Dan Faculty of Pharmacy (Gomes, Tadrous), University of Toronto, Toronto, Ont.; Schools of Pharmacy and of Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont
| | - Colleen J Maxwell
- Toronto Rehabilitation Institute (Iaboni), University Health Network; Department of Psychiatry (Iaboni), University of Toronto; ICES (Campitelli, Bronskill, Diong, Kumar, Maclagan, Gomes, Tadrous, Maxwell); Institute of Health Policy, Management and Evaluation (Bronskill, Gomes), University of Toronto; Sunnybrook Research Institute (Bronskill), Sunnybrook Health Sciences Centre; Women's College Research Institute (Bronskill, Tadrous), Women's College Hospital; Li Ka Shing Knowledge Institute (Gomes, Tadrous), St. Michael's Hospital; Leslie Dan Faculty of Pharmacy (Gomes, Tadrous), University of Toronto, Toronto, Ont.; Schools of Pharmacy and of Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont.
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23
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Marttinen MK, Kautiainen H, Haanpää M, Pohjankoski H, Vuorimaa H, Hintikka J, Kauppi MJ. Pain-related factors in older adults. Scand J Pain 2019; 19:797-803. [PMID: 31085750 DOI: 10.1515/sjpain-2019-0039] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 04/20/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND AIMS Pain is an evident factor affecting the quality of life in all age groups. The objective was to examine the prevalence of self-reported SF-36 bodily pain and pain-related factors in community-dwelling older adults. METHODS One thousand four hundred and twenty adults aged 62-86 years self-reported SF-36 bodily pain during the previous month. For the analysis, four pain groups were formed (group I [0-45, moderate to very severe pain intensity and interference], group II [47.5-70], group III [77.5-90], and group IV [100, no pain at all]). Additional questionnaire-provided data regarding education, wealth, life habits, and morbidity, as well as clinical data were considered. RESULTS The overall pain prevalence was 78% (SF-36 bodily pain score <100). The prevalence of cohabiting, as well as the years of education and household income were found to decrease with an increasing SF-36 bodily pain score. The prevalence of a BMI of over 30 and of central obesity emerged as the highest in group I. Morbidities were found to be most prevalent in group I. CONCLUSIONS A high prevalence of intense and interfering pain was reported. Multiple factors that were found to relate to pain have previously been demonstrated to associate with social exclusion. Increasing attention should be paid to distinguishing these factors in patients with pain, as well as targeted pain assessment and measures to improve the sense of community among older adults. IMPLICATIONS There is a lack of large studies that examine a wide scale of pain-related factors in the older adult population. To distinguish subjects with multiple such factors would help medical professionals to target their attention to patients at a high risk of chronic pain.
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Affiliation(s)
- Maiju K Marttinen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 8, 00290 Helsinki, Finland
| | - Hannu Kautiainen
- Folkhälsan Research Center, Helsinki, Finland.,Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland
| | - Maija Haanpää
- Ilmarinen Mutual Pension Insurance Company, Helsinki, Finland.,Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland
| | - Heini Pohjankoski
- Department of Pediatrics, Päijät-Häme Central Hospital, Lahti, Finland
| | - Hanna Vuorimaa
- Department of Pediatrics, Päijät-Häme Central Hospital, Lahti, Finland
| | - Jukka Hintikka
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Psychiatry, Päijät-Häme Central Hospital, Lahti, Finland
| | - Markku J Kauppi
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Rheumatology, Päijät-Häme Central Hospital, Lahti, Finland
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24
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Delwel S, Scherder EJA, de Baat C, Binnekade TT, van der Wouden JC, Hertogh CMPM, Maier AB, Perez RSGM, Lobbezoo F. Orofacial pain and its potential oral causes in older people with mild cognitive impairment or dementia. J Oral Rehabil 2018; 46:23-32. [PMID: 30281826 PMCID: PMC7380060 DOI: 10.1111/joor.12724] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 09/24/2018] [Accepted: 09/26/2018] [Indexed: 12/24/2022]
Abstract
Background The number of people with dementia and natural dentition is growing. As dementia progresses, the degree of self‐care decreases and the risk of oral health problems and orofacial pain increases. Objectives To examine and compare the presence of orofacial pain and its potential causes in older people with Mild Cognitive Impairment (MCI) or dementia. Methods In this cross‐sectional observational study, the presence of orofacial pain and its potential causes was studied in 348 participants with MCI or dementia with all levels of cognitive impairment in two outpatient memory clinics and ten nursing homes. Results Orofacial pain was reported by 25.7% of the 179 participants who were considered to present a reliable pain self‐report (Mini‐Mental State Examination score ≥14 points), while it could not be determined in people with more severe cognitive impairment. The oral health examination of the 348 participants indicated that potential painful conditions, such as coronal caries, root caries, tooth root remnants or ulcers were present in 50.3%. There was a significant correlation between the level of cognitive impairment and the number of teeth, r = 0.185, P = 0.003, teeth with coronal caries, r = −0.238, P < 0.001, and the number of tooth root remnants, r = −0.229, P = 0.004, after adjusting for age. Conclusions This study indicated that orofacial pain and its potential causes were frequently present in participants with MCI or dementia. Therefore, a regular oral examination by (oral) healthcare providers in people with MCI or dementia remains imperative, even if no pain is reported.
