Decision Factors Nurses Use to Assess Pain in Nursing Home Residents With Dementia
Section snippets
Sample and Setting
An exploratory study using focus group methodology was conducted at two long-term care facilities in the greater Nashville, Tennessee area. Facility A had 250 beds and was located in an urban area; facility B had 160 beds and was located in a suburban setting. Criteria for participation were: registered (RN) or licensed practical (LPN) nurses with direct care responsibilities. Nurses were excluded if their responsibilities did not include the assessment and management of pain.
Procedure
The study was
Results
An overarching theme was identified that recurred and underpinned the nurses' reflections about pain management in people with dementia, “Putting together a complex jigsaw puzzle.” Five additional subthemes were noted throughout the transcripts of the nurses' responses: uncertainty about the pain experience of residents with dementia; ‘being a detective’ to determine pain extent and site; clarifying factors; conflict resolution; and the role of the nurse.
Discussion
The focus group forum provided a picture of the long-term care nurses' roles and necessary skills in determining and treating pain among residents with dementia. A wide spectrum of issues exists that nurses must juggle in addressing this issue. We found that nurses use the constructs of ‘comfort’ and ‘quality of life’ as key components in their overall pain assessment strategy in people with dementia. Indeed, the extensive process they use involving frequent reassessment and application of
Acknowledgment
Funding sources for this project include: The John A. Hartford Foundation, The Mayday Fund, Vanderbilt Office of Clinical and Translational Scientist Development, Vanderbilt Clinical and Translational Research Scholars Program, and the NIH National Institutes of Health (5KL2TR000446-08 from NCATS). The contents are solely the responsibility of the authors and do not necessarily represent the official views of these institutions. Study data were collected and managed using REDCap electronic data
References (34)
- et al.
Pain in cognitively impaired nursing home patients
Journal of Pain and Symptom Management
(1995) - et al.
Attitudes of health care professionals to opioid prescribing in end-of-life care: A qualitative focus group study
Journal of Pain and Symptom Management
(2012) - et al.
Tools for assessment of pain in nonverbal older adults with dementia: A state-of-the-science review
Journal of Pain and Symptom Management
(2006) - et al.
Pain assessment in the nonverbal patient: Position statement with clinical practice recommendations
Pain Management Nursing
(2006) - et al.
Pain assessment in the patient unable to self-report: Position statement with clinical practice recommendations
Pain Management Nursing
(2011) - et al.
Who suffers most? Dementia and pain in nursing home patients: A cross-sectional study
Journal of the American Medical Directors Association
(2008) - et al.
Assessment of pain: A community-based diary survey in the USA
Lancet
(2008) - et al.
A comparison of pain and its treatment in advanced dementia and cognitively intact patients with hip fracture
Journal of Pain and Symptom Management
(2000) - et al.
Literature review of pain prevalence among older residents of nursing homes
Pain Management Nursing
(2010) Projected future growth of older population
Alzheimer's disease facts and figures
The management of chronic pain in older persons. AGS Panel on Chronic Pain in Older Persons
Geriatrics
The management of persistent pain in older persons
Journal of the American Geriatrics Society
Treatment of pain in cognitively impaired compared with cognitively intact older patients with hip-fracture
Journal of the American Geriatrics Society
Understanding nurses' decisions to treat pain in nursing home residents with dementia
Research in Gerontological Nursing
Alzheimer disease in the US population: Prevalence estimates using the 2000 census
Archives of Neurology
Assessment of pain in older adults with severe cognitive impairment
Annals of Long Term Care
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