Health Services Management : Assignment

HEALTH SERVICES MANAGEMENT
Pain Management at Mercy Community Residential
Aged Care Services
5/24/2018 Bahar Lal

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Acknowledgement
I would like to convey my special gratitude to my supervisor Helen Spyt as well as our
lecturer Sheree Lloyd who gave me this golden opportunity to do this wonderful project on
Pain Management at Mercy Community Residential Aged Care Services, which helped me in
doing a lot of Research and enabling me to develop Health Services Management and
Leadership skills. Furthermore, I would also like to thank Tracy Thompson (Diversional
Therapist) and Mr. Paramjit (Registered Male Nurse) who supported me and helped me
throughout duration of my WIL. Nonetheless, I would like to also thank my parents who
brought me up and made sure that I get whatever I want and supported throughout to pursue
my master’s degree.

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EXECUTIVE SUMMARY
The purpose of this report is to document current Pain Management Process at Mercy
Community Residential Aged Care Services. This project aimed to follow the pre-determined
project plan by conducting literature review as well as a systematic practical field-based
research. Research was based on a primary data collection where the data collected was
conducted in a real time environment. To analyse the data and find out the result that would
help to achieve the research objectives the quantitative data analysis method is used. Patients
who suffer from dementia and other associated problems have been also included in this
execution of the project. It has been found that appropriate education and training of the staffs
of the mercy community services and implementation of appropriate protocols and policies
are the key strategies to improve the health care services of the hospital that can ensure the
best quality of treatment towards the implementation of the pain management framework for
aged people especially who are suffering from dementia.

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Table of Content
Introduction:...............................................................................................................................4
Background............................................................................................................................4
Case for change......................................................................................................................4
Analysis of Objectives...............................................................................................................5
Literature review........................................................................................................................6
Project methodologies................................................................................................................7
Project plan.............................................................................................................................7
Stakeholder identification......................................................................................................8
Communication plan............................................................................................................10
Timeline:..............................................................................................................................11
Risk management.................................................................................................................12
Deliverables..............................................................................................................................14
Evaluation................................................................................................................................15
Data analysis............................................................................................................................16
Key Findings and Conclusion..................................................................................................24
Recommendations....................................................................................................................25
Reference:................................................................................................................................28
Appendices:..............................................................................................................................30

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Introduction:
Currently in an Aged Care Residential Services, specifically in the Mercy Community
Residential Aged Care Service, it was necessary to conduct a quality evaluation survey for
residents living with pain. This project focused on identifying the barriers to effective pain
management for the residents of Mercy Community Residential Aged Care Services.
Residents suffering from Dementia and other Cognitive Impairment diseases have also been
included in the execution of this project. This report documents the current Pain Management
Process at Mercy Community Residential Aged Care Services from the resident’s
prospective. This project aimed to follow the predetermined project plan by conducting
literature review as well as a practical field-based research.
Background
About 196 residents with various diseases including dementia, Osteoarthritis, cancer,
chronic kidney diseases are living in this Residential Care facility. Pain management refers to
the process of managing the pain with diagnosis, treatment and medical care. Pain
management is a major part of a palliative approach to dementia care. Therefore, to
understand the pain management, the current health condition of dementia and the suffered
population must be also considered (Corbett et al., 2016). However, the pain management
process is also associated with other issues such as cardiac decease, chronic bronco
infections, arthritics and others. In case of dementia, the identification of pain and the
amplitude of suffering from pain are difficult. Therefore, its crucial to follow an effective
Pain Management approach including assessment of pain by means of non-verbal
approaches. Residents suffering from dementia have limited verbal capability, so they should
be assessed by their expressions.

