Factors related to nurses' beliefs regarding pain assessment in people living with dementia

AIM

To evaluate registered nurses' beliefs and related factors regarding pain assessment in people living with dementia.

DESIGN

A descriptive cross-sectional survey was conducted between July 2022 and April 2023.

METHODS

An online survey comprised of demographics, knowledge scale, and beliefs scale relating to pain assessment in dementia was distributed to registered nurses (RNs) caring for people living with dementia in Australia.

RESULTS

RNs (N = 131) completed the survey. Most respondents were females (87.0%) and self-identified as Caucasian (60.3%). The mean beliefs score was 72.60 (±6.39) out of a maximum possible score of 95. RNs' beliefs about pain assessment varied based on their education, dementia pain assessment knowledge, nursing experience, and ethnicity. Hierarchical multiple regression analysis revealed factors significantly related to the beliefs score (i.e. education and dementia pain assessment knowledge).

CONCLUSION

The relationship between education and knowledge, and the beliefs score indicates the potential to improve RNs' knowledge and overcome their erroneous beliefs about pain assessment in dementia.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Education and training in assessing pain in people living with dementia should be tailored to overcome RNs' misconceived beliefs. These programmes should be integrated into continuous learning programmes.

IMPACT

Some RNs' beliefs about pain assessment in dementia were not evidence-based, and knowledge and educational status were the strongest factors related to RNs' beliefs. RNs' erroneous beliefs about pain assessment in dementia need to be addressed to improve pain assessment and management. Researchers should explore the potential of educational interventions to overcome RNs' misconceived beliefs about pain assessment in dementia.

REPORTING METHOD

This study was reported adhering to the Strengthening the Reporting of Observational Studies in Epidemiology checklist.

PATIENT OR PUBLIC CONTRIBUTION

RNs caring for people living with dementia participated as survey respondents. Additionally, RNs were involved in the pre-testing of the study's survey instrument.

Quality of care as perceived by caregivers and residents in aged care homes in Sri Lanka: a qualitative study

OBJECTIVE

Quality of care determines the physical and psychological wellbeing of aged care residents. The study aims to explore barriers and facilitators of quality of care in aged care homes (ACHs) in Sri Lanka from the perspective of older adults and caregivers.

METHODS

This qualitative descriptive exploratory study was conducted in selected five ACHs in Galle District, Sri Lanka, from May 2021 to January 2022. We recruited a purposive sample of residents and caregivers and conducted ten in-depth interviews with ten caregivers and nine focus group discussions with forty-five residents. The data were analysed using the thematic analysis.

RESULTS

The majority of caregivers and residents were females. Caregivers and residents were aged 25-35 years and 70-80 years, respectively. Two major themes emerged: (a) barriers of quality of care and (b) facilitators of quality of care. Both residents and caregivers reported a lack of referring system facilities; a lack of financial support on the infrastructure; a lack of financial support in supplying medication and employing human resources; insufficient knowledge of gerontological care and geriatric syndromes for both caregivers and residents; and lack of interest in being a caregiver at the ACHs as barriers in providing quality care. Moreover, caregivers and older people reported donations by philanthropists; supportive leadership; and welfare benefits from the government authorities as facilitators of quality care. Additionally, caregivers reported a lack of in-service programmes for caregivers as a barrier and positive institutional values as a facilitator for providing quality care.

CONCLUSION

The available human and physical resources are insufficient to address the demanding needs of residents in ACHs, apart from the received donations. There is a simultaneous need for healthcare policymakers' and social welfare authorities' attention to implementing necessary measures to uplift the quality of care for residents in ACHs to enhance their quality of life.

Psychological disturbances encountered by the healthcare professionals, military professionals and general public in Sri Lanka during COVID-19 pandemic: a cross-sectional study

BACKGROUND

The COVID-19 pandemic is a serious global health concern, posing a greater risk of psychological vulnerabilities for frontline healthcare workers (HCWs), military professionals and the general public around the globe. These psychological issues appear to be long lasting and heighten the risk of mental health disorders. Therefore, this study aimed to identify psychological problems encountered by HCWs, military professionals, and the general public in Sri Lanka during the COVID-19 pandemic.

METHODS

A descriptive cross-sectional study was undertaken with 367 participants, including frontline HCWs (n = 128), military professionals (n = 102), and the general public (n = 137). Depression and anxiety were assessed using the Peradeniya Depression Scale (PDS) and the Generalized Anxiety Disorder scale (GAD-7), respectively.

RESULTS

Mean (± SD) age of the participants was 35.0 (± 10.6) years. A reasonable proportion of participants experienced depressive symptoms (39.25%, n = 144) and severe anxiety (12.8%, n = 47). Military professionals showed depressive symptoms (73.50%, n = 75) and severe anxiety (32.4%, n = 33) predominantly. Multivariate binary logistic regression revealed that only the level of education and professional engagement affected depressive symptoms and severe anxiety (p < 0.01). Having a high level of education was a protective factor for depressive symptoms (Adjusted OR = 0.34) compared to lower-level education, while being a HCW (Adjusted OR = 4.40) and military professional (Adjusted OR = 5.43) were identified as risk factors for depressive symptoms compared to the general public. Similarly, having a high level of education was a protective factor for severe anxiety (Adjusted OR = 0.29) compared to lower-level education, while being a HCW (Adjusted OR = 3.90) and military professional (Adjusted OR = 4.52) were identified as risk factors for severe anxiety compared to the general public.