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Affiliation(s)
- Suzanne Delwel
- Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Clinical Neuropsychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Erik J A Scherder
- Department of Clinical Neuropsychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Cees de Baat
- Department of Oral Function and Prosthetic Dentistry, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tarik T Binnekade
- Department of Clinical Neuropsychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Johannes C van der Wouden
- Department of General Practice & Elderly Care Medicine, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Cees M P M Hertogh
- Department of General Practice & Elderly Care Medicine, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Andrea B Maier
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia.,Department of Human Movement Sciences, @AgeAmsterdam, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit, Amsterdam, The Netherlands
| | - Roberto S G M Perez
- Department of Anesthesiology, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Frank Lobbezoo
- Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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25
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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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26
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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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27
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Delwel S, Perez RSGM, Maier AB, Hertogh CMPM, de Vet HCW, Lobbezoo F, Scherder EJA. Psychometric evaluation of the Orofacial Pain Scale for Non-Verbal Individuals as a screening tool for orofacial pain in people with dementia. Gerodontology 2018; 35:200-213. [PMID: 29707824 DOI: 10.1111/ger.12339] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2018] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The aim of this study was to describe the psychometric evaluation of the Orofacial Pain Scale for Non-Verbal Individuals (OPS-NVI) as a screening tool for orofacial pain in people with dementia. BACKGROUND The OPS-NVI has recently been developed and needs psychometric evaluation for clinical use in people with dementia. The pain self-report is imperative as a reference standard and can be provided by people with mild-to-moderate cognitive impairment. METHODS The presence of orofacial pain during rest, drinking, chewing and oral hygiene care was observed in people with mild cognitive impairment (MCI) and dementia using the OPS-NVI. Participants who were considered to present a reliable self-report were asked about pain presence, and in all participants, the oral health was examined by a dentist for the presence of potential painful conditions. After item-reduction, inter-rater reliability and criterion validity were determined. RESULTS The presence of orofacial pain in this population was low (0%-10%), resulting in an average Positive Agreement of 0%-100%, an average Negative Agreement of 77%-100%, a sensitivity of 0%-100% and a specificity of 66%-100% for the individual items of the OPS-NVI. At the same time, the presence of oral problems, such as ulcers, tooth root remnants and caries was high (64.5%). CONCLUSION The orofacial pain presence in this MCI and dementia population was low, resulting in low scores for average Positive Agreement and sensitivity and high scores for average Negative Agreement and specificity. Therefore, the OPS-NVI in its current form cannot be recommended as a screening tool for orofacial pain in people with MCI and dementia. However, the inter-rater reliability and criterion validity of the individual items in this study provide more insight for the further adjustment of the OPS-NVI for diagnostic use. Notably, oral health problems were frequently present, although no pain was reported or observed, indicating that oral health problems cannot be used as a new reference standard for orofacial pain, and a regular oral examination by care providers and oral hygiene care professionals remains indispensable.
