Use Of Pain Assessment Tools Research Articles

The challenge of pain identification, assessment, and management in people with dementia: a qualitative study.

BackgroundPainful conditions are common in older adults, including people with dementia. The symptoms associated with dementia (for example, diminished language capacity, memory impairment, and behavioural changes), however, may lead to the suboptimal identification, assessment, and management of pain. Research has yet to qualitatively explore pain management for community-dwelling people with dementia.AimTo explore pain identification, assessment, and management for community-dwelling people with dementia.Design & settingA qualitative study was undertaken, set in England.MethodSemi-structured interviews took place with people with dementia, family caregivers, GPs, and old-age psychiatrists. Data were analysed thematically.ResultsInterviews were conducted with eight people with dementia, nine family caregivers, nine GPs, and five old-age psychiatrists. Three themes were identified that related to pain identification and assessment: gathering information to identify pain; the importance of knowing the person; and the use of pain assessment tools. A further three themes were identified that related to pain management: non-drug strategies; concerns related to analgesic medications; and responsibility of the caregiver to manage pain.ConclusionIdentifying and assessing the pain experienced by people with dementia was challenging. Most people with dementia, family caregivers, and healthcare professionals supported non-drug strategies to manage pain. The minimal concerns associated with non-drug strategies contrasted the multifactorial concerns associated with analgesic treatment for people with dementia. Given the complexity of pain identification, assessment, and management, primary care should work together with family caregivers and community services, with case finding for pain being considered in all assessment and management plans.

A Psychometric Analysis Update of Behavioral Pain Assessment Tools for Noncommunicative, Critically Ill Adults.

This is an updated, comprehensive review of the psychometric properties of behavioral pain assessment tools for use with noncommunicative, critically ill adults. Articles were searched in 5 health databases. A total of 106 articles were analyzed, including 54 recently published papers. Nine behavioral pain assessment tools developed for noncommunicative critically ill adults and 4 tools developed for other non-communicative populations were included. The scale development process, reliability, validity, feasibility, and clinical utility were analyzed using a 0 to 20 scoring system, and quality of evidence was also evaluated. The Behavioral Pain Scale, the Behavioral Pain Scale-Nonintubated, and the Critical-Care Pain Observation Tool remain the tools with the strongest psychometric properties, with validation testing having been conducted in multiple countries and various languages. Other tools may be good alternatives, but additional research on them is necessary.

Knowledge and practice regarding neonatal pain management in the opinion of nurses and midwives working in Polish neonatal units

Nurses and midwives working in neonatal units play a key role in the assessment and treatment of pain. Due to their nature of work, which is based on continuous observation of the patient, they constitute a professional group that responds to changes in the child’s general condition. Thanks to this, the physicians get information about pain intensity or the need of pain treatment, which is relevant among patients who cannot report any symptoms of pain by themselves. The aim of the study was to describe nurses’ and midwives’ basic knowledge about pain and the practice regarding procedural pain assessment and management in Polish neonatal care units. The studies were carried out among 617 nurses and midwives working in neonatal units in Poland. We collected data by using a researcher-developed questionnaire. The significance level was set at p<0.5. 30% of nurses never used nonpharmacological methods of pain relief before painful procedures. Moreover, the higher the level of reference, the more often no non-pharmacological methods were used. Knowledge related to the basic problems associated with pain can be described as insufficient (Me = 4). Frequent use of sedation drugs has also been reported (III level NICU: phenobarbital per os/per rectum 72.8% of respondents, opioids – 34.9%, II level NICU: phenobarbital per os/ per rectum 45.2%, opioids: 4.5%). The longer nurses and midwives worked, the lower the frequency of use of pain assessment tools was (p = 0.0048, R = -0.113). The lack of appropriate pharmacological and non-pharmacological pain treatment and lack of use of pain scales are a significant problem in the care of newborns. Our research indicates the need for education in the field of pain assessment and treatment methods in newborns.

