Pain Assessment in Elderly Residents with Severe Dementia – Nurses’ Point of View

Abstract

Background: Pain is often underrated or under-recognized in people with severe dementia for many reasons. In care unit, both register nurses and practical nurses are equally responsible for pain assessment because practical nurses work most of the time alone in shifts. Several tools have been designed to attempt pain assessment and management of pain, however they have not been routinely used in practice. So, the aim of this thesis is to understand ongoing pain assessment practices in the ward through a nurses’ point of view. Methods: The face-to-face interview was used with seventeen nurses working in the care unit. The data were analysed with the three-step content analysis, reduction, clustering, and grouping of data. There are three research questions, namely: How do nurses experience the pain assessment procedures in the care home? How do nurses assess pain assessment in severe dementia? What factors do nurses see as a barrier to improving pain assessment among those with severe dementia? Through these questions, we tried to gain information about nurses’ knowledge, experiences, others influence factors towards the pain assessment. Results: In the care units, practical nurses were working alone in shifts (evening, night shifts) were equally responsible in pain assessment with the register nurses. The data analysed produced eleven themes. Seven themes were developed under the nurses’ approaches in pain assessment: Facial, body language and vocal as pain assessment, Physiological changes as pain indicator, non-medical approach, terminal illness as pain indicator, relatives’ information as work force, knowledge on individual needs, medical history as pain assessment and the remaining four themes consisted under the factors affected in pain assessment were education role, lack of documentation, communication as a barrier in pain assessment, and pain tools in pain assessment. Behaviour and psychological approaches were not mentioned(separately) as possible pain indicators. It was considered more as a dementia process than pain related. Which was discussed under the communication barrier. Theses experience of nurses showed the lack of evidence base knowledge in present scenario about the topic. The common pain assessment was based on facial expression. Conclusion: It is suggested to adapt pain management using appropriate pain (s) tool to avoid a gap between knowledge (that has had already and new knowledge) and experience between staffs. The management helps to create the close intervention with the target group for a long period and makes the assessment process better