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Affiliation(s)
- Suzanne Delwel
- Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Clinical Neuropsychology, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Roberto S G M Perez
- Department of Anesthesiology and Amsterdam Public Health Research Institute, VU University Medical Centre, Amsterdam, The Netherlands
| | - Andrea B Maier
- Department of Medicine and Aged Care, The Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
- Department of Human Movement Sciences, MOVE Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Cees M P M Hertogh
- Department of Elderly Care Medicine, Faculty of Medicine, VU University Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - Henrica C W de Vet
- Department of Epidemiology and Biostatistics and Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Frank Lobbezoo
- Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Erik J A Scherder
- Department of Clinical Neuropsychology, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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28
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Ammaturo DA, Hadjistavropoulos T, Williams J. Pain in Dementia: Use of Observational Pain Assessment Tools by People Who Are Not Health Professionals. PAIN MEDICINE 2017; 18:1895-1907. [PMID: 27837033 DOI: 10.1093/pm/pnw265] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective Pain is prevalent among older adults but is often underestimated and undertreated, especially in people with severe dementia who have limited ability to self-report pain. Pain in patients with moderate to severe dementia can be assessed using observational tools. Informal caregivers (relatives of seniors with dementia) are an untapped assessor group who often bear the responsibility of care for their loved ones. Our objective was to evaluate the ability of laypeople to assess pain using observational measures originally developed for use by health care professionals. Design We employed a quasi-experimental design and presented videos depicting patients with dementia (portrayed by actors) displaying pain behaviors or during a calm relaxed state (no pain) to long-term care nurses and laypeople. Participants rated the pain behaviors observed in each video by completing two standardized observational measures that had been previously developed for use by long-term care staff. Results As expected, both laypeople and nurses were able to effectively differentiate painful from nonpainful situations using the standardized tools. Both groups were also able to discriminate among gradations of pain (i.e., no pain, mild, moderate, severe) and required comparable amounts of time to complete the assessments. Conclusions We conclude that, as hypothesized, the instruments under study can be used for the assessment of pain by laypeople. This is the first study to validate these instruments for use by laypeople. The use of these tools by laypeople (under the guidance of health professionals) has the potential of facilitating earlier detection and treatment of pain in older adults with dementia who live in community settings.
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Affiliation(s)
- Delaine A Ammaturo
- Department of Psychology and Centre on Aging and Health, University of Regina, Regina, Saskatchewan, Canada
| | - Thomas Hadjistavropoulos
- Department of Psychology and Centre on Aging and Health, University of Regina, Regina, Saskatchewan, Canada
| | - Jaime Williams
- Department of Psychology and Centre on Aging and Health, University of Regina, Regina, Saskatchewan, Canada
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29
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Abstract
Pain in aging adults is a global health problem requiring a proactive and consistent assessment approach. Pain assessment is critical to detecting pain and developing a collaborative and adaptive pain management plan. Getting health providers to assess and measure pain even in older adults who are communicative and can self-report remains a challenge. Self-report is the best method for identifying pain. Using a validated pain assessment scale is key to evaluate pain intensity. This article discusses techniques to obtain self-report and describe appropriate self-report pain tools for a focused pain assessment and reassessment in adults in later life.
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Affiliation(s)
- Staja Q Booker
- The University of Iowa, College of Nursing, 50 Newton Road, Iowa City, IA 52242, USA
| | - Keela A Herr
- The University of Iowa, College of Nursing, 50 Newton Road, Iowa City, IA 52242, USA.
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30
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Thakur ER, Amspoker AB, Sansgiry S, Snow AL, Stanley M, Wilson N, Freshour J, Kunik ME. Pain Among Community-Dwelling Older Adults with Dementia: Factors Associated with Undertreatment. PAIN MEDICINE 2016; 18:1476-1484. [DOI: 10.1093/pm/pnw225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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31
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Implementation of a nursing home quality improvement project to reduce resident pain: a qualitative case study. J Nurs Care Qual 2016; 30:261-8. [PMID: 25407787 DOI: 10.1097/ncq.0000000000000099] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This article describes the experiences of staff members working within nursing homes that successfully implemented a quality improvement project aimed at reducing resident pain. Interviews were conducted with 24 nursing home employees from within 8 facilities participating in the quality improvement project. Findings were organized using the Consolidated Framework for Implementation Research. Interdisciplinary communication, supportive leadership, training, and nursing assistant participation facilitated implementation. Increased documentation, resistance to change, and difficulty measuring outcomes were perceived challenges.
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32
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Increasing the Frequency and Timeliness of Pain Assessment and Management in Long-Term Care: Knowledge Transfer and Sustained Implementation. Pain Res Manag 2016; 2016:6493463. [PMID: 27445619 PMCID: PMC4904616 DOI: 10.1155/2016/6493463] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 12/17/2015] [Indexed: 11/17/2022]
Abstract
Background. Although feasible protocols for pain assessment and management in long-term care (LTC) have been developed, these have not been implemented on a large-scale basis. Objective. To implement a program of regular pain assessment in two LTC facilities, using implementation science principles, and to evaluate the process and success of doing so. Methods. The implementation protocol included a pain assessment workshop and the establishment of a nurse Pain Champion. Quality indicators were tracked before and after implementation. Focus groups and interviews with staff were also conducted. Results. The implementation effort was successful in increasing and regularizing pain assessments. This was sustained during the follow-up period. Staff members reported enthusiasm about the protocol at baseline and positive results following its implementation. Despite the success in increasing assessments, we did not identify changes in the percentages of patients reported as having moderate-to-severe pain. Discussion. It is our hope that our feasibility demonstration will encourage more facilities to improve their pain assessment/management practices. Conclusions. It is feasible to implement regular and systematic pain assessment in LTC. Future research should focus on ensuring effective clinical practices in response to assessment results, and determination of longer-term sustainability.