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Case for change
Mercy Community Residential Aged Care Services, Nudgee is a well-known
Residential Aged Care Organisation for aged people who are suffering from various chronic
diseases and mental disorders. Strategic implementation of pain management for these
residents should be the chief concern. Every organisation is equipped with different
assessment tools to be used for Pain Management. This project was important to evaluate the
current Pain Management process. This project enabled organisation to know the
effectiveness of the current Pain Management process being used at Mercy Community
Residential Aged Care Services to evaluate the effectiveness of current process.
The implementation of effective pain management framework is crucial especially for
the dementia patients and others who have cognitive disabilities. Identification of regular
practice and the associated barriers, as well as potential improvement, must be found to
ensure the adequate treatment in case of any painful condition among residents. Identification
of most appropriate solutions for this operational anomaly and the process of their
implementation are equally important.
Analysis of Objectives
Through the various proposed methods and tools, the current pain management
process at Mercy Community Residential Aged Care Services has been identified. Along
with how the existing pain management plan is implemented for dementia and other
cognitive impaired residents. This identification and analytic process has been done with
support from the existing project supervisor, residents, doctors, psychologist, nursing staff
and other stakeholders of the organisation. From participation to data collection and data
protection procedure, staff helped to conduct the research. The officially enforced current

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pain management framework has been clearly disclosed by the staff that helped to gather the
theoretical discrepancy.
Project methodologies
Project plan
This project is based on a realistic environmental regulated by every day assessment
practice of the staff at Mercy Community Residential Aged Care Services regarding the pain
management approach. Therefore, to select an appropriate methodology that can be
configured under the realism philosophy. In this philosophy, the appropriate and specific
method selection is required which would be relevant to the research field. Through project
management methodology approach, this project has found out the effectiveness of current
Pain Management approach at MCRACS and the potential recommendations to improve it.
However, the research was based on primary data collection where the data collection was
conducted in a real time environment. The research tool of this project was an individual
survey from residents on a stipulated sample size. Staff were also considered by asking them
to fill out the google survey form to know the current Pain Management approach being used
at MCRACS. The data collection was conducted on 20 residents who are suffering from
chronic painful diseases. The sample size was limited to 10% of the total residents count. To
analyse the data and find out the result that would help to achieve the research objectives, the
project management methodology was used. Through this method, this project has analysed
the survey report numerically.
Moreover, systemic literature review was conducted using the Griffith University
Library. Key search terms used were “PAIN MANAGEMENT”, “RESIDENTIAL AGED

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CARE”, “BARRIERS” and “PAIN ASSESSMENT”. Search was refined to articles published
between 2012 and 2018, journal articles and full text online. Articles published in English
language only were reviewed. Initially about 4300 articles came up as a result. After reading
abstract of all the articles 100 articles seemed suitable for the review. After complete
evaluation of those 100 articles, 25 articles were selected for the literature review to form the
survey questions and provide recommendations along with the survey. The survey was
conducted on the residents of Mercy Community Residential Aged Care Services. Therefore,
ethical consideration of this research project must be the major concern keeping the
venerability of the respondents in mind. In accordance to the data protection act this project
has the commitment that the collected data and information will only be used for research
purposes by prioritising the confidentiality. Similarly, the participation of the residents was
voluntarily. The willingness of the residents was the major concern while ensuring the
research procedure would not cause any harm to the respondents.
Stakeholder identification
Stakeholders are the core responsible people for any project who regulate the
accuracy and effectiveness of the outcomes from the data collection and analysis process. The
sponsors have the major role to support the project and its execution by providing financial
feedback. The supervisor of this project monitored the overall activity and the efficiency of
the research procedure and executions. In evaluation part, supervisors had the most valuable
role to control and regulate the project operations to the most accurate functionality.
Cooperative coordination within the project team is the key to this successful research
project. The nurses and caregivers have been provided adequate information about residential
aged care based organisational operation in existing pain management practice. Along with
the residents, the staff supported the project by informing about the barriers they face in

