Decision Factors Nurses Use to Assess Pain in Nursing Home Residents With Dementia

Monroe, Todd B.; Parish, Abby Luck; Mion, Lorraine C.

doi:10.1016/j.apnu.2015.05.007

Cited by 46 publications

(56 citation statements)

References 26 publications

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“…Difficulties in dealing with behaviors likely relate to difficulties in communication, and both require familiarity with the individual (Bolt, van der Steen, Schols, Zwakhalen, Pieters, & Meijers, 2019). Certain behaviors may be due to underlying pain (Malara et al, 2016;Pieper et al, 2013), and communication difficulties leave staff unsure about interpreting individual care needs (Midtbust, Alnes, Gjengedal, & Lykkeslet, 2018a;Monroe, Parish, & Mion, 2015). The finding that nursing staff want to devote personal attention and make a connection with the individual further supports previous statements about the importance of a person-centered approach in dementia care (Kitwood & Bredin, 1992) and in palliative care for persons with dementia (Bolt, van der Steen, Schols, Zwakhalen, Pieters, & Meijers, 2019;van der Steen et al, 2014).…”

Section: Discussionmentioning

confidence: 99%

Nursing Staff Needs in Providing Palliative Care for Persons With Dementia at Home or in Nursing Homes: A Survey

Bolt

Meijers

Steen

et al. 2020

J of Nursing Scholarship

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Purpose This study aimed to evaluate what types and forms of support nursing staff need in providing palliative care for persons with dementia. Another aim was to compare the needs of nursing staff with different educational levels and working in home care or in nursing homes. Design A cross‐sectional, descriptive survey design was used. Methods A questionnaire was administered to a convenience sample of Dutch nursing staff working in the home care or nursing home setting. Data were collected from July through October 2018. Quantitative survey data were analyzed using descriptive statistics. Data from two open‐ended survey questions were investigated using content analysis. Findings The sample comprised 416 respondents. Nursing staff with different educational levels and working in different settings indicated largely similar needs. The highest‐ranking needs for support were in dealing with family disagreement in end‐of‐life decision making (58%), dealing with challenging behaviors (41%), and recognizing and managing pain (38%). The highest‐ranking form of support was peer‐to‐peer learning (51%). If respondents would have more time to do their work, devoting personal attention would be a priority. Conclusions Nursing staff with different educational levels and working in home care or in nursing homes endorsed similar needs in providing palliative care for persons with dementia and their loved ones. Clinical Relevance It is critical to understand the specific needs of nursing staff in order to develop tailored strategies. Interventions aimed at increasing the competence of nursing staff in providing palliative care for persons with dementia may target similar areas to support a heterogeneous group of nurses and nurse assistants, working in home care or in a nursing home.

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Section: Discussionmentioning

confidence: 99%

Nursing Staff Needs in Providing Palliative Care for Persons With Dementia at Home or in Nursing Homes: A Survey

Bolt

Meijers

Steen

et al. 2020

J of Nursing Scholarship

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“…In the USA, over 61% of aged care residents have moderate-to-severe cognitive impairment [11]. Nursing staff have reported difficulty in detecting pain in these residents, and even with experience they remain poor at interpreting facial expressions indicative of pain [12, 13]. Moreover, there is evidence that even interdisciplinary evaluation of pain fails to assess pain correctly [14].…”

Section: Introductionmentioning

confidence: 99%

Psychometric Evaluation of the Electronic Pain Assessment Tool: An Innovative Instrument for Individuals with Moderate-to-Severe Dementia

Atee

Hoti

Hughes

2017

Dement Geriatr Cogn Disord

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Background/Aims: Pain is common in aged care residents with dementia; yet it often goes undetected. A novel tool, the electronic Pain Assessment Tool (ePAT), was developed to address this challenging problem. We investigated the psychometric properties of the ePAT. Methods: In a 10-week prospective observational study, the ePAT was evaluated by comparison against the Abbey Pain Scale (APS). Pain assessments were blindly co-performed by the ePAT rater against the nursing staff of two residential aged care facilities. The residents were assessed twice by each rater: at rest and following movement. Results: The study involved 34 residents aged 85.5 ± 6.3 years, predominantly with severe dementia (Psychogeriatric Assessment Scale – Cognitive Impairment score = 19.7 ± 2.5). Four hundred paired assessments (n = 204 during rest; n = 196 following movement) were performed. Concurrent validity (r = 0.911) and all reliability measures (κ_w = 0.857; intraclass correlation coefficient = 0.904; α = 0.950) were excellent, while discriminant validity and predictive validity were good. Conclusion: The ePAT is a suitable tool for the assessment of pain in this vulnerable population.