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Jensen-Dahm C, Madsen CS, Waldemar G, Ballegaard M, Hejl AM, Johnsen B, Jensen TS. Contact Heat Evoked Potentials (CHEPs) in Patients with Mild-Moderate Alzheimer's Disease and Matched Control--A Pilot Study. PAIN MEDICINE 2015; 17:675-84. [PMID: 26814248 DOI: 10.1093/pm/pnv012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Clinical studies have found that patients with Alzheimer's disease report pain of less intensity and with a lower affective response, which has been thought to be due to altered pain processing. The authors wished to examine the cerebral processing of non-painful and painful stimuli using somatosensory evoked potentials and contact heat evoked potentials in patients with Alzheimer's disease and in healthy elderly controls. DESIGN Case-control study SETTING AND SUBJECTS Twenty outpatients with mild-moderate Alzheimer's disease and in 17 age- and gender-matched healthy controls were included METHOD Contact heat evoked potentials and somatosensory evoked potentials were recorded in all subjects. Furthermore, warmth detection threshold and heat pain threshold were assessed. Patients and controls also rated quality and intensity of the stimuli. RESULTS The authors found no difference on contact heat evoked potential amplitude (P = 0.59) or latency of N2 or P2 wave (P = 0.62 and P = 0.75, respectively) between patients and controls. In addition, there was no difference in regard to pain intensity scores or pain quality. The patients and controls had similar warmth detection threshold and heat pain threshold. Somatosensory evoked potentials, amplitude, and latency were within normal range and similar for the two groups. CONCLUSIONS The findings suggest that the processing of non-painful and painful stimuli is preserved in patients with mild to moderate Alzheimer's disease.
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Affiliation(s)
- Christina Jensen-Dahm
- *Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark;
| | - Caspar Skau Madsen
- Danish Pain Research Centre, Department of Neurology, Aarhus University Hospital, Denmark
| | - Gunhild Waldemar
- *Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark
| | - Martin Ballegaard
- Department of Clinical Neurophysiology, Rigshospitalet, University of Copenhagen, Denmark
| | - Anne-Mette Hejl
- *Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark
| | - Birger Johnsen
- Department of Clinical Neurophysiology, Aarhus University Hospital, Denmark
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34
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van der Steen JT, Sampson EL, Van den Block L, Lord K, Vankova H, Pautex S, Vandervoort A, Radbruch L, Shvartzman P, Sacchi V, de Vet HCW, Van Den Noortgate NJA. Tools to Assess Pain or Lack of Comfort in Dementia: A Content Analysis. J Pain Symptom Manage 2015. [PMID: 26212095 DOI: 10.1016/j.jpainsymman.2015.05.015] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CONTEXT There is need for tools to help detect pain or lack of comfort in persons unable to communicate. However, pain and (dis)comfort tools have not been compared, and it is unclear to what extent they discriminate between pain and other possible sources of discomfort, or even if items differ. OBJECTIVES To map and compare items in tools that assess pain and the broader notion of discomfort or comfort in people with severe dementia or at the end of life. METHODS Using qualitative content analysis with six classifications, we categorized each item of four thoroughly tested observational pain tools (Pain Assessment in Advanced Dementia [PAINAD], Pain Assessment Checklist for Seniors with Limited Ability to Communicate [PACSLAC], Doloplus-2, and draft Pain Assessment in Impaired Cognition [PAIC]), and four discomfort tools (including distress, comfort, and quality of life in severe dementia or at the end of life; Discomfort Scale-Dementia Alzheimer Type [DS-DAT], Disability Distress Assessment Tool [DisDAT], End-of-Life in Dementia-Comfort Assessment in Dying with Dementia [EOLD-CAD], and Quality of Life in Late-Stage Dementia [QUALID] scale). We calculated median proportions to compare distributions of categories of pain and discomfort tools. RESULTS We found that, despite variable content across tools, items from pain and discomfort tools overlapped considerably. For example, positive elements such as smiling and spiritual items were more often included in discomfort tools but were not unique to these. Pain tools comprised more "mostly descriptive" (median 0.63 vs. 0.44) and fewer "highly subjective" items (0.06 vs. 0.18); some used time inconsistently, mixing present and past observations. CONCLUSION This analysis may inform a more rigorous theoretical underpinning and (re)development of pain and discomfort tools and calls for empirical testing of a broad item pool for sensitivity and specificity in detecting and discriminating pain from other sources of discomfort.