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managing pain especially for cognitive impaired residents. The structured stakeholder
analysis has been described below:
Stakeholder Engagement Activity
Sponsor Provide sufficient funds for the project
Supervisor Manage, monitor and control project
Doctors Informing existing issues regarding pain management approach and
practices for residents
Project Manager Execute the project
Staff Informing existing issues regarding pain management approach and
practices for residents
Aged Care Residents Take part in various everyday activities like Exercises, Music Therapy,
Dancing therapy and other occupational therapies. 8
Families Supported the project by participating in survey regarding effective pain
management process among dementia patients.
The engagement of stakeholder needs a cyclic flow of information that allows the
fluent information transaction through the various responsible blocks of stakeholder
engagement. These set of information were collected by the project team and supported by
the other stakeholders like occupational caregivers, nurse, clinical supervisors and others.
From developing the project plan to collecting and analysing the resonance report the data
and information transfer followed the stakeholder engagement cycle.

Measuring & reporting
the progress Engagement
activities Setup
Identifying & assessing
stakeholders
Assessing the engagement
process
Respond to
engagement results
Stakeholders
Engagement
Cycle
Implement the
engagement plan
Developing engagement
plan & techniques
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Figure 1: Stakeholders Engagement Cycle
Source: Created by (Lal, B (2018)
Communication plan
A communication plan is one of the most effective strategic tools that allow each
stakeholder to communicate with others to maintain effective information interchange during
the execution of this research project. In implementation of the communication plan some
alterations have been done to make the communication process efficient and flawless. The
following communication plan is representing the communication framework executed
within the research project involving the stakeholders of Mercy Community aged care
services
Item Frequency Format Sponsor Supervisor Project
Team
Nurses Aged
People
Families

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Status
Report
Monthly Email /
Paper
document
I R R I I I
Project
Funding
Once Online
Document
R I I I I I
Project
Plan
Once Project
Charter
I R R I I I
E
Portfolio
Weekly Email I I R I I I
Final
Project
Report
Once Paper
Document
I I R I I I
Survey Monthly Online
Document
I R I I I I
Timeline:
Activity Start Date Duration
Setting up Goal 18-05-18 8
External and Internal Organizational Research 25-05-18 20
Communicating with stakeholders 11-06-18 15
Decision making 17-06-18 10
Project Plan 25-06-18 20
Resource allocation 12-07-18 5
Budget Plan 15-07-18 2

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Operational Forecast 17-07-18 5
Execution 20-07-18 15
Evaluation 28-07-18 18
Evaluation
Execution
Operational Forecast
Budget Plan
Resource allocation
Project Plan
Decision making
Communicating with
stakeholders
External and Internal
Organisational Research
Setting up Goal
10-05-18
25-05-18
09-06-18
24-06-18
09-07-18
24-07-18
08-08-18
Start Date
Gantt Chart
Risk management
The predetermined risk management plan has helped to cope up with sudden
operational failure during the internal and external unexpected regulatory activities. However,
the project has been completed successfully without having any severe failure of research
operation. However insufficient time and other external factors hinder the overall quality of
the project to some extent. However, a negligible amount of deficiency in technical
knowledge and slightly disputed implementation has been experienced during the execution

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of the project plan. However, the teamwork and internal coordination was the strength of this
project team that has led to the successful implementation of the research project plan. The
following table describes the number of occurrence and potential impact of risk factor
including the mitigation strategies.
Risk Possible Impact
on Project
Mitigation Strategy Occurrence
Insufficient timings and
operational delay High
Prepare accurate
project schedule and
time management
strategy
Noticeable
Communicational complexity
within stakeholders High
Redeveloping the
suitable
communication plan
with adequate and
strategic alteration
Twice
Lack of teamwork and work
flow deficiency Very High
Team monitoring
during the project Never
Lack of technical knowledge
among nurses High
Training to use proper
knowledge aligned
with their duties
Negligible

