Documented nursing practices of pain assessment and management when communicating about pain in dementia care

Abstract

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.

Practices and Behaviors Regarding the Use of Analgesics

“…Importantly, the lack of education and recommendations regarding analgesics from health professionals is very concerning, as there's a risk of potentially life-threatening analgesic-induced adverse effects, especially as a high percentage were using two Non-steroidal anti-inflammatory drugs (NSAIDs) concomitantly. Knowledge of these practices gained through this study could allow for the development and implementation of corrective strategies to promote education and safe practice of analgesic use in runners (Tsai et al, 2022), (Grézy-Chabardès et al, 2015), (Daifallah et al, 2021), (AlSaeed & Elmaghraby, 2021), (Jankovic et al, 2019), (Pareek, 2022), (Mostafa et al, 2022), (Khetarpal et al, 2021).…”

“…Rational use of Analgesics (RUA) project investigated the current clinical practices to manage pain in patients with cancer in Italy by gathering the opinion of almost 200 Italian specialists working in the palliative care field (Varrassi et al, 2021). Disproportionate pain tool application and nonassociation between pain scores and analgesic management suggest a potential knowledge gap among nurses about the practical (Tsai et al, 2022). Self-medication was seen as a widespread phenomenon.…”

Nurses’ Assessments Versus Patients’ Self-Assessments of Postoperative Pain: Knowledge and Skills of Nurses for Effective Pain Management

“…Subjective pain assessment includes one-dimensional and multidimensional tools. The most commonly used one-dimensional tools in the assessment of acute pain intensity are visual analogue scales; verbal, graphic, and numeric rating scales; pain flow diagrams; computer graphics; and pictorial scales [18,19], as such scales are fast, accurate, easy to use, and understandable. In the acute pain model, it is recommended to systematically introduce a numeric or visual scale when assessing the intensity of postoperative acute pain [20].…”

“…In Dijkers' longitudinal study [21], significant differences in the use of VRS and NRS scales were observed among neurosurgical patients, as well as a lack of understanding of the meaning of the VRS scale among certain patients. Multidimensional tools [19] can provide information on the qualitative and quantitative aspects of pain and may be useful in cases of suspected neuropathic pain.…”

“…Quality assurance programs must include an assessment of the quality of healthcare (effectiveness and monitoring of indicators, adverse events), recognition of problems, and analysis of weak points by comparing them to standards. After analysis, proposals are necessary for overcoming the problems and continuous monitoring of success [19]. There are several components of quality assurance for pain management [1], such as general healthcare conditions that include the qualification of healthcare professionals, the quality of the equipment, and organisational financial opportunities of the organisation.…”