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Affiliation(s)
- Jenny T van der Steen
- EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; Department of General Practice & Elderly Care Medicine, VU University Medical Center, Amsterdam, The Netherlands.
| | - Elizabeth L Sampson
- Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London, London, United Kingdom; Barnet Enfield and Haringey Mental Health Trust Liaison Team, North Middlesex University Hospital, London, United Kingdom
| | - Lieve Van den Block
- End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Belgium, Brussels, Belgium
| | - Kathryn Lord
- Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London, London, United Kingdom
| | - Hana Vankova
- Faculty of Humanities and Third Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Sophie Pautex
- Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - An Vandervoort
- End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Belgium, Brussels, Belgium
| | - Lukas Radbruch
- Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany; Center for Palliative Care, Malteser Hospital Seliger Gerhard Bonn/Rhein-Sieg, Bonn, Germany
| | - Pesach Shvartzman
- Pain and Palliative Medicine Unit, Division of Community Health, Department of Family Medicine, Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Valentina Sacchi
- Lincolnshire Partnership Foundation Trust, Lincoln, Lincolnshire, United Kingdom
| | - Henrica C W de Vet
- EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
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Jensen-Dahm C, Werner MU, Jensen TS, Ballegaard M, Andersen BB, Høgh P, Waldemar G. Discrepancy between stimulus response and tolerance of pain in Alzheimer disease. Neurology 2015; 84:1575-81. [PMID: 25788560 DOI: 10.1212/wnl.0000000000001465] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 01/05/2015] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Affective-motivational and sensory-discriminative aspects of pain were investigated in patients with mild to moderate Alzheimer disease (AD) and healthy elderly controls using the cold pressor test tolerance and repetitive stimuli of warmth and heat stimuli, evaluating the stimulus-response function. METHODS A case-control design was applied examining 33 patients with mild to moderate AD dementia and 32 healthy controls with the cold pressor test (4°C). Warmth detection threshold (WDT) and heat pain threshold (HPT) were assessed using 5 stimulations. A stimulus-response function was estimated using 4 incrementally increasing suprathreshold heat stimuli. RESULTS Cold pressor tolerance was lower in patients with AD dementia than in controls (p = 0.027). There were no significant differences between groups regarding WDT and HPT. Significant successive increases in HPT assessments indicated habituation (p < 0.0001), which was similar in the 2 groups (p = 0.85). A mixed model for repeated measures demonstrated that pain rating of suprathreshold stimuli depended on HPT (p = 0.0004) and stimulus intensity (p < 0.0001). Patients with AD dementia had significantly lower increases in pain ratings than controls during suprathreshold stimulation (p = 0.0072). CONCLUSION Our results indicate that AD dementia is not associated with a propensity toward development of sensitization or a lack of habituation, suggesting preservation of sensory-discriminative aspects of pain perception. The results further suggest that the attenuated cold pressor pain tolerance may relate to impairment of coping abilities. Paradoxically, we found an attenuated stimulus-response function, compared to controls, suggesting that AD dementia interferes with pain ratings over time, most likely due to memory impairment.
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Affiliation(s)
- Christina Jensen-Dahm
- From the Danish Dementia Research Centre, Department of Neurology (C.J.-D., B.B.A., G.W.), the Multidisciplinary Pain Centre, Neuroscience Center (M.U.W.), and the Department of Clinical Neurophysiology (M.B.), Rigshospitalet, University of Copenhagen; the Danish Pain Research Centre, Department of Neurology (T.S.J.), Aarhus University Hospital; and the Regional Dementia Research Centre, Department of Neurology (P.H.), Roskilde Hospital, University of Copenhagen, Roskilde, Denmark.