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Deliverables
This research project poses various scopes to deliver value to the study of finding the
current pain management framework at Mercy Community Residential Aged Care Services
and the solution for these discrepancies. The deliverable components have several segments
or phase that have been operated sequentially. The basic phases of the deliverables are
Learning, Initiation, Planning, Execution and closure. In each of these parts, there are
multiple deliverable outcomes from the conducted research project.
Phase Deliverables
Learning
Initial Meeting conducting
Identifying and analysing the Project Requirements
Designing and developing the Project Presentation
Accumulating information and executing Project
Workshop
Initiation
Ensuring the acceptance of the project throughout the
stakeholders
Producing Budget plan and estimated cash flow
Arranging Team Members
Planning
Developing effective Project Schedule
Developing the Project Plan
Procuring the Project Resources
Confirming the appropriate time management
Implementation/Execution
Conducting Literature Review
Preparing real time data collection module
Execute Project Work and data collection

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Analysis and findings from the collected data
Closure Project Report
Appraisal and Feedback
Stakeholder Signoff
Project Handover
Evaluation
Through evaluation process, the research method and its effectiveness have been
measured while making adequate changes to it. The evaluation framework of this research
project has been followed a cyclic procedure. After developing the project tools as per the
project plan the survey has been conducted on the sample sized residents. To monitor the
implementation process and gather information about effectiveness and ethical measurement
the post-survey feedback process has been done. This feedback collection will be conducted
on the participants as well as all the stakeholders namely nurse, doctors, caregivers, project
team members and supervisors. These collected feedbacks have been helped to analyse the
efficiency and the effectiveness of the current survey method. As per the analysis the required
changes have been identified to develop the research method for the next phase.
Dimension Dimension Assessment
Time 13 weeks were allocated to
complete the project for
Assessment of Pain
Management Process at Mercy
Community Residential Aged
The Project was produced
within the allocated timeframe.

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Dimension Dimension Assessment
Care Services by conducting a
survey and literature review.
The original Gantt chart had
identified that staff and
residents’ surveys and
interviews would be conducted
however project scope was
modified when it was identified
that to assess the pain
management process, it should
only be determined by the
resident’s point of view
because they are the targeted
group which would benefit
from this project.
Scope Scope was modified after
continuous communication
between the project supervisor
and the project manager.
Modification of a scope created
some issues by interacting with
the project plan which was
planned.
Resources Risks which were identified in
the project plan occurred.
Access to the internet was a
problem faced by the students
but managed it by contacting
the course tutor.
Access to the internet is crucial
in conducting any project so it
was managed by contacting the
course tutor who supported and
provided the internet device by
the University.
Final deliverable Comprehensive and useable A high-quality project was able

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Dimension Dimension Assessment
report was specified by the
sponsor and key stakeholder for
this project.
to be delivered as a detailed
report on current Pain
Management process at
MCRACS.
Figure 2: Evaluation framework
Source: (Created by author)
Data analysis
 The resident has been assessed for pain
Answer Number of response Total respondents Percentage
YES 18 20 90%
NO 2 20 10%
Developing
method
Executing
project tool
Collecting
post-servey
feedback
Analysis
Identificatio
n of
requered
changes

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90%
10%
Number of response
Positive
Negative
 Does the pain management care plan reflect the current assessment?
Answer Number of response Total respondents Percentage
YES 19 20 95%
NO 4 20 5%
95%
5%
Number of response
Positive
Negative
 Episodes of pain are recorded

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Answer Number of response Total respondents Percentage
YES 18 20 90%
NO 2 20 10%
90%
10%
Number of response
Positive
Negative
 Medical practitioner has assessed pain
Answer Number of response Total respondents Percentage
YES 19 20 95%
NO 1 20 5%

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95%
5%
Number of response
Positive
Negative
 Analgesia has been ordered by the medical practitioner
Answer Number of response Total respondents Percentage
YES 19 20 95%
NO 1 20 5%
95%
5%
Number of response
Positive
Negative

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 Analgesia has been administered as per orders
Answer Number of response Total respondents Percentage
YES 18 20 90%
NO 2 20 10%
90%
10%
Number of response
Positive
Negative
 Has the pain management plan been regularly evaluated?
Answer Number of response Total respondents Percentage
YES 18 20 90%
NO 2 20 10%

