Nurses’ experiences of pain management for people with advanced dementia approaching the end of life

Pain management in end-stage dementia is a fundamental aspect of end-of-life care; however, it is unclear what challenges and facilitators nurses experience in practice, whether these differ across care settings, and whether training needs to be tailored to the context of care | Journal of Clinical Nursing

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Aims and objectives: To explore hospice, acute care and nursing home nurses’ experiences of pain management for people with advanced dementia in the final month of life. To identify the challenges, facilitators and practice areas requiring further support.

 

Conclusions: Achieving pain management in practice was highly challenging. A number of barriers were identified; however, the manner and extent to which these impacted on nurses differed across hospice, nursing home and acute care settings. Needs-based training to support and promote practice development in pain management in end-stage dementia is required.

Relevance to clinical practice: Nurses considered pain management fundamental to end-of-life care provision; however, nurses working in acute care and nursing home settings may be undersupported and under-resourced to adequately manage pain in people dying with advanced dementia. Nurse-to-nurse mentoring and ongoing needs-assessed interactive case-based learning could help promote practice development in this area. Nurses require continuing professional development in pharmacology.

Full reference: De Witt Jansen, B. et al. Nurses’ experiences of pain management for people with advanced dementia approaching the end of life: a qualitative study. Journal of Clinical Nursing. 26,(9-10) pp. 1234–1244

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Nurses’ experiences of pain management for people with advanced dementia approaching the end of life

De Witt Jansen, B. et al. (2017) Journal of Clinical Nursing. 26(9-10) pp. 1234–1244

Aims and objectives: To explore hospice, acute care and nursing home nurses’ experiences of pain management for people with advanced dementia in the final month of life. To identify the challenges, facilitators and practice areas requiring further support.

Background: Pain management in end-stage dementia is a fundamental aspect of end-of-life care; however, it is unclear what challenges and facilitators nurses experience in practice, whether these differ across care settings, and whether training needs to be tailored to the context of care.

Conclusions: Achieving pain management in practice was highly challenging. A number of barriers were identified; however, the manner and extent to which these impacted on nurses differed across hospice, nursing home and acute care settings. Needs-based training to support and promote practice development in pain management in end-stage dementia is required.

Relevance to clinical practice: Nurses considered pain management fundamental to end-of-life care provision; however, nurses working in acute care and nursing home settings may be undersupported and under-resourced to adequately manage pain in people dying with advanced dementia. Nurse-to-nurse mentoring and ongoing needs-assessed interactive case-based learning could help promote practice development in this area. Nurses require continuing professional development in pharmacology.

Read the abstract here

Improved decision support in the assessment and management of pain for people with dementia in hospital

Closs, S.J. et al. NIHR. Published online: October 2016

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It is difficult for people with dementia to communicate their pain to health-care professionals. Pain often has damaging effects on mental and physical health, and research has shown that pain is often poorly managed in people with dementia in hospital.

We aimed to develop a new system that would help staff to manage pain. To this end, we first identified any accurate and reliable pain assessment tools available for use with hospital patients who have dementia. We then explored how pain is currently recognised, assessed and managed in people with dementia in four hospitals in England and Scotland.

We found 28 pain assessment tools which had been reviewed, but none had been tested rigorously. Seven had potentially useful features, but no single tool could be recommended for wider use. The 11 hospital wards studied were all different, with their own complex pain assessment and management practices. Information from different staff and carers was produced at different times and in different formats, and was recorded in separate documents. This information was mentally pulled together into an ‘overall picture’ of pain by each staff member for each individual patient.

We suggest developing a combined education package and electronic health record, the Pain And Dementia Decision Support (PADDS) intervention, to help staff recognise, assess and manage pain. This should incorporate carer input, staff narratives, pain histories, intensity assessments, medication and other interventions provided, and present an overall picture of pain in an integrated and easily accessible visual format. This will require thorough development and testing.

Read the full report here