| | - Mads U Werner
- From the Danish Dementia Research Centre, Department of Neurology (C.J.-D., B.B.A., G.W.), the Multidisciplinary Pain Centre, Neuroscience Center (M.U.W.), and the Department of Clinical Neurophysiology (M.B.), Rigshospitalet, University of Copenhagen; the Danish Pain Research Centre, Department of Neurology (T.S.J.), Aarhus University Hospital; and the Regional Dementia Research Centre, Department of Neurology (P.H.), Roskilde Hospital, University of Copenhagen, Roskilde, Denmark
| | - Troels Staehelin Jensen
- From the Danish Dementia Research Centre, Department of Neurology (C.J.-D., B.B.A., G.W.), the Multidisciplinary Pain Centre, Neuroscience Center (M.U.W.), and the Department of Clinical Neurophysiology (M.B.), Rigshospitalet, University of Copenhagen; the Danish Pain Research Centre, Department of Neurology (T.S.J.), Aarhus University Hospital; and the Regional Dementia Research Centre, Department of Neurology (P.H.), Roskilde Hospital, University of Copenhagen, Roskilde, Denmark
| | - Martin Ballegaard
- From the Danish Dementia Research Centre, Department of Neurology (C.J.-D., B.B.A., G.W.), the Multidisciplinary Pain Centre, Neuroscience Center (M.U.W.), and the Department of Clinical Neurophysiology (M.B.), Rigshospitalet, University of Copenhagen; the Danish Pain Research Centre, Department of Neurology (T.S.J.), Aarhus University Hospital; and the Regional Dementia Research Centre, Department of Neurology (P.H.), Roskilde Hospital, University of Copenhagen, Roskilde, Denmark
| | - Birgitte Bo Andersen
- From the Danish Dementia Research Centre, Department of Neurology (C.J.-D., B.B.A., G.W.), the Multidisciplinary Pain Centre, Neuroscience Center (M.U.W.), and the Department of Clinical Neurophysiology (M.B.), Rigshospitalet, University of Copenhagen; the Danish Pain Research Centre, Department of Neurology (T.S.J.), Aarhus University Hospital; and the Regional Dementia Research Centre, Department of Neurology (P.H.), Roskilde Hospital, University of Copenhagen, Roskilde, Denmark
| | - Peter Høgh
- From the Danish Dementia Research Centre, Department of Neurology (C.J.-D., B.B.A., G.W.), the Multidisciplinary Pain Centre, Neuroscience Center (M.U.W.), and the Department of Clinical Neurophysiology (M.B.), Rigshospitalet, University of Copenhagen; the Danish Pain Research Centre, Department of Neurology (T.S.J.), Aarhus University Hospital; and the Regional Dementia Research Centre, Department of Neurology (P.H.), Roskilde Hospital, University of Copenhagen, Roskilde, Denmark
| | - Gunhild Waldemar
- From the Danish Dementia Research Centre, Department of Neurology (C.J.-D., B.B.A., G.W.), the Multidisciplinary Pain Centre, Neuroscience Center (M.U.W.), and the Department of Clinical Neurophysiology (M.B.), Rigshospitalet, University of Copenhagen; the Danish Pain Research Centre, Department of Neurology (T.S.J.), Aarhus University Hospital; and the Regional Dementia Research Centre, Department of Neurology (P.H.), Roskilde Hospital, University of Copenhagen, Roskilde, Denmark
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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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Takai Y, Yamamoto-Mitani N, Kawakami S, Abe Y, Kamiyama M, Saito S. Differences between Nurses' and Care Workers' Estimations of Pain Prevalence among Older Residents. Pain Manag Nurs 2015; 16:20-32. [DOI: 10.1016/j.pmn.2014.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 03/09/2014] [Accepted: 03/17/2014] [Indexed: 10/25/2022]
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Hadjistavropoulos T, Kaasalainen S, Williams J, Zacharias R. Improving Pain Assessment Practices and Outcomes in Long-Term Care Facilities: A Mixed Methods Investigation. Pain Manag Nurs 2014; 15:748-59. [DOI: 10.1016/j.pmn.2013.07.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 07/27/2013] [Accepted: 07/29/2013] [Indexed: 10/26/2022]
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Stubbs B, Mitchell AJ, De Hert M, Correll CU, Soundy A, Stroobants M, Vancampfort D. The prevalence and moderators of clinical pain in people with schizophrenia: a systematic review and large scale meta-analysis. Schizophr Res 2014; 160:1-8. [PMID: 25458569 DOI: 10.1016/j.schres.2014.10.017] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 09/17/2014] [Accepted: 10/09/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND People with schizophrenia frequently have physical comorbidities that can cause pain. Experimental studies report reduced pain sensitivity among schizophrenia patients, but it remains unclear if clinically relevant pain is less prevalent in schizophrenia. METHOD We systematically searched major electronic databases from inception till 03/2014. Articles were included that reported the prevalence of clinical pain in people with schizophrenia. Two independent authors conducted searches, completed methodological quality assessment and extracted data. A random effects relative risks (RR) meta-analysis was conducted to determine the prevalence of all-cause and specific pain in schizophrenia, and the relative prevalence compared to the general population, and to assess moderators. RESULTS Altogether, 14 studies were included encompassing 242,703 individuals with schizophrenia (30.2-55.8 years) and 4,259,221 controls. Different types of pain were considered. The overall pooled prevalence of clinical pain in people with schizophrenia was 34.7% (95% CI=23.6-46.6). In the comparative analysis involving 7 studies with controls, the RR was 0.99 (95% CI=0.83-1.19). The pooled prevalence of headache among 94,043 individuals with schizophrenia was 29.9% (95% CI=3-69%) and the RR compared to 4,248,284 controls was 1.32 (95% CI=0.85-2.07). In moderator analyses, neither age, sex, study quality or pain assessment method influenced pain prevalence. CONCLUSION Clinical pain affects a third of people with schizophrenia and levels are similar with age- and sex-comparable controls. Future research is needed to determine if similar clinical pain prevalences in schizophrenia occur despite having more painful conditions, resulting from under-reporting, higher pain thresholds or lower help seeking behaviours.