Nurses' Assessment Practices of Pain Among Critically Ill Patients

BackgroundSystematic pain assessment is necessary to ensure effective pain management. Despite the availability of recommendations, guidelines, and valid tools for pain assessment, the actual implementation in clinical practice is inconsistent. AimsThe purpose of this study was to investigate intensive care nurses’ pain assessment practices among critically ill patients in Jordanian hospitals. DesignA descriptive cross sectional design was used in this study. SettingsThis study was conducted in 22 intensive care unites located in eight hospitals in Jordan. Participants/SubjectsConvenience sampling was used to recruit a sample of 300 nurses working in intensive care units. MethodsThe Pain Assessment and Management for the Critically Ill survey was used to collect data. Descriptive statistics, χ2, and correlational analysis were used to analyze data. ResultsA total of 89.7% of nurses (N = 300) used pain assessment tools with patients able to communicate, and the numeric rating scale was the most commonly used tool. A total of 81.7% of the nurses used a pain assessment tool with patients unable to communicate, and the Adult Nonverbal Pain Scale was the most commonly used tool. Nurses’ perceived importance of pain assessment was positively associated with frequent use of pain assessment tools. Nurses perceived the use of pain assessment tools for patients able to communicate as being more important than the use of pain assessment tools for patients unable to communicate. ConclusionsThe majority of intensive care unit nurses used pain assessment tools for patients both able and unable to communicate; however, the most valid and reliable tools were not used often. Nurses were not aware of the pain behaviors most indicative of pain among critically ill patients.

A review of compliance with pain assessments within a UK ICU.

clinical audits highlight areas where care may not be of the desired quality; they are essential to ensure care is safe and effective. Effective assessment and management of pain have been shown to improve patient wellbeing and clinical outcomes. this audit aimed to identify compliance with pain assessment tools and documentation within intensive care and make recommendations to improve practice. compliance with documenting pain assessments was poor, a finding that is consistent with the literature. Although a wealth of evidence has shown pain assessments are not being completed effectively, this continues to be a problem. Intensive care has significant areas for improvement in this area, which would improve patients' experiences and outcomes. Nurses should be educated in the use of pain assessment tools and compliance. providing patients in intensive care with appropriate analgesia benefits their physical and psychological health. Areas for improvement identified in this audit include that pain assessments need to be carried out and documented regularly. The audit has implications for practice in that it shows a need for reinforced education for staff, better communication and updates to promote pain assessment and the implementation of guidelines.

Children’s views on postsurgical pain in recovery units in Norway: A qualitative study

To explore children's postsurgical experiences with pain and pain management in the recovery unit. Children's pain is underestimated and undertreated. Untreated pain can cause unnecessary suffering, increased complication risks and may lead to chronic pain. Research exploring children's experiences with postoperative pain and pain management is limited. A qualitative, exploratory study. The study complied with the Consolidated Criteria for Reporting Qualitative Research (COREQ). Children (N=20), 8-16years old, took part in semi-structured interviews about their experiences with pain and postoperative pain management while they were in a recovery unit. Data were collected at two university hospitals in Norway. Content analysis was used to analyse the data. Three themes emerged from the interviews: "children's experiences of what felt unpleasant and painful," "children's experiences with pain management" and "children's recommendations for future pain management". About half of the children reported moderate to severe pain while in the recovery unit and they did not always tell their nurses when they had pain. They also reported experiencing pain in places other than their surgical wounds and stated that nausea and vomiting felt unpleasant and painful. The children indicated that pain medications and the use of nonpharmacological methods helped them cope with their pain and provided several recommendations about how to improve pain management. Paediatric postoperative pain management remains suboptimal. The children in our study provided useful information about their pain experiences, how to improve pain management and explained why they did not tell their nurses when they were in pain. These findings should direct further improvements in paediatric postoperative pain management, such as increased use of pain assessment tools and preparatory information, as well as more appropriate administration of pain medications.

