None listed
Conditions
Brief summary
Undermanaged pain among older patient with dementia continues to impact on patient centre care provided among acute care settings. As the dementia population continues to grow, there is a need to address this issue by finding the solution for a better outcome. The challenges in assessing pain in dementia play a major barrier for nurses in conducting effective pain management (Bruneau & Benjamin, 2014; Coker et al., 2008; De Witt Jansen et al., 2017; Laflamme et al., 2012; Rantala, Kankkunen, Kvist, & Hartikainen, 2014b). This intervention study aims to investigate if nurses’ daily pain assessment and management for older patients with dementia can be improved by a simple and routinised intervention program. The project will introduce an innovative intervention program, which prompts nurse participants to undertake pain assessment during their routine vital sign round, that is, pain become embedded as a fifth vital sign. The study aims: 1). To explore if older people with dementia provide self-report of pain while hospitalised; 2). To examine whether routinisation of pain assessment and subsequent management by nurses has an effect on pain management in older people with dementia in hospital settings. Study hypothesis: H0: 1. There are no differences before and after the intervention program in the level of self-reported pain by older patients with dementia between two groups; intervention groups and control groups. 2. There are no effect on nurses’ practice in the routinisation of pain assessment and management for older patients with dementia before and after the intervention program between two groups; intervention groups and control groups. Ha: 1. There are differences before and after the intervention program in the level of self-reported pain by older patients with dementia between two groups; intervention groups and control groups. 2. There are effect on nurses’ practice in routinisation of pain assessment and management for older patients with dementia before and after the intervention program between two groups; intervention groups and control groups.
Interventions
Undermanaged pain among older patients with dementia continues to be of concern. The reviewed evidence indicated that pain has not been well assessed and pain assessment tool has not been routinely used for patients with dementia. This requires an attention among the health care professionals in pain and dementia care, in particular for older patients with dementia who may have difficulty report their pain through verbal communication.
The aims of this study are to explore if older people with
Undermanaged pain among older patients with dementia continues to be of concern. The reviewed evidence indicated that pain has not been well assessed and pain assessment tool has not been routinely used for patients with dementia. This requires an attention among the health care professionals in pain and dementia care, in particular for older patients with dementia who may have difficulty report their pain through verbal communication. The aims of this study are to explore if older people with dementia self-report pain while hospitalised and to examine whether routinisation of pain assessment by nurses has an effect on pain management for older patients with dementia in acute care settings. The study will be conducted in two local health district hospitals (Gosford and Wyong). Four units will be randomly assigned into two for intervention units and two for control units. The study will use both quantitative and qualitative methods. A quasi-experimental design will be employed as quantitative methodology. The study will conduct auditing of patients' medical records, surveying nurses, and delivering the information sessions, An individual interview and document analysis will be employed as qualitative approaches. The study will use a developed pain checklist for conducting an audit, Tool for Evaluating the ways Nurse Assess Pain (TENAP) for nurses' survey, ASK 4 brochures and ASK 4 portable cards for the information sessions and in nurses' daily practice. The study comprises three stages: pre-intervention stage, intervention stage, and post-intervention stage. In pre-intervention stage, the study will audit of patients’ medical records (Document analysis) using a developed pain checklist. Nurses' survey (TENAP) will be distributed to all the participation units. For the intervention stage, the study will held several Information/education sessions. The information sessions will take place in every week throughout 6 weeks of the intervention program, and it will take about 20-30 minutes for each information session. The nurses (n=30-40) who work in the two intervention units will be invited to attend the information sessions for the entire 6 weeks of the intervention program. The intervention 'ASK 4' algorithm will be introduced. The ASK 4 comprised 4 simple steps that prompt nurses to initiate a pain assessment when caring for patients with dementia. The Ask 4 includes 1.DO YOU HAVE PAIN? 2. DOCUMENT THE SCORE 3. PROVIDE NURSING ACTION 4. REASSESS and ENTER in nursing progress notes. Nurses attending the information sessions will be informed about how to implement ‘ASK 4’ into their routine vital sign round including 1). the importance of patient’s self-report pain, 2). utilise the pain assessment tools including self-report and observation pain tools into routine practice, 3). take action into pain management, 4). reassessment, and documentation. The designed ASK 4 cards will be distributed as a reminder of the everyday practice of pain in dementia. The researcher who is an experienced Registered Nurse and PhD candidate will deliver the information sessions. The dementia care providers are the Registered Nurses (RNs) who work regularly in the participantion units. Those RNs include senior, experienced, and new graduated nurses on the wards. The care provided is part of their routine practice. There is no direct contact to the patients with dementia. After the intervention stage, the study will conduct auditing of medical records, TENAP nurses' survey again and interview of the individual nurses..
Sponsors
Sarah Jeong
Study design
Allocation
Non-randomised trial
Intervention model
Parallel
Primary purpose
Educational / counselling / training
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Patients: Patients aged 65 years and over who have a diagnosis of dementia will be included in the study. Dementia diagnosis is confirmed with a structured clinical assessment based on international DSM-IV criteria, and or had a clear documented dementia diagnosis in the electronic medical record system (EMR). Nurses: The Registered Nurses (RNs) who work in the participation units on a regular basis and have a direct involvement in the care of older patients with dementia will be recruited.
Exclusion criteria
Patients without dementia diagnosis and documented All Registered Nurses in the participation units will be included
Outcome results
None listed