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Affiliation(s)
- Brendon Stubbs
- Faculty of Education and Health, University of Greenwich, Southwood Site, Avery Hill Road, Eltham, London SE9 2UG, UK.
| | - Alex J Mitchell
- Department of Psycho-oncology, University of Leicester, Leicester LE1 5WW, UK.
| | - Marc De Hert
- University Psychiatric Centre, KU Leuven, KU Leuven Departement of Neurosciences, Leuvensesteenweg 517, B-3070 Kortenberg, Belgium.
| | - Christoph U Correll
- Zucker Hillside Hospital, Long Island Jewish Medical Center, Glen Oaks, NY 11004, USA.
| | - Andy Soundy
- Department of Physiotherapy, University of Birmingham, Birmingham B15 2TT, UK.
| | - Marc Stroobants
- University Psychiatric Centre, KU Leuven, KU Leuven Departement of Neurosciences, Leuvensesteenweg 517, B-3070 Kortenberg, Belgium.
| | - Davy Vancampfort
- University Psychiatric Centre, KU Leuven, KU Leuven Departement of Neurosciences, Leuvensesteenweg 517, B-3070 Kortenberg, Belgium; KU Leuven Department of Rehabilitation Sciences, Tervuursevest 101, B-3001 Leuven, Belgium.
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Kobentar R. Celostni pristop k ugotavljanju in obravnavi bolečine pri obolelih za demenco: na dokazih podprta priporočila za dobro prakso. OBZORNIK ZDRAVSTVENE NEGE 2014. [DOI: 10.14528/snr.2014.48.3.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Uvod: Neustrezna obravnava bolečine pri obolelih za demenco je neposredno povezana s slabšim kognitivnim funkcioniranjem, izgubo komunikacijskih sposobnosti ter omejitvami pri izražanju bolečine. Namen prispevka je predstavitev znanstvenih dokazov s področja ocene bolečine pri obolelih za demenco.
Metode: Uporabljen je sistematični pregled znanstvene in strokovne literature, omejene na objave v angleščini, nemščini in slovenščini ter izdajo v časovnem obdobju 2007-2013. Izbor člankov je bil določen glede na naslednje kriterije: dostopnost, znanstvenost, vsebinska ustreznost in aktualnost. Podatki so bili po izboru obdelani s kvalitativno vsebinsko analizo.
Rezultati: Z vsebinsko analizo 16 znanstvenih besedil so podana temeljna izhodišča za oceno in obravnavo bolečine pri obolelih za demenco. Tako je bilo identificiranih pet vsebinskih kategorij: razlogi za bolečino, spremljajoči znaki, instrumenti za ugotavljanje bolečine, zdravstvena obravnava in vloga medicinske sestre.
Diskusija in zaključek: Priporoča se, da se ocena bolečine pri obolelih za demenco obravnava celostno v kontekstu vedenjskih motenj, funkcioniranja in življenjskih pogojev. Na podlagi izsledkov bi bilo potrebno za obolele za demenco uporabiti primeren instrumentarij, ki bo del standarda kakovostne obravnave, saj obstajajo omejitve v zvezi s preverjanjem v klinični praksi.
