Pain Management Decision Making Among Long-Term Care Physicians and Nurses

Kaasalainen, Sharon; Coker, Esther; Dolovich, Lisa; Παπαϊωάννου, Αλεξάνδρα; Hadjistavropoulos, Thomas; Emili, Anna; Ploeg, Jenny

doi:10.1177/0193945906295522

Cited by 112 publications

(129 citation statements)

References 23 publications

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“…making strategies for pain management in nursing homes and long term care facilities internationally (Gilmore-Bykovskyi and Bowers, 2013, Kaasalainen et al, 2007). The process of pain assessment and management took place in a context which is reliant on effective communication; where the patient needs to be able to communicate their pain and where there is a nurse available to receive that communication.…”

Section: Discussionmentioning

confidence: 99%

Using sense-making theory to aid understanding of the recognition, assessment and management of pain in patients with dementia in acute hospital settings

Dowding

Lichtner

Allcock

et al. 2016

International Journal of Nursing Studies

118

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Background: The recognition, assessment and management of pain in hospital settings is suboptimal, and is a particular challenge in patients with dementia. The existing process guiding pain assessment and management in clinical settings is based on the assumption that nurses follow a sequential linear approach to decision making. In this paper we re-evaluate this theoretical assumption drawing on findings from a study of pain recognition, assessment and management in patients with dementia. Aim:To provide a revised conceptual model of pain recognition, assessment and management based on sense-making theories of decision making. Methods:The research we refer to is an exploratory ethnographic study using nested case sites. Patients with dementia (n= 31) were the unit of data collection, nested in 11 wards (vascular, continuing care, stroke rehabilitation, orthopaedic, acute medicine, care of the elderly, elective and emergency surgery), located in four NHS hospital organizations in the UK. Data consisted of observations of patients at bedside (170 hours in total); observations of the context of care; audits of patient hospital records; documentary analysis of artefacts; semi-structured interviews (n=56) and informal open conversations with staff and carers (family members).Findings: Existing conceptualizations of pain recognition, assessment and management do not fully explain how the decision process occurs in clinical practice. Our research indicates that pain recognition, assessment and management is not an individual cognitive activity; 2 rather it is carried out by groups of individuals over time and within a specific organizational culture or climate, which influences both health care professional and patient behavior. Conclusions:We propose a revised theoretical model of decision making related to pain assessment and management for patients with dementia based on theories of sense-making, which is reflective of the reality of clinical decision making in acute hospital wards. The revised model recognizes the salience of individual cognition as well as acknowledging that decisions are constructed through social interaction and organizational context. The model will be used in further research to develop decision support interventions to assist with the assessment and management of patients with dementia in acute hospital settings.

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Section: Discussionmentioning

confidence: 99%

Using sense-making theory to aid understanding of the recognition, assessment and management of pain in patients with dementia in acute hospital settings

Dowding

Lichtner

Allcock

et al. 2016

International Journal of Nursing Studies

118

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“…Workload and lack of time have been identified as barriers to optimal pain management practices (Dalton et al, 2001;Kaasalainen et al, 2007;Pack-Mabien et al, 2001;Schafheutle et al, 2001). Kaasalainen et al (2007) explored the decision-making process of physicians and nurses in pain management for older adults with cognitive impairment.…”

Section: Contextual Influencesmentioning

confidence: 99%

“…Kaasalainen et al (2007) explored the decision-making process of physicians and nurses in pain management for older adults with cognitive impairment. The results revealed that nurses were constantly working under immense pressure to meet the demands of their workload and had difficulty including time to adequately assess patients' pain or provide psychosocial support.…”

Section: Contextual Influencesmentioning

confidence: 99%

An Ethnography of the Culture of Pain in a Non-Pediatric Emergency Department

Cummings¹

2013

Journal of Pediatric Health Care

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Rationale for the Study: Despite the exponential growth in pharmacological and nonpharmacological methods for the treatment of pediatric procedural pain there remains a gap between available interventions and actual practice in the emergency department clinical setting. Researchers have recommended the examination of unit culture since culture is proposed to be a major factor that affects the implementation of pain management practices. Method:Ethnography was employed to gain access to the beliefs and practices of healthcare participants in a Northeastern non-pediatric emergency department. Data were collected for 5 months with over 100 hours of observation. Six key informants were interviewed and 44 pediatric procedural interactions with 27 healthcare providers during the treatment of children two to eight years of age undergoing procedures were observed.Other information gathered included documents from the institution, and pain related information from the patient's medical record. All interviews were recorded and transcribed verbatim. Data were managed using the Ethnograph 6.0 and analyzed using the procedure developed by Leininger and McFarland (2006). Results:Seven major themes with categories were discovered that included assessment, ii procedural pain, treatment of pain, communication related to comfort, fragmentation of care in the emergency department, healthcare provider attitudes, and environmental issues and policies. Conclusion:The results of this study suggest that practice environment of the emergency department and organizational culture exerted a significant degree of influence over healthcare providers' pediatric pain management practices. Nurses' did not use pain measurement tools as they were intended to be used and instead improvised measurement by observing the child's behavior. The management of children during painful procedures consisted of an array of behaviors and practices. The use of physical restraint during painful procedures was a common practice. Participants continue to hold many assumptions and misconceptions about pediatric pain assessment and management. The findings of this study provide insight to the everyday practice of emergency department healthcare providers for pediatric pain in a non-pediatric setting.iii Acknowledgments and Dedication

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“…Dette vil kunne føre til økt avhengighet av andre, ensomhet og økt bruk av det offentlige helsetilbudet (15). Det er også avdekket at pasienter underrapporterer smerte og ber heller ikke om hjelp til smertelindring (16 sepersonell gir for lite smertestillende til eldre på grunn av redsel for bivirkninger (17,18). Det er også beskrevet kjønnsforskjeller med hensyn til smerterapportering (19,20) og medikamentbruk (21), hvor eldre kvinner rapporterer mer smerte enn menn og har et høyere forbruk av opioider og sedativer (22).…”

Section: Bakgrunnunclassified

“…Resultatene det her refereres til, gjelder legemiddelhåndtering generelt. Vi mener at resultatene kan overføres til smertebehandling, da barrierene synes å vaere de samme (18). Årsaker til underbehandling av smerte kan også tilskrives at pasientene underrapporterer smerten.…”

Section: Variablerunclassified