Knowledge and practice regarding neonatal pain management in the opinion of nurses and midwives working in Polish neonatal units

Nurses and midwives working in neonatal units play a key role in the assessment and treatment of pain. Due to their nature of work, which is based on continuous observation of the patient, they constitute a professional group that responds to changes in the child’s general condition. Thanks to this, the physicians get information about pain intensity or the need of pain treatment, which is relevant among patients who cannot report any symptoms of pain by themselves. The aim of the study was to describe nurses’ and midwives’ basic knowledge about pain and the practice regarding procedural pain assessment and management in Polish neonatal care units. The studies were carried out among 617 nurses and midwives working in neonatal units in Poland. We collected data by using a researcher-developed questionnaire. The significance level was set at p<0.5. 30% of nurses never used non-pharmacological methods of pain relief before painful procedures. Moreover, the higher the level of reference, the more often no non-pharmacological methods were used. Knowledge related to the basic problems associated with pain can be described as insufficient (Me = 4). Frequent use of sedation drugs has also been reported (III level NICU: phenobarbital po / pr: 72.8% of respondents, opioids - 34.9%, II level NICU: phenobarbital po / pr 45.2%, opioids: 4.5%). The longer nurses and midwives worked, the lower the frequency of use of pain assessment tools was (p = 0.0048, R = -0.113). The lack of appropriate pharmacological and nonpharmacological pain treatment and lack of use of pain scales are a significant problem in the care of newborns. Our research indicates the need for education in the field of pain assessment and treatment methods in newborns.

Observational Pain Assessment Instruments for Use With Nonverbal Patients at the End-of-life: A Systematic Review.

To review studies pertaining to the reliability and validity of observational pain assessment tools for use with nonverbal patients at the end-of-life, a field of research not documented by previous systematic reviews. Databases (PubMed, Embase, Epistemonikos, the Cochrane Library, and CINAHL) were systematically searched for studies from study inception to February 21, 2016 (update in May 9, 2018). Two independent reviewers screened study titles, abstracts, and full texts according to inclusion and exclusion criteria. Disagreements were resolved through consensus. Reviewers also extracted the psychometrics properties of studies of observational pain assessment instruments dedicated to a noncommunicative population in palliative care or at the end-of-life. A comprehensive quality assessment was conducted using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) to derive poor, fair, good or excellent ratings for the psychometric tests reported in each study. Four studies linked to 4 different tools met the inclusion criteria. Study populations included dementia, palliative care and severe illness in the context of intensive care. All the studies included in this review obtained poor COSMIN ratings overall. At this point, it is impossible to recommend any of the tools evaluated given the low number and quality of the studies. Other analyses and studies need to be conducted to develop, adapt, or further validate observational pain instruments for the end-of-life population, regardless of the disease.

Nursing pain assessment in non verbal intensive care patient

Introduction: It has been found out that pain is one of the most important issues that patients have to deal with while they are hospitalized in an intensive care unit (ICU), especially when they are non-communicative. Nurses play the most important role in the pain assessment through the everyday contact with patients and with the use of a variety of pain assessment tools as well.Aim: The purpose was to determine nurses’ level of knowledge about the use of pain assessment tools (especially pain scales) in the unconscious intensive care patients – To investigate the level of pain assessment tools application in the daily nursing routine by the ICU nurses.Material and Method: A systematic review in the followed database was applied: Pubmed-Medline-Embase. The entry criteria in the review were: a) Publication date: 1990-2017 b) Greek or English language c) the sample of research must necessarily include experienced nurses who work exclusively in an intensive care unit. d) the use of pain assessment tools for non verbal patients should be included in the nursing interventions e) nurses should be responsible for the daily care of non verbal patients f) the results must be concern exclusively non communicative patients.Results: From the research four studies have emerged which met the standards of the review. The common findings among these researches result in the fact that although nurses believe that an effective pain assessment is important to a great extent, very few of them use pain assessment tools according to protocols especially in the unconscious patients.Conclusions: Nursing pain assessment concerning non verbal patients still remain inadequate and doesn’t seem to be a priority during the daily nursing routine. The promotion of education of nurses concerning pain assessment is required and the use of protocols as well in order to ease the process of a reliable and valid pain assessment.

