Effective Pain Assessment Strategies for Elderly Dementia Patients

The assignment content discusses the importance of identifying pain and its cause in elderly patients with dementia. It emphasizes the need to redesign the system of care to promote carers' time in identifying behavioral patterns of dementia patients, as pain assessment in these patients requires more cognitive power. The sense-making approach is used to collect cues related to patient patterns of pain, recognizing signs of pain through behavior, vocalization, and formal assessment tools. The recognition-primed decision (RPD) model is proposed as a health promotion approach to improve the safety of patients in nursing home settings.

Running head: PAIN IN DEMENTIA PATIENT
Pain in dementia patient
Name of the student:
Name of the University:
Author’s note:

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Health issue: Recognizing pain in elderly people with dementia who are living in the
nursing home
Description of health issues:
Dementia is a common health issue in elderly people and it significantly interferes with
normal daily life activities. The disease is associated with gradual deterioration in memory,
communication, reasoning and judgment skills, ability to focus and visual perception. However,
cognitive problem is not the only challenge for care givers of elderly people with dementia. In
nursing homes, it has been found that 50% of elderly people have dementia and recognizing and
assessing pain such people is very challenging (Hadjistavropoulos et al., 2014). Many barrier to
pain assessment is seen because of personality changes, memory loss and impairment if
judgment and abstract thinking skill in elderly people. Error in assessment might also occur
because sometimes symptoms attributed with dementia are actually an indication of pain in
patient. For example, dementia patients may display aggressive behavior when they experience
pain and the care may mistake it as a symptom of dementia (Lichtner et al., 2014). Hence,
considering unique challenges in recognizing pain in dementia patient, this report proposed
developing a health promotion strategy to improve pain assessment of elderly people with
dementia. The focus is mainly on female patients with dementia as women are at greater risk
from dementia than men (Knapton, 2017).
Evidence based strategy for health improvement:
The evidence based strategy that is proposed for mitigating the barrier in pain assessment
and managing pain in elderly patient with dementia is the use of sense-making theories to

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interpret pain in nursing homes. The strategy of using intuitive perception is considered
important to mitigate the barrier to pain assessment because pain assessment tool does not
provide the information that nurse need to recognize pain in patient. Hence, using the sense
making theory may help to develop the intuitive knowledge of carer in nursing homes and
improve their decision making regarding pain recognition and management. The theories of
sense-making focuses on giving meaning to experiences and interpreting information from those
experiences (Dowding et al., 2016). Hence, this approach can be used in nursing home to use
intuitive skills to recognize the characteristics of cognition in elderly women dementia. This
form of decision-making is highly dependent on interaction with patient and the higher
interaction, the more information is gained regarding level of pain in dementia patients.
Mamykina, Smaldone, & Bakken, (2015) also support the benefits of the sense making theory in
management of chronic disease by using the framework of sense making for diabetes self-
management. Hence, instead of relying on the technology and clinical tools, this health
promotion project encourages carers observe patient’s behavior and make sense of those
information to manage chronic diseases.
Overview of the strategy:
This health promotion strategy proposes developing the intuitive perception of nurse or
care or elderly people with dementia by the application of the sense making theory and
supporting them to recognize and assess pain in such patients. Sense making is mainly dependent
on a person’s ability to make sense of the phenomena (patient’s behavior or expression in
response to pain), construct mental representation of that phenomenon and using this to guide
action. This enables developing a pattern related to behavior of dementia patients during pain,
discovering connections associated with pain and then engaging in appropriate management

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activities to reduce pain interaction, the more information is gained regarding level of pain in
dementia patients (Mamykina, Smaldone, & Bakken, 2015). Hence, in the context of recognizing
pain the in dementia patient, the implementation of this health promotion intervention is
dependent on extensive training of staffs and their experience in caring for dementia patients in
nursing home.
In nursing home, sense making theory can be applied for recognition of pain in dementia
patients in the following ways:
 Nurses must be trained to build mental patterns of the patient’s behavior with
time. The advantage of this approach is that it will support the nurse to identify
the behavior or characteristics that indicate pain.
 Three necessary sense making strategies that will be necessary for the nurse to
recognize pain will include perception of new information related to expression of
pain in patient, development of inferences from certain behavior of patient and
carrying out appropriate strategies to manage pain (Dowding et al., 2016).
 There is also need for collective work of the team because cognitive activity
cannot be individual person and group of individuals monitoring the patient’s
behavior and health status may give good information regarding identification of
pain and cause of pain (Goodwin et al., 2014).
 As pain assessment in elderly dementia patient requires more cognitive power, it
is necessary that organization routines and boundaries also support carers to
devote time in identifying behavioral patterns of dementia patient. Therefore,
redesigning the system of care will be necessary to promote care of elder adults
with dementia (Callahan et al., 2014).