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Section: Discussionmentioning

confidence: 99%

“…Detecting pain is challenging in people with dementia who do not have intellectual disability (Barry, Parsons, Passmore, & Hughes, ; Cohen‐Mansfield, ) and is a significant quality of life and quality of care issue if poorly treated (Monroe, Parish, & Mion, ). People with dementia with and without intellectual disability experience similar challenges in pain assessment and treatment, as dementia advances, they lose the ability to self‐report their pain, and nurses are uncertain about the pain experiences of the people they care for (Monroe et al, ). There is a reliance on self‐reporting of pain (McAuliffe, Nay, O'Donnell, & Fetherstonhaugh, ), and the impact of cognitive decline associated with dementia added to any pre‐existing communication challenges often results in the person with intellectual disability and dementia not being able to express their pain experience to their carers (Cleary & Doody, ; Fahey‐McCarthy et al, ).…”

Section: Discussionmentioning

confidence: 99%

“…It is evident that nurses caring for people with intellectual disability often lack knowledge about ageing, dementia and pain (Beacroft & Dodd, 2011;Doody & Bailey, 2017;McGuire & Kennedy, 2013). For nurses to provide true person-centred care, they require knowledge of age- 2015; Cohen-Mansfield, 2014) and is a significant quality of life and quality of care issue if poorly treated (Monroe, Parish, & Mion, 2015). People with dementia with and without intellectual disability experience similar challenges in pain assessment and treatment, as dementia advances, they lose the ability to self-report their pain, and nurses are uncertain about the pain experiences of the people they care for (Monroe et al, 2015).…”

Section: Discussionmentioning

confidence: 99%

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Nursing people with intellectual disability and dementia experiencing pain: An integrative review

Dillane¹,

Doody

2019

Journal of Clinical Nursing

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Aims and objectives To explore the current evidence of nurses caring for people with intellectual disability and dementia who experience pain. Background People with intellectual disability are ageing and are experiencing age‐related health conditions including dementia and conditions associated with pain, but at an earlier age. Addressing the needs of people with intellectual disability who develop dementia is a new challenge for nurses. Design An integrative literature review. Methods A systematic search of databases: CINAHL, MEDLINE, PsycINFO, Cochrane, EMBASE, Academic Search Complete, Scopus and Web of Science between 27 October 2017–7 November 2017. Hand searching and review of secondary references were also undertaken. Quality appraisal (Crowe Critical Appraisal Tool), thematic data analysis (Braun and Clarke, Qualitative Research in Psychology, 3, 2006, 77) and reporting using the PRISMA guidelines. Results Seven papers met the inclusion criteria, and three themes emerged from this review: nurses knowledge of ageing, dementia and pain; recognising pain in people with intellectual disability and dementia; and the role of nurse education. People with intellectual disability and dementia have difficulty communicating their pain experience compounded by pre‐existing communication difficulties. Conclusions A pain experience can present similar to behavioural and psychological symptoms of dementia, and diagnostic overshadowing often occurs whereby a pain need is misinterpreted as behavioural and psychological symptoms resulting in inappropriate treatment. Nurses need greater knowledge about the presence of pain and potential causes in people with intellectual disability and dementia, and education can be effective in addressing this knowledge deficit. Relevance to clinical practice Pain assessment tools for people with intellectual disability and dementia need to include behavioural elements, and baseline assessments are required to identify changes in presentation. Nurses need to recognise and respond to pain based on the evidence in order to deliver quality care.

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Decision Factors Nurses Use to Assess Pain in Nursing Home Residents With Dementia

Cited by 46 publications

References 26 publications

Nursing Staff Needs in Providing Palliative Care for Persons With Dementia at Home or in Nursing Homes: A Survey

Nursing Staff Needs in Providing Palliative Care for Persons With Dementia at Home or in Nursing Homes: A Survey

Psychometric Evaluation of the Electronic Pain Assessment Tool: An Innovative Instrument for Individuals with Moderate-to-Severe Dementia

Nursing people with intellectual disability and dementia experiencing pain: An integrative review

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