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The Effective Management of Pain in Adults Living with Dementia

   

Added on  2020-06-06

20 Pages9175 Words252 Views
What factors affect the effective management of pain for individuals living withdementia in an acute hospital setting? Section 1 Introduction It has been well documented that pain affects one in three elderly adults in community. It isa common problem that pain is unrecognized and poorly managed in adult patients with dementia,who are then admitted to acute hospital wards (Horgas and Tsai, 1998; Corbett et al., 2012 andLautenbacher, 2014). Research findings show that some reasons for undiagnosed and untreated painin patients with dementia may be that they are unable to understand pain in a meaningful way. Also,they have been found to be unable in verbally expressing that they are in pain due to their cognitiveimpairment resulting from the decline of their brain functioning (Schofield, 2014). Moreover, someother contributors in ineffective pain management strategies on this particular population thatincludes healthcare professionals’ possessing inadequate skills and knowledge of pain recognition.Moreover, they are also unable toassess and manage the shortcomings from organizational support,education provision, training and facilitation for care staff (Achterberg et al., 2013).This often hampers the quality of care, treatment intervention and pain management that arebeing received by the patients, suggesting that there are some barriers that nurses may encounterwithin this field. This paper will look at some evidence from literature