Pain Assessment In Dementia Research Articles

Nurses' Beliefs About Pain Assessment in Dementia: A Qualitative Study Informed by the Theory of Planned Behaviour.

To explore registered nurses' beliefs regarding pain assessment in people living with dementia. A descriptive exploratory qualitative study informed by the Theory of Planned Behaviour. Online semi-structured in-depth interviews were conducted from January to April 2023 with a purposive sample of 15 registered nurses caring for people with dementia. Following transcription, data were analysed using direct content analysis. Registered nurses believe pain assessment improves the well-being of people with dementia and informs and evaluates practice. However, there is a possibility of misdiagnosing pain as agitation or behavioural problems, leading to inaccurate pain management. Interpersonal factors, such as registered nurses' knowledge and experience, beliefs and motivation to improve care provision, were the primary facilitators of pain assessment. Physical and behavioural dimensions of the pain of the dementia syndrome were the most reported barriers to pain assessment. Registered nurses reported that multidisciplinary team members expect them to do pain assessments. Most did not experience disapproval when performing pain assessments. Registered nurses hold beliefs about pain assessment benefits, consequences, enablers, barriers, approvals and disapprovals regarding dementia. The findings could inform interventions to enhance pain assessment practices. Policymakers should provide education opportunities for registered nurses to improve their knowledge, skills and beliefs about pain assessment in dementia. Future research should develop and implement multidisciplinary, multifaceted pain assessment protocols to enhance the accuracy of pain assessment practices. Pain is underassessed in dementia, and this could stem from registered nurses' beliefs about pain assessment in dementia. The findings could inform interventions to enhance pain assessment beliefs and practices. This study adhered to the COREQ criteria. Registered nurses caring for people living with dementia participated as interview respondents.

Factors related to nurses' beliefs regarding pain assessment in people living with dementia.

To evaluate registered nurses' beliefs and related factors regarding pain assessment in people living with dementia. A descriptive cross-sectional survey was conducted between July 2022 and April 2023. An online survey comprised of demographics, knowledge scale, and beliefs scale relating to pain assessment in dementia was distributed to registered nurses (RNs) caring for people living with dementia in Australia. RNs (N = 131) completed the survey. Most respondents were females (87.0%) and self-identified as Caucasian (60.3%). The mean beliefs score was 72.60 (±6.39) out of a maximum possible score of 95. RNs' beliefs about pain assessment varied based on their education, dementia pain assessment knowledge, nursing experience, and ethnicity. Hierarchical multiple regression analysis revealed factors significantly related to the beliefs score (i.e. education and dementia pain assessment knowledge). The relationship between education and knowledge, and the beliefs score indicates the potential to improve RNs' knowledge and overcome their erroneous beliefs about pain assessment in dementia. Education and training in assessing pain in people living with dementia should be tailored to overcome RNs' misconceived beliefs. These programmes should be integrated into continuous learning programmes. Some RNs' beliefs about pain assessment in dementia were not evidence-based, and knowledge and educational status were the strongest factors related to RNs' beliefs. RNs' erroneous beliefs about pain assessment in dementia need to be addressed to improve pain assessment and management. Researchers should explore the potential of educational interventions to overcome RNs' misconceived beliefs about pain assessment in dementia. This study was reported adhering to the Strengthening the Reporting of Observational Studies in Epidemiology checklist. RNs caring for people living with dementia participated as survey respondents. Additionally, RNs were involved in the pre-testing of the study's survey instrument.

Pain Assessment in Dementia: Evaluation of a Point-of-Care Technological Solution.

Pain is common among people with moderate to severe dementia, but inability of patients to self-report means it often goes undetected and untreated. We developed the electronic Pain Assessment Tool (ePAT) to address this issue. A point-of-care App, it utilizes facial recognition technology to detect facial micro-expressions indicative of pain. ePAT also records the presence of pain-related behaviors under five additional domains (Voice, Movement, Behavior, Activity, and Body). In this observational study, we assessed the psychometric properties of ePAT compared to the Abbey Pain Scale (APS). Forty aged care residents (70% females) over the age of 60 years, with moderate to severe dementia and a history of pain-related condition(s) were recruited into the study. Three hundred and fifty-three paired pain assessments (either at rest or post-movement) were recorded and analyzed. The ePAT demonstrated excellent concurrent validity (r = 0.882, 95% CI: 0.857–0.903) and good discriminant validity. Inter-rater reliability score was good overall (weighted κ= 0.74, 95% CI: 0.68–0.80) while internal consistency was excellent. ePAT has psychometric properties which make it suitable for use in non-communicative patients with dementia. ePAT also has the advantage of automated facial expression assessment which provides objective and reproducible evidence of the presence of pain.