Are the current pain assessment tools used by paramedics in Ireland, suitable for use with cognitively impaired (dementia) patients?

<p><span style="text-decoration: underline;"><strong>Background</strong></span></p><p>Dementia is a disease affecting 55,000 Irish people. (1) It is characterised by progressive cognitive impairment, ranging from mild impairment, which may affect memory, to severe impairment where the ability to communicate may be absent. These people are at risk of having their pain underassessed and undermanaged. (2) A survey exploring Irish Paramedics and Advanced Paramedics views on the current pain assessment tools available to them, and whether these tools are suitable for use with dementia patients is proposed. Existing observational pain assessment tools used with dementia patients are examined and their suitability for pre-hospital use discussed.</p><p><span style="text-decoration: underline;"><strong>Introduction</strong></span></p><p>Adults with cognitive impairments, such as dementia, are at a much higher risk of not receiving adequate analgesia for their pain. (3) It is estimated between 40% and 80% of dementia patients regularly experience pain. (4) Current pain assessment tools used pre-hospital in Ireland are: Numerical Rating Scale for patients >8yrs, Wong Baker Scale for pediatric patients and the FLACC Scale for infants. There is no specific pain assessment tool for use with patients who are not capable of self-reporting their level of pain.</p><p><span style="text-decoration: underline;"><strong>Objective</strong></span></p><p>This research aimed to identify observational pain assessment tools used in this cohort. The most consistently recommended tools were identified. The suitability of these tools for use in the pre-hospital setting assessed.</p><p><span style="text-decoration: underline;"><strong>Findings</strong></span></p><p>Literature review identified 29 observational pain assessment tools. There is a lack of literature relating to the pre-hospital setting. The American Geriatric Society (AGS) identified six pain behaviors in dementia patients, changes in facial expression, activity patterns, interpersonal relationships and mental status, negative vocalisation, change in body language. These six criteria should be the foundation of any pain assessment tool. (5) The three most consistently recommended tools identified were as follows:</p><p><em>Abbey Pain Scale</em></p><p>6 items assessed, meets AGS criteria, quick and easy to implement, moderate to good reliability and validity (6)</p><p><em>Doloplus 2</em></p><p>15 items assessed, meets 5 of 6 AGS criteria, requires observation over time, prior knowledge of patient required, moderate to good reliability and validity (6)</p><p><em>PAINAD</em></p><p>5 items assessed, meets 3 of 6 AGS criteria, less then 5 minutes to implement, may be influenced by psychological distress, good reliability and validity (6)</p><p> </p><p><span style="text-decoration: underline;"><strong>Conclusion</strong></span></p><p>The ability to self report pain is deemed “gold standard”. Patients with mild to moderate disease, and indeed, some with severe disease, may retain the ability to self report. An observational tool is required when dementia has progressed to the point where the patient becomes unable to self report or becomes non-verbal. It is in these patients where undetected, misinterpreted or inaccurate assessment of pain becomes frequent. (7) The aim of any tool is to gain a good assessment of pain, however, the pain scale used should be suitable to the clinical setting. The feasibility of an assessment tool is an important factor along with reliability and validity. No one assessment tool could be recommended over another. Abbey and PAINAD have potential for use pre-hospital, however, further research, clinical evaluation and trial in an ambulance service is required.</p>

Pain in older adults with dementia : Asurvey across Europe on current practices, use of assessment tools, guidelines and policies.