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90%
10%
Number of response
Positive
Negative
 Has the effectiveness of the analgesia been documented in pain chart &/or progress
notes?
Answer Number of response Total respondents Percentage
YES 19 20 95%
NO 1 20 5%

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95%
5%
Number of response
Positive
Negative
 Pain documented in the progress notes when PRN analgesia is administered
Answer Number of response Total respondents Percentage
YES 18 20 90%
NO 2 20 10%
90%
10%
Number of response
Positive
Negative

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Issue Number of negative
response
Percentage
The resident has been assessed for pain 2 10%
Does the pain management care plan reflect the
current assessment?
1 5%
Episodes of pain are recorded 2 10%
Medical practitioner has assessed pain 1 5%
Analgesia has been ordered by the medical
practitioner
1 5%
Analgesia has been administered as per orders 2 10%
Has the pain management plan been regularly
evaluated?
2 10%
Has the effectiveness of the analgesia been
documented in pain chart &/or progress notes?
1 5%
Pain documented in the progress notes when PRN
analgesia is administered
2 10%

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The resident has been assessed
PNP reflects the assessment
Episodes of pain are recorded
Medical practitioner has assessed pain
Medical practitioner ordered Analgesia
Analgesia administered
PNP regularly evaluated
Documented of analgesia effects
Pain documented during PRN analgesia
0%
5%
10%
15%
10%
5%
10%
5% 5%
10% 10%
5%
10%
Percentage of negative response for each question
Key Findings:
According to Henwood et al., (2017), more than 47 million people are living with
dementia which is going to rise to 75 million by 2030. Most of these dementia patients suffer
from the several additional physical disabilities or painful issues. On the other hand, about
80% of dementia patients in residential aged care facilities usually are affected by pain
(Mitchell & Pachana, 2013). This number is also rising along with the growth of dementia
patient count. In many residential aged care centre of Australia, this pain management
process has been failed repeatedly due to lack of efficient framework and attainability. At the
same time lower capability of these patients regarding verbal communication also makes the
whole pain management implementation complicated to execute. As per the epidemiological
research in pain in older people, it has been found that the most common causes of the pain in
older patients are degenerative joint disease and spine disease along with the leg, foot, chest

25HEALTH SERVICES MANAGEMENT
and other pains. The severe painful issues in older people are often found because of cancer,
bone fracture and various bone marrow infections.
In any residential aged care facilities, light or severe pain can be assessed and treated
with medication as well as non-medication pain-relieving treatment. From recent practices in
pain management process of these facilities, it has been found that regular non-medication
treatment like physiotherapy is very helpful to decline the pain range as well as the frequency
of occurrence. On the other hand, inadequate assessment for main management can cause
declining physical activities, participation and cognition while increasing agitation,
restlessness, depression and sleep disturbance in aged patients. These symptoms can be more
observable in case of dementia patients.
People with dementia who are living with pain in the various caregiving home are
being undertreated compared to other patients. However, a dementia patient has more
potentialities to suffer from multiple pains compared to others. As opined by De Witt Jansen
et al., (2017), The detection of pain is 31.5% in cognitively impaired patients while 61% of
cognitively intact patients. This undertreatment causes severe chronic pain condition that
reduces the overall quality of life significantly. Majority depression and anxiety disorder in
these patients who suffer from sever painfulness have 30% to 40% greater chances of causing
Post Traumatic Stress Disorder or PTSD (Regan, Colling & Tapley, 2015).
Pain management is one of the essential parts of the palliative approach towards the
dementia care among aged population. Though the access to the management of pain has
been globally acknowledged as the fundamental human right, the mercy community services
are falling short in providing effective pain care to the aged residential population. There are
a considerable number of aged individuals who reported to have undertreated and