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 With the use of sense making approach, the nurse can collect cues related to
patient patterns of pain. Some of the signs of pain may be recognized by behavior,
vocalization of pain and scores on formal assessment tools. Hence, pain
assessment tool is not totally excluded in this intervention, instead this also
informs about the pattern related to pain event in elderly patient. In response to
this information, clinician or nurse can identify the experience as pain and
implement necessary action to manage such patient situation (Dowding et al.,
2016).
Health promotion approach model to be used for the strategy:
The above mentioned strategy is mainly based on the model of recognition-primed
decision model (RPD). This model defines the process needed for effective decision making
during complex situations. It can regarded as an effective health promotion approach model for
dementia patients because this model also supports taking intuitive strategies such as pattern
recognition to take proper action. The role of cognition is critical in improving safety of patient
in nursing home setting and the RPD model will support the nurse to effectively recognize and
manage pain of elderly adults (Lighthall & Vazquez-Guillamet, 2015.
The model will promote health promotion activities for dementia patients in nursing
home because it also combines the intuitive and clinical information processing components to
improve health status of individual. This is relevant to the sense making approach needed for
recognition of pain and using this model as a framework will give direction to nurses or carer
regarding the pain recognition and assessment process.

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Description of health promotion activities:
To successful develop the skills of nurse in pattern recognition related to pain recognition
in elderly dementia patients, the following health promotion activities will be necessary:
 Firstly, it will necessary to develop the cognitive skills of nurse and carers so that they
engage in pattern recognition and develop intuitions regarding the behavior that is an
indication of pain in patient. Hence, training sessions will mainly use the cognitive
forcing strategies to encourage nurse to monitor dementia patients and increase their
competency in using heuristics for identification of pain (Lichtner et al., 2016).
 The key resource required for this health promotion activities include pain assessment
tool, appropriate behavior characteristics form of patient, training materials related to
strategies needed for pattern recognition and follow up form to inform about patient’s
behavioral patterns. The training and material and pain assessment tool is critical for
carers because training material will enable nurse or carer too characterize patient’s
behavior related to pain and tools will give information regarding pain levels and type of
pain (Newton et al, 2014). Secondly, behavior characteristics form will inform the staffs
about the individual response of patients to pain and this will be useful in communicating
the information to other staffs involved in care of that patients too.
 The training activities will be collected prior to the implementation of activities and the
process of intuition to collected cues related to pain will be done in nursing home. This
health promotion project will need investment in the area of relevant pain assessment tool
for dementia patient and covering the training cost.

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Evaluating the success of the strategy:
The main objective of the use of sense making in recognizing pain in elderly people with
dementia is :
 Eliminate the barrier to recognition of pain and assessment of pain such as
misinterpreting patient’s behavior in response to pain as symptom of dementia
 Getting all the cues related to specific behavior that is an indication of pain in patient
 Recognizing the factors that is the cause of pain in patients (Lichtner et al., 2016)
The success of the project will be determined by taking the feedback from the nurses or
carers regarding the use of sense making approach for pain recognition. If they express that
challenges in pain assessment has reduced after this approach, then this intervention can be
continued for long term too. The next aspect is related to evaluating the outcome of dementia
patient after the recognition of pain. Insufficient training or education regarding effective pain
assessment is often a barrier to pain recognition and the outcome of patient may give an
indication whether cares have been successful in conceptualizing pain situations of dementia
patient or not. Secondly, the level of use of pain assessment tool is also critical for this pain
assessment project because pattern recognition is also dependent on effectively measuring pain
levels (Chacko, 2014).

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Reference
Callahan, C. M., Sachs, G. A., LaMantia, M. A., Unroe, K. T., Arling, G., & Boustani, M. A.
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