We aimed to explore the existing use of pain assessment tools and guidelines, and develop understanding of the practical considerations required to facilitate their use within the nursing home, hospital and community settings. Aself-administered web-based survey was conducted with nurses, health and social care workers with an interest in the assessment of pain in older adults with cognitive impairment. The survey was distributed to participants in Austria, Belgium, Denmark, Germany, The Netherlands, Switzerland and United Kingdom. Only aminority of staff reported use of (inter-)national or local standards or specific pain assessment tools in daily practice. Arange of tools were reported as being used, which varied across country. While participants generally reported that these pain assessment tools were easy/very easy to use, many participants reported that they were difficult to interpret. Assessment is generally performed whilst providing nursing care. This was highlighted in 70-80% of all participating countries. While many of these tools rely on facial expression of pain, facial expressions were considered to be the least useful in comparison to other items. Furthermore findings showed that nurses employed in long-term care settings did not feel that they were educated enough in pain assessment and management. Our findings suggest that pain education is required across all countries surveyed. This should include afocus on guidelines and standards for assessment and subsequent management of pain. Findings suggest that clinical staff find interpreting facial expressions in relation to pain more difficult.

Developing a pain assessment tool for patients after major abdominal surgery.

The purpose of this study was to develop a pain assessment tool for use among postoperative patients in Zambia (Postoperative Pain Assessment tool for Zambia, or POPAZ). Phase 1 of this project was an epidemiological quantitative analytical study conducted at the University Teaching Hospitals, Lusaka in Zambia. The sample comprised of 30 nurses and surgeons who were actively involved in providing direct patient care to post-surgical patients. An adapted Clinical Decision Making Survey tool was used to collect the data. The study revealed five relevant measures of postoperative pain: patient mobility/activity, level of tolerance to activity, facial expressions, vital signs and overall patient behaviour. The findings of this phase have thus provided a framework for the development of a postoperative pain assessment tool that can be used with postsurgical patients following major abdominal surgery.

The status quo and influencing factors of pain assessment by nurses in intensive care units of Class III hospitals

Objective To explore the status quo of pain assessment by the nurses in intensive care units (ICU) of Class Ⅲ hospitals, to analyze the factors influencing the implementation of pain assessment by ICU nurses, and to provide evidence for improving the practice of pain assessment by ICU nurses. Methods Totally 410 ICU nurses from 11 ClassⅢ hospitals in Hu'nan, Guangdong, Beijing and Hebei were selected by convenient sampling and investigated with the self-designed pain assessment questionnaire between April and July 2017. SPSS 21.0 was used to conduct the statistical analysis of the data. Results The implementation rate of pain assessment by ICU nurses was 77.6%. The application of subjective pain assessment tools was consistent mainly with the Numeric Rating Scale (NRS) (74.2%) , while objective assessment tools were less used, including the Critical Care Pain Observation Tool (CPOT) (40.6%) and Behavioral Pain Scale (BPS) (29.9%) . The standard rate of the use of pain assessment tools in ICU was 81.8%. The type of ICU and the frequency of continuing education in pain among ICU nurses were the factors that affected pain assessment by ICU nurses. Conclusions ICU nurses have not standardized their pain assessment, applied less objective pain assessment tools, and lacked norms for pain assessment in ICU. It is suggested that hospitals and departments should formulate relevant pain management rules and regulations, strengthen the continuous professional education for ICU nurses, and standardize and promote the clinical pain assessment of ICU nurses so as to improve the quality of pain care in ICU. Key words: Nurses; Intensive care unit; Pain; Assessment; Status quo; Influencing factors

Neonatal nurses’ perceptions of pain management

ObjectivesTo describe the perceptions of nurses in neonatal units on pain management, meet the educational profile and describe the use of pain assessment tools and non-pharmacological management for treatment. MethodsCross-sectional descriptive multicentre study, developed during the months of February to September 2015, in the neonatology services of three hospitals at the Community of Madrid, Spain. Data collection was performed through an ad hoc questionnaire on paper or electronically using Survey Monkey platform. ResultsThe sample consisted of 142 professionals, with a response rate of 55%: 47.9% (68) confirmed they had received specific training in pain management; 39.5% (56) stated that pain is regularly assessed in the unit; only 43.6% reported using validated scales, the most used being the Premature Infant Pain Profile (PIPP). As for the non-pharmacological management, swaddling and non-nutritive sucking it is the most used, followed by sucrose. Intravenous cannulation was identified as the most painful procedure. ConclusionsPain management is in the process of improvement, because of training and because there is little pain assessment using validated scales. The improvement in the use of non-pharmacological management for the relief of pain in minor procedures is noteworthy.

