Valentina Lichtner
The assessment and management of pain in patients with dementia in hospital settings: a multi-case exploratory study from a decision making perspective
Lichtner, Valentina; Dowding, Dawn; Allcock, Nick; Keady, John; Sampson, Elizabeth L.; Briggs, Michelle; Corbett, Anne; James, Kirstin; Lasrado, Reena; Swarbrick, Caroline; Closs, S. Jos�
Authors
Dawn Dowding
Nick Allcock
John Keady
Elizabeth L. Sampson
Michelle Briggs
Anne Corbett
Kirstin James
Reena Lasrado
Caroline Swarbrick
S. Jos� Closs
Abstract
BACKGROUND:
Pain is often poorly managed in people who have a dementia. Little is known about how this patient population is managed in hospital, with research to date focused mainly on care homes. This study aimed to investigate how pain is recognised, assessed and managed in patients with dementia in a range of acute hospital wards, to inform the development of a decision support tool to improve pain management for this group.
METHODS:
A qualitative, multi-site exploratory case study. Data were collected in four hospitals in England and Scotland. Methods included non-participant observations, audits of patient records, semi-structured interviews with staff and carers, and analysis of hospital ward documents. Thematic analysis was performed through the lens of decision making theory.
RESULTS:
Staff generally relied on patients' self-report of pain. For patients with dementia, however, communication difficulties experienced because of their condition, the organisational context, and time frames of staff interactions, hindered patients' ability to provide staff with information about their pain experience. This potentially undermined the trials of medications used to provide pain relief to each patient and assessments of their responses to these treatments. Furthermore, given the multidisciplinary environment, a patient's communication about their pain involved several members of staff, each having to make sense of the patient's pain as in an 'overall picture'. Information about patients' pain, elicited in different ways, at different times and by different health care staff, was fragmented in paper-based documentation. Re-assembling the pieces to form a 'patient specific picture of the pain' required collective staff memory, 'mental computation' and time.
CONCLUSIONS:
There is a need for an efficient method of eliciting and centralizing all pain-related information for patients with dementia, which is distributed in time and between personnel. Such a method should give an overall picture of a patient's pain which is rapidly accessible to all involved in their care. This would provide a much-needed basis for making decisions to support the effective management of the pain of older people with dementia in hospital.
Citation
Lichtner, V., Dowding, D., Allcock, N., Keady, J., Sampson, E. L., Briggs, M., Corbett, A., James, K., Lasrado, R., Swarbrick, C., & Closs, S. J. (2016). The assessment and management of pain in patients with dementia in hospital settings: a multi-case exploratory study from a decision making perspective. BMC Health Services Research, 16(1), https://doi.org/10.1186/s12913-016-1690-1
Journal Article Type | Article |
---|---|
Acceptance Date | Aug 18, 2016 |
Online Publication Date | Aug 24, 2016 |
Publication Date | 2016-12 |
Deposit Date | Nov 15, 2018 |
Publicly Available Date | Nov 16, 2018 |
Journal | BMC Health Services Research |
Publisher | BMC |
Peer Reviewed | Peer Reviewed |
Volume | 16 |
Issue | 1 |
DOI | https://doi.org/10.1186/s12913-016-1690-1 |
Keywords | Dementia, pain assessment, pain management, aged, hospitalization, decision making, qualitative research |
Public URL | http://researchrepository.napier.ac.uk/Output/1357955 |
Contract Date | Nov 16, 2018 |
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Copyright Statement
© 2016 The Author(s). Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
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