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Evidence-based Development and Initial Validation of the Pain Assessment Checklist for Seniors With Limited Ability to Communicate-II (PACSLAC-II). Clin J Pain 2014; 30:816-24. [DOI: 10.1097/ajp.0000000000000039] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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McPherson CJ, Hadjistavropoulos T, Devereaux A, Lobchuk MM. A qualitative investigation of the roles and perspectives of older patients with advanced cancer and their family caregivers in managing pain in the home. BMC Palliat Care 2014; 13:39. [PMID: 25140119 PMCID: PMC4137110 DOI: 10.1186/1472-684x-13-39] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 07/31/2014] [Indexed: 12/04/2022] Open
Abstract
Background Pain in advanced cancer is complex and multifaceted. In older patients comorbidities and age-related functional decline add to the difficulties in managing cancer pain. The current emphasis on care in the community, and preference by patients with life-limiting disease to receive care in the home, has meant that patients and their family caregivers have become increasingly responsible for the day-to-day management of cancer pain. An appreciation of patients’ and caregivers’ roles and perspectives managing pain is, therefore, fundamental to addressing cancer pain in this setting. Consequently, we sought to explore and describe their perspectives and roles. Methods A qualitative descriptive approach was used. Semi-structured interviews were conducted with a purposeful sample of patient- family caregiver dyads. Participants included 18 patients aged 65 years and over, with advanced cancer, receiving palliative care at home, and 15 family caregivers. The interview data were analysed using thematic analyses. Strategies were used to establish rigour. Results Two main themes were identified. The first theme, "Communicating the pain", represented pain assessment and incorporated four subthemes in which participants described: their roles in pain assessment, the identification and expression of pain, and the communication of pain between patients and caregivers. The second theme, "Finding a solution", comprised of four subthemes that reflected participants’ roles and approaches in controlling pain; as well as their beliefs about cancer pain control, experience with side effects, and perspectives on the goals of treatment. Conclusions The findings support other studies in identifying knowledge and attitudinal barriers to pain control; while adding to the literature by highlighting practical and relational barriers faced by older patients and their family caregivers. Health care professionals can do much to address the barriers identified by: correcting misconceptions regarding cancer pain, facilitating the communication of pain within dyads, and ensuring that patients and family caregivers have the knowledge, skills, and ability to assess and implement pain treatment strategies. This support needs to be individually tailored to meet the ongoing needs of both members of the dyad so that the shared goals of pain management are accomplished.
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Affiliation(s)
- Christine J McPherson
- School of Nursing, Faculty of Health Sciences, University of Ottawa, 451, Smyth Road, Ottawa, Ontario K1H 8M5, Canada
| | | | - Alana Devereaux
- School of Nursing, Faculty of Health Sciences, University of Ottawa, 451, Smyth Road, Ottawa, Ontario K1H 8M5, Canada
| | - Michelle M Lobchuk
- Faculty of Nursing, University of Manitoba, Winnipeg, Manitoba R3T 2N2, Canada
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Quantitative sensory testing and pain tolerance in patients with mild to moderate Alzheimer disease compared to healthy control subjects. Pain 2014; 155:1439-1445. [DOI: 10.1016/j.pain.2013.12.031] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 12/23/2013] [Accepted: 12/30/2013] [Indexed: 11/24/2022]
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Ahn H, Horgas A. Does Pain Mediate or Moderate the Effect of Cognitive Impairment on Aggression in Nursing Home Residents with Dementia? Asian Nurs Res (Korean Soc Nurs Sci) 2014; 8:105-9. [DOI: 10.1016/j.anr.2014.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Revised: 09/12/2013] [Accepted: 02/01/2014] [Indexed: 10/25/2022] Open
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Differences in Pain Measures by Mini-Mental State Examination Scores of Residents in Aged Care Facilities: Examining the Usability of the Abbey Pain Scale–Japanese Version. Pain Manag Nurs 2014; 15:236-45. [PMID: 23237690 DOI: 10.1016/j.pmn.2012.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 09/15/2012] [Accepted: 09/21/2012] [Indexed: 11/23/2022]
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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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Chatterjee J. Improving pain assessment for patients with cognitive impairment: development of a pain assessment toolkit. Int J Palliat Nurs 2012; 18:581-90. [DOI: 10.12968/ijpn.2012.18.12.581] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jane Chatterjee
- St Gemma’s Hospice and University of Bradford, 329 Harrogate Road, Moortown, Leeds, LS17 6QD, England
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O Connor L. Case report: A patient with dementia presenting with hip fracture in the emergency department – Challenges of acute pain assessment. Int Emerg Nurs 2012; 20:255-60. [DOI: 10.1016/j.ienj.2012.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Accepted: 03/18/2012] [Indexed: 11/30/2022]
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Carnahan R. The “Improving Antipsychotic Appropriateness in Dementia Patients” clinical tools and training program. Ment Health Clin 2012. [DOI: 10.9740/mhc.n107121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ryan Carnahan
- University of Iowa College of Public Health, Department of Epidemiology
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