Percepción del personal de enfermería sobre el manejo del dolor en neonatos

ObjectivesTo describe the perceptions of nurses in neonatal units on pain management, meet the educational profile and describe the use of pain assessment tools and non-pharmacological management for treatment. MethodsCross-sectional descriptive multicentre study, developed during the months of February to September 2015, in the neonatology services of three hospitals at the Community of Madrid, Spain. Data collection was performed through an ad hoc questionnaire on paper or electronically using Survey Monkey platform. ResultsThe sample consisted of 142 professionals, with a response rate of 55%: 47.9% (68) confirmed they had received specific training in pain management; 39.5% (56) stated that pain is regularly assessed in the unit; only 43.6% reported using validated scales, the most used being the Premature Infant Pain Profile (PIPP). As for the non-pharmacological management, swaddling and non-nutritive sucking it is the most used, followed by sucrose. Intravenous cannulation was identified as the most painful procedure. ConclusionsPain management is in the process of improvement, because of training and because there is little pain assessment using validated scales. The improvement in the use of non-pharmacological management for the relief of pain in minor procedures is noteworthy.

Pain Assessment of Elderly Patients with Cognitive Impairment in the Emergency Department: Implications for Pain Management-A Narrative Review of Current Practices.

Elderly people are susceptible to both falls and cognitive impairment making them a particularly vulnerable group of patients when it comes to pain assessment and management in the emergency department (ED). Pain assessment is often difficult in patients who present to the ED with a cognitive impairment as they are frequently unable to self-report their level of pain, which can have a negative impact on pain management. This paper aims to review how cognitive impairment influences pain assessment in elderly adults who present to the ED with an injury due to a fall. A literature search of EMBASE, ProQuest, PubMed, Science Direct, SciFinder and the Curtin University Library database was conducted using keyword searches to generate lists of articles which were then screened for relevance by title and then abstract to give a final list of articles for full-text review. Further articles were identified by snowballing from the reference lists of the full-text articles. The literature reports that ED staff commonly use visual or verbal analogue scales to assess pain, but resort to their own intuition or physiological parameters rather than using standardised observational pain assessment tools when self-report of pain is not attainable due to cognitive impairment. While studies have found that the use of pain assessment tools improves the recognition and management of pain, pain scores are often not recorded for elderly patients with a cognitive impairment in the ED, leading to poorer pain management in this patient group in terms of time to analgesic administration and the use of strong opioids. All healthcare professionals involved in the care of such patients, including pharmacists, need to be aware of this and strive to ensure analgesic use is guided by appropriate and accurate pain assessment in the ED.

A pilot study on pain assessment among elderly with severe dementiain residential aged care facilities of Reggio Emilia district

Despite the availability of pain assessment tools and best practice recommendations for the assessment and management of pain in people with severe dementia, pain in residential aged care facilities is still undetected or misinterpreted. To assess pain prevalence and analgesic load medication in people with severe cognitive impairment admitted to residential aged care facilities of Reggio Emilia (Italy) province. A pilot cross-sectional study was conducted on 84 elderly patients affected by severe dementia and resident in aged care facilities. Pain was assessed with the PAINAD observational scale, both at rest and during routine procedures: positioning in bed, from bed to standing position, from bed to chair or during the medication of a pressure sore (under challenge). 33.4% of patients had pain at rest, mainly mild, and 86.9 % under challenge. During routine interventions, in 64 patients (76.2%) pain increased compared to at rest condition (for 39, 2/3, moderate-severe); although 46 of them were prescribed as-required analgesic medication, none had received the drug. Also patients with analgesics on regular basis experienced more pain during routine procedures. Many patients experienced pain during routine procedures. The regular use of pain assessment tools and adequate training of all healthcare professionals are essential requirements for an effective pain control.