Nurses' knowledge and attitudes towards pain assessment for people with dementia in a nursing home setting.

The aim of this study was to determine nurses' knowledge and attitudes towards pain assessment for people with dementia in a nursing home setting. Pain is highly prevalent among older people, yet is often under-recognised and undertreated in people with dementia. People with dementia can lose the ability to report pain and it is the role of the nurse to identify and appropriately assess pain, to provide effective treatment. This requires nurses to have sufficient knowledge and training in the assessment and management of pain in residents with dementia; however, research suggests deficits in this area. A cross-sectional survey design was used to determine nurses' knowledge and attitudes to pain assessment in dementia. A questionnaire comprising three sections was distributed to 96 registered nurses across 17 nursing homes in a health-care trust in a UK region. A total of 32 responses were obtained (response rate 33%). The majority of nurses had a good knowledge in relation to the assessment and management of pain in residents with dementia. There was, however, some uncertainty among nurses over analgesic choice, the safety of opioid use in dementia, and the use of dementia-specific pain assessment tools for residents with no cognitive impairment. The main barriers to effective pain assessment for older people with dementia were workload pressures, poor staffing and lack of medical support. This study highlights the need to develop pain education programmes and clear guidance specifically designed for nurses caring for older people with dementia. It also emphasises the need for better communication and co-ordination of pain treatment for nursing home residents with dementia.

Palliative care in dementia: literature review of nurses' knowledge and attitudes towards pain assessment.

Pain is prevalent among older people, yet is often under-recognised and undertreated in people with dementia. The nurse has a central role in identifying and appropriately assessing pain in order to provide effective treatment. Research however suggests there are significant deficits in this area. To explore the evidence on nurses' knowledge and attitudes to pain assessment in older people with dementia. A systematic narrative review of peer-reviewed articles published between 2000 and 2014. Seven electronic data bases (CINAHL, MEDLINE, PsycInfo, Wiley, Pubmed, ProQuest and OVID) were searched and articles focusing on nurses knowledge and attitudes on pain assessment towards people with dementia. Research participants within the studies reviewed were to include registered nurses involved in the assessment and management of pain in older adults with dementia from across all healthcare settings (e.g. dementia units, nursing homes, community and acute settings). Data were systematically analysed from 11 papers. Using an inductive approach for thematic content analysis informed by the theory of planned behaviour, five themes were identified. These included: 1) Challenges in diagnosing pain in dementia 2) Inadequacies of pain assessment tools 3) Time constraints and workload pressures 4) Lack of interdisciplinary teamwork and communication 5) Training and education. Nurses play a key role in the effective management of pain through the use of pain assessment tools, behavioural observation, and analgesic choice. Pain assessment in dementia remains challenging for nurses due to the complexity and individualisation of pain behaviours. The accessibility of appropriate training, workforce stability and a standardised approach to pain assessment are key to the successful management of pain in older people with dementia.

Loss in Executive Functioning Best Explains Changes in Pain Responsiveness in Patients with Dementia-Related Cognitive Decline.

There is ample evidence that dementia changes the processing of pain. However, it is not known whether this change in pain processing is related to the general decline in cognitive functioning or whether it may be related to specific domains of cognitive functioning. With the present study we tried to answer this question. We assessed different cognitive domains (orientation, memory, abstract thinking/executive function, aphasia and apraxia, and information processing speed) in 70 older patients with cognitive impairment (mild cognitive impairment up to moderate degrees of dementia). Pain responsiveness was assessed by measuring the nociceptive flexion reflex (NFR) threshold and facial responses to noxious electrical stimulation. Using regression analyses, we assessed which domain of cognitive functioning best predicted variance in pain responsiveness. Variance in pain responsiveness (NFR and facial expressions) was best explained by those items assessing executive functioning even when controlling for overall cognitive performance and memory functioning. The close association between executive functioning and pain responsiveness suggests that dementia-related neurodegeneration in prefrontal areas might result not only in reduced executive functioning but also in a loss of pain inhibitory potency, rendering the patient more vulnerable to pain. Our findings also suggest that pain assessment in dementia should be regularly completed by tests of cognitive functions.