The Role of Nurses' Uncertainty in Decision-Making Process of Pain Management in People with Dementia.

Mohammad Rababa

doi:10.1155/2018/7281657

Abstract

Pain in people with dementia (PWD) is underassessed and undertreated. Treatment of pain in people with dementia goes awry because of poor assessment, poor treatment, and factors related to nursing decision-making skills. Several theoretical models addressed the role of nurses' critical thinking and decision-making skills in pain treatment, like the cognitive continuum theory (CCT) and the adaptive pain management (APT). Only the Response to Certainty of Pain (RCP) model was the first model to posit relationships between nurses' uncertainty, pain assessment, and patient outcomes. Gilmore-Bykovskyi and Bowers developed the RCP, which incorporates the concept of uncertainty and how it relates to the problem of unrelieved pain in PWD. The RCP model has the potential to provide good understanding of the problem of unrelieved pain in people with dementia. It also could help to develop a research study that brings comfort to an often neglected and vulnerable population.

Highlights

Pain is one of the most prevalent problems in the elderly; pain affects approximately 20% of the elderly population [1]
The purpose of this paper is to provide a brief overview of evidence related to poor assessment and poor treatment of pain in people with dementia (PWD) and to describe in more detail nurses’ critical thinking and decision-making, with a description and explanation of how the Response to Certainty of Pain (RCP) model [12] may help elucidate how nurse uncertainty regarding suspected pain drives assessment and predicts patient outcomes
While the adaptive pain management (APM) theory identifies the best choice of pain treatment in elderly patients and demonstrates a decision support system based on dynamic programming process, the process implies that nurse should continually adapt and readapt the treatment to the patient [32]

Summary

Introduction

Pain is one of the most prevalent problems in the elderly; pain affects approximately 20% of the elderly population [1]. Fifty-six of community-dwelling older adults and 70% of nursing home residents have pain [3] This high prevalence of pain among older adult patients is explained in part by physiological age-related changes and comorbid problems that happen in later life (Gibson and Lussier, 2012; [2, 4]). Despite the high prevalence of pain among older adults, people with dementia (PWD) appear to be at great risk of poor treatment of pain because they have difficulty communicating their unmet comfort needs [6]. Nurses may start with nonpharmacological treatment to address pain in PWD and delay analgesics The reason for this is that nurses may have misconceptions about behavioral symptoms of pain in PWD. Despite nurses’ efforts to treat pain in PWD, they may feel frustrated with this group of older adults who have difficulty verbalizing their pain [25]

Critical Thinking and Decision-Making

Background of Decision-Making Theory

Uncertainty and Pain Assessment

Findings

Conclusion