Pain Management Perceptions of the Neonatal Nurses in NICUs and Neonatal Units in Ardebil, Iran

Background: This study aimed to determine neonatal nurses’ perceptions of knowledge and practice in pain management in NICUs & neonatal units. Methods: A cross-sectional descriptive study design was used. A total of 120 neonatal nurses who working in NICUs & neonatal units in Ardebil province, Iran were selected using the convenience sampling technique. A questionnaire of Nurses’ Perceptions of Neonatal Pain (Cong, 2013), including 36 questions with Likert scale and 2 open ended questions, was used. Data collected were analyzed with descriptive statistics of frequencies and percentages.Results: Nurses had Appropriate knowledge of neonatal pain management , but less than 50% felt that they received adequate training and continuing education on pain. Participants reported that they don’t use of pain assessment tools (65%). Less than half felt that the pain tool used in their unit was an accurate measure (44.2%). Fewer than half reported that pain was well managed (28.3%) , that their pain protocols were research evidence based (34.2%) and more than half reported that parents should be involve with the care and comfort of their infant during painful procedures (71.6%). Barriers to effective pain management emerged as high workload, shortage of personnel, lack of knowledge, absence of pain protocols, lack of time, and lack of trust in the pain assessment tools.Conclusions: proper pain management was significantly correlated with adequate training, use of proper and accurate pain tools, and clear and research-based protocols and parental involvement. It can be improved by developing guidelines and support of nurses, develop of clinically feasible pain tools, adequate training and proper supervision.

Appropriate pain assessment tools for use in patients with dementia in the out-of-hospital environment

There is substantial evidence to suggest adults with cognitive impairment, caused by degenerative conditions such as dementia, are at a significantly higher risk of suboptimal pain assessment and management in the acute care setting when compared to adults without cognitive impairment. This paper aims to assess the pain assessment tools most appropriate for use in adults with cognitive impairment as a result of dementia within the out-of-hospital setting. A search of the literature was conducted in May 2016. The databases searched were Pubmed (Medline) and Embase. The primary types of literature retrieved were meta-reviews, systematic reviews or reviews. All subcategories of dementia were included in this review. From the search strategies, 12 relevant articles and 35 pain assessment tools for use in patients with dementia were identified. In this review, the Abbey Pain Scale and PAINAD have been identified as tools substantiated in the literature for use in detecting pain in adults with dementia, which likely have applications in the out-of-hospital environment. A trial of either the Abbey Pain Scale or PAINAD in an emergency ambulance service is appropriate and likely warranted to assess their impact on pain assessment in this vulnerable patient group.

Acute pain assessment among critically ill adult patients: Nurses' knowledge, practices, and perceived barriers

Background: Pain, a universal health problem, affects a substantive number of individuals in chronic or acute form. In the emergency and critical care settings, patients suffer moderate-to-severe acute pain from numerous sources. If not adequately managed, acute pain can transform to a chronic pain syndrome. The physical disabilities and psychological disorders associated with poorly controlled pain diminish patients' comfort and quality of life among the survivors. The study aimed at describing the knowledge and practices related to pain assessment, and perceived barriers among nurses caring for critically ill - adult patients (CIAP). Methods: A descriptive cross-sectional design was employed to collect data from 170 nurses caring for CIAP in Uganda using a standardized survey tool. Results: Nurses had adequate knowledge levels with gaps regarding the need for pre-emptive analgesia for painful procedures like airway suctioning, invasive line placement, and spontaneous breathing trial. Substantively, nurses did not know that the patient is the most accurate rater of their pain experience. Nurses reported poor pain assessment practices, including lack of use of pain assessment tools and guidelines, which were significantly associated with workload and the low priority set to pain assessment and management. Physicians' prescription of adequate analgesics was the only perceived enabler. Conclusion: There is need to reprioritize pain management in emergency and critical care settings. This can be achieved through strategies that enhance the quality and quantity of resources for health care to reduce the perceived barriers and boost the enablers. Continuous professional education, provision of medication, human resources and guidelines for pain management can promote good pain assessment and management practices.