26HEALTH SERVICES MANAGEMENT
unnecessary sufferings due to pain in the current scenario. In case of dementia, the
identification of the pain and the amplitude of suffering the pain are more difficult. Thus, it is
thus essential for the mercy community services to prioritize an industry-wide and
multidisciplinary approach to effectively address the issues related to pain management.
Appropriate education and training of the staffs of the mercy community services and
implementation of appropriate protocols and policies are the key strategies to improve the
health care services of the hospital to ensure the best quality of treatment towards the
implementation of the pain management framework for aged people especially who are
suffering from dementia.
Recommendations
Chronic pain is one of the common situations among the aged residents and thus it is the
responsibility of the care providers of the mercy community services to ensure effective pain
management (Corbett et al., 2014). Unmanaged and poor pains tend to result in degrading
quality of life among the aged individuals and distress for the family members as reported in
various cases of mercy community services. Some of the recommendations for ensuring best
practice and effective pain management in the mercy community services among all the
residents of aged care facilities are stated below.
 Adequate training and education of the residential aged care staff-
The aged care staffs are largely responsible for under-reporting any sort of pain among the
aged residential individuals. Inadequate training and knowledge regarding the field often
result in degrading health among the aged group of people. From the recent cases and reports
of mercy community services, it has been found that more than 41.6% of the care
professionals engaged in the community services have received no knowledge or training

27HEALTH SERVICES MANAGEMENT
regarding the assessment of pain among the people suffering from dementia (Woolf &
Andrews, 2017). Implementation and organization of effective training and educational
knowledge are thus essential and vital for providing high quality residential aged care. The
mercy community services should also ensure that age care staffs should have adequate
sound knowledge in managing pain for the people suffering from dementia to address the
issues and difficulties of the patients like psychological disturbances, non-verbal behaviours
and more.
 Improvement in the report of the policies-
The management of the mercy community services must develop protocols and standards for
ensuring provider establish systems for the aged care staff. This should be initiated to conduct
daily pain assessments for the aged individuals in the community services. In the current
scenario, there are no standards or protocols in the mercy community services for the
effective implementation of an essential level of care for the aged individuals in the hospital
by the nurses or the health care staffs (Harmon et al., 2015). Furthermore, the measurement
of customer satisfaction should also be initiated by the mercy community services for
monitoring and maintain a higher level of care among the aged individuals of the hospital.
The mercy community services must ensure that the residents are able to report their pain or
injuries by developing and restructuring their management and policy procedures.
 Expansion of support by the means of Aged Care Funding instruments-
The instrument of Age Care Funding of mercy community services does not provide
adequate funding for the allied healthcare facilities that include the assessments to pain
management (Woolf & Andrews, 2017). The instrument in the hospital currently fails in
supporting the best practice on evidence-based management for the pain to the aged
population. This should be altered, and the mercy community services should expand its

28HEALTH SERVICES MANAGEMENT
support so that there remains an adequate funding for the health care facilities of the hospital
which includes assessments of pain, support towards appropriate plans regarding person-
centred care (Peisah et al., 2014). Furthermore, the mercy community services should also
ensure clinical care for achieving best possible outcomes related to care. It is important for
the hospital and the healthcare professionals in the mercy community services to recognize
the preferences of the aged individuals who need end of life care treatments and initiate
measures to minimize the effect of the chronic pain for improving the quality and
functionality of the life. The mercy community services should abide by the National Pain
Strategy.
 Education and sound knowledge for the aged care residents with the capacity of
sufficient cognition-
Previous reports and cases of the mercy community services revealed that many older and
aged people take pain as a normal part of the ageing and lacks hope in its improvement. The
care staffs and the health care professionals of mercy community services thus should
introduce programs such as Seniors ADAPT for propagating the belief that age is not at all a
factor or an obstacle in the pathway of improvement (De Witt Jansen et al., 2017). The
management and the care staffs of mercy community services thus should provide the
residents with appropriate education regarding pain management and self-management. The
care staff and allied health professionals of mercy community services should also encourage
the aged residents to participate to form their self-care plan and end life plan which should
include effective pain management strategies (Dewing & Dijk, 2016).
 Need for a coordinated approach in the residential aged care sector-
There lays a serious problem regarding the absence of leadership in the mercy community
services for improving the policies that are related to the best and effective practices in the

29HEALTH SERVICES MANAGEMENT
context of treatment and pain management (Husebo & Corbett, 2014). It is thus important for
the mercy community services to prioritize the field of pain care management and ensure that
best and top-quality treatments are featured and provided to the aged population and ensure
good quality aged care.