CONCLUSION

The current study revealed a greater level of anxiety and depressive symptoms among frontline HCWs and military professionals in Sri Lanka during the pandemic of COVID-19 compared to the general public. Therefore, providing psychological first aid for them to better deal with mental problems and an emergency preparedness plan to deal with sudden outbreaks of infectious situations are important.

Cultural Influence on Nurses' Pain Observations Related to Dementia: An Integrative Review

BACKGROUND

Nurses play a pivotal role in pain observation in people living with dementia. However, currently, there is little understanding of the influence culture may have on the way nurses observe pain experienced by people living with dementia.

AIM

This review explores the influence of culture on nurses... pain observations experienced by people living with dementia.

SETTINGS

Studies were included regardless of the setting (e.g., acute medical care, long-term care, community).

DESIGN

An integrative review.

PARTICIPANTS/SUBJECTS

PubMed, Medline, Psychological Information Database, Cochrane Library, Scopus, Web of Science, Cumulative Index of Nursing and Allied Health Literature, and ProQuest were included in the search.

METHODS

Electronic databases were searched using synonyms for "dementia," "nurse," "culture," and "pain observation." The review included ten primary research papers following the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines.

RESULTS

Nurses reported that pain observation in people living with dementia is challenging. Four themes were identified by data synthesis: (1) using behaviors for pain observation; (2) information from carers for pain observation; (3) pain assessment tools for pain observation; and (4) role of knowledge, experience, and intuition in pain observation.

CONCLUSIONS

There is a limited understanding of the role of culture on nurses' pain observations. However, nurses take a multifaceted approach to observing pain using behaviors, information from carers, pain assessment tools, and their knowledge, experience, and intuition.

Associated factors for cognition of physically independent elderly people living in residential care facilities for the aged in Sri Lanka

BACKGROUND

As the elderly population and prevalence of dementia is increasing, it is necessary to have a better comprehension of the influence of specific factors on cognitive function. Dementia is not an inevitable consequence of ageing. Lifestyle factors might either increase or decrease the risk. Even though different studies have focused on individual factors, only a few studies are available which assess all these factors as a whole. Available evidence on these factors is mainly from high income countries and much less evidence is available from low and middle income countries. As cognition is critical for elderly people to engage in a physically independent life, we aimed to identify the associated factors of cognition.

METHODS

This was a descriptive cross sectional study performed with 421 elderly people dwelling in residential care facilities for the aged in two selected districts in the Southern Province of Sri Lanka. Cognition was assessed using the Mini Mental State Examination (MMSE). Independent sample t test, ANOVA and regression analyses were used to explore associated factors for cognition. The statistical significance was kept at bonferroni adjusted p < 0.004.

RESULTS

The study included elderly people with a mean age of 71.9 ± 6.7 years and of them 65.8% were females. Factors affecting higher level of cognition were, having upper secondary, advanced and higher education; being married; arriving at the facility on one's own accord; being visited by family members; higher physical activity levels and engaging in social and leisure activities (p < 0.004). The factors, namely physical activity level, educational status, visits by family members and engaging in leisure activities were the predictors of cognition in the regression model.

CONCLUSION

Though there were several factors that associated with the level of cognition such as educational status, marital status, reason for attending the facility, visits by family members, physical activity levels and participation in social and leisure activities, only the factors, such as physical activity levels, visits by family members, educational status and engaging in leisure activities were the predictors of cognition.

Effect of cognitive and executive functions on perception of quality of life of cognitively normal elderly people dwelling in residential aged care facilities in Sri Lanka

BACKGROUND

Although cognitive functions affect the health related quality of life (QoL), the relationship between perceived QoL and cognition including executive functions has not been studied adequately. Available studies show moderate to weak correlations. We evaluated the association of cognition and executive functions, namely working memory (WM) and inhibitory control (IC) with the perceived QoL of a sample of elderly people dwelling in residential aged care facilities (RACFs) in Southern Province of Sri Lanka.

METHODS

Cognition was assessed using Mini-Mental State Examination (MMSE), while verbal WM (VWM), visuo-spatial WM (VSWM) and IC (interference control, inhibition of pre potent and ongoing responses) were assessed using VWM, VSWM tasks, colour word Stroop (CWS), go/no-go (GNG) and stop signal (SS) tasks respectively. WHOQoL-Bref (Total score and domain scores) were used to assess QoL. The relationship was analysed using Pearson correlation and hierarchical multiple regression analysis.

RESULTS

Study included 237 elderly people with a mean age of 71.11 ± 6.44 years. Participants scored the highest in the domain of environment (63.48 ± 10.63) and lowest in the domain of social relationships (55.43 ± 21.84) of QoL. Psychological health domain positively correlated with MMSE, VSWM and VWM scores and negatively correlated with CWS, SS and GNG task errors. Both physical health domain and total QoL demonstrated positive correlations with MMSE, VSWM and VWM scores, while negative correlations were observed with CWS task errors. Social relationships domain demonstrated a significant positive correlation with VSWM score. Environment domain positively correlated with MMSE, VSWM and VWM scores and negatively correlated with CWS and SS task errors. All were significant but weak correlations. When controlled for covariates, such as educational status, physical activity and marital status, cognition was a predictor of the domain of environment of QoL, while executive functions were not predictors of total QoL and domains of QoL.

CONCLUSION

Cognition and executive functions weakly but significantly correlated with different domains of QoL. Only the level of cognition measured by MMSE was a predictor of the domain of environment of QoL and executive functions were not predictors of total QoL and domains of QoL in elderly people with normal cognitive functions dwelling in RACFs.