Aims To synthesize and evaluate the effectiveness of interventions for nurses to improve the assessment and management of pain in people living with dementia. Design Systematic review and meta‐analyses of randomized controlled trials. Data sources CINAHL, Joanna Briggs Institute (JBI) EBP, Cochrane Library, PubMed, and Scopus databases were searched for all journal articles published between 2009 ‐2019. Review methods Papers were included under population intervention comparator outcome (PICO) framework for: (a) people living with dementia aged 65 years and over; (b) interventions developed for nurses or other health professionals; (c) comparison group of standard care or control; and (d) outcome that measures the intervention effects on nurses and people living with dementia. Independent reviewers undertook critical appraisal, data abstraction, and synthesis. Meta‐analyses were performed to determine the effectiveness of interventions. Results Of 2099 titles and abstracts screened, six interventions with low‐to‐moderate risk of bias met inclusion criteria. Studies that implemented a routine pain assessment tool showed no effect on nurses’ analgesic management. Studies that developed a comprehensive pain model involving multidisciplinary health professionals showed overall effects on pain assessment and management in dementia care. Physician involvement had an impact on analgesic management. Conclusion Comprehensive pain models improve nurses’ pain assessment and management. A lack of balance between analgesia use and non‐pharmacological pain management in dementia care is evident. Multidisciplinary health professionals’ involvement is essential for effective intervention design for pain management in dementia. Impact Various pain assessment tools have been considered to assist identification and management of pain in people living with dementia. Nevertheless, challenges exist when caring for people living with dementia in pain. These findings support the development of a comprehensive pain model, which may be a more effective strategy than routine use of a pain tool alone for nurses to improve pain management in dementia care.

Aim: To evaluate nurses' documented practice when communicating about pain for people with dementia in hospital.Design: Retrospective medical record review.Method: Medical records were retrieved from four inpatient units in a district and a tertiary teaching hospital of people aged 65 years and over with documented dementia. Data were extracted on nurses' documented pain assessment and management.Pain frequency and association between patient self-report, pain scores, cognition levels and analgesics used during hospitalization were analysed using descriptive and inferential statistics. Multivariate regression examined patient characteristics, pain characteristics and length of hospital stay.Results: One-hundred patient records met the inclusion criteria between 1 January and 31 August 2017. Sixty-six percent of patients with dementia had pain documented at least once during hospitalization with 58% reported as moderate to severe pain intensity. Patients' pain severity during admission was associated with their length of hospital stay. Ninety-three percent of nurses used a self-reporting pain tool and 7% used an observational pain tool. Pain scores were not associated with patients' cognition level, nurses' pain reports or analgesic management. Conclusion:Pain frequently occurs in people with dementia during hospitalization. Fragmented pain reporting influences the translation of pain messages.Disproportionate pain tool application and non-association between pain scores and analgesic management suggest a potential knowledge gap among nurses about the practical use of pain tools and practice gap between pain assessment and management in dementia care.Impact: Pain was regularly assessed by nurses and implemented as a fifth vital sign for people with dementia in hospitals. However, the high frequency of pain affects care outcomes. Areas for improvement include nursing practice of pain assessment and management in dementia care in hospitals. Further understanding of the usefulness of pain tools and the efficacy of pain scores when communicating about pain in dementia care in hospitals is required.

Objective To explore nurses' perspectives and generate recommendations for nursing practice of pain assessment and management in dementia care in a hospital setting. Methods Semi‐structured face‐to‐face interviews were conducted with nurses who had experience in dementia care from two care units of a regional hospital. Data were analysed using six phases of reflexive thematic analysis. Results Eight nurses from two inpatient units of a local district hospital were interviewed. Five themes were identified: (1) ways of understanding, (2) practicality of pain assessment tools, (3) usefulness of pain scores, (4) analgesia use and (5) limitations to practice. Nurses perceived pain tools did not sufficiently help to assess pain in people with dementia, and adaptation was often needed when scoring pain. Overuse of analgesia, trial‐and‐error practice and delayed prescriptions for analgesia limited pain management effectiveness for people with dementia during hospitalisation. Conclusions Pain tools are preferably used as a complementary method in addition to nurses' intuitional judgement. Reporting pain via scores requires a more complete narrative description from the source of pain reports to allow clinicians to accurately report a persons' pain. Clinicians must minimise trial‐and‐error practice in analgesia by conducting comprehensive pain assessments. Health‐care organisations need to foster timely collaboration between clinicians to support nurses' practice limitations for effective analgesia administration in dementia care.