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Reference:
Corbett, A., Nunez, K. M., Smeaton, E., Testad, I., Thomas, A. J., Closs, S. J., . . . Lawrence,
V. (2016). The landscape of pain management in people with dementia living in care
homes: a mixed methods study. International Journal of Geriatric Psychiatry, 31(12),
1354-1370. doi:10.1002/gps.4445
Henwood, T., Neville, C., Baguley, C., & Beattie, E. (2017). Aquatic exercise for residential
aged care adults with dementia: benefits and barriers to participation.
INTERNATIONAL PSYCHOGERIATRICS, 29(9), 1439-1449.
doi:10.1017/S104161021700028X
Mitchell, L. K., & Pachana, N. A. (2013). Rehabilitation in residential aged care facilities:
Barriers and facilitators in a dementia context. Australian Journal of Rehabilitation
Counselling, The, 19(1), 57-63. doi:10.1017/jrc.2013.5
Regan, A., Colling, J., & Tapley, M. (2015). Pain management: a fundamental component of
dementia care. Nursing standard (Royal College of Nursing (Great Britain): 1987),
30(9), 43. doi:10.7748/ns.30.9.43. s45
Corbett, A., Husebo, B. S., Achterberg, W. P., Aarsland, D., Erdal, A., & Flo, E. (2014). The
importance of pain management in older people with dementia. British medical
bulletin, 111(1).
De Witt Jansen, B., Brazil, K., Passmore, P., Buchanan, H., Maxwell, D., McIlfactrick, S. J.,
& Parsons, C. (2017). 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), 1234-1244.

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Dewing, J., & Dijk, S. (2016). What is the current state of care for older people with
dementia in general hospitals? A literature review. Dementia, 15(1), 106-124.
Harmon, J., Summons, P., Maslin-Prothero, S., & Higgins, I. (2015). Provision of pain
comfort care for the older hospitalised person: An ethnographic study of nursing
clinical pain management practices. The Australian Nursing and Midwifery
Organising Committee would like to acknowledge the assistance of the following
people in preparing this publication ABSTRACT REVIEW COMMITTEE, 78.
Husebo, B. S., & Corbett, A. (2014). Dementia: pain management in dementia—the value of
proxy measures. Nature Reviews Neurology, 10(6), 313.
Maaden, T., Steen, J. T., Vet, H. C., Achterberg, W. P., Boersma, F., Schols, J. M., ... &
Koopmans, R. T. (2015). Development of a practice guideline for optimal symptom
relief for patients with pneumonia and dementia in nursing homes using a Delphi
study. International journal of geriatric psychiatry, 30(5), 487-496.
Peisah, C., Weaver, J., Wong, L., & Strukovski, J. A. (2014). Silent and suffering: a pilot
study exploring gaps between theory and practice in pain management for people with
severe dementia in residential aged care facilities. Clinical interventions in aging, 9,
1767.
Woolf, C., & Andrews, N. (2017). Development of Novel Local Analgesics for Management
of Acute Tissue Injury Pain. Childrens Hospital Corporation Boston United States.

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Appendices:
Appendix1: Survey report
Number of
respondents
Question Yes No
The resident has been assessed for pain 15 5
Does the pain management care plan reflect the current assessment? 16 4
Episodes of pain are recorded 18 2
Medical practitioner has assessed pain 19 1
Analgesia has been ordered by the medical practitioner 17 3
Analgesia has been administered as per orders 16 4
Has the pain management plan been regularly evaluated? 15 5
Has the effectiveness of the analgesia been documented in pain chart &/or progress
notes?
19 1
Pain documented in the progress notes when PRN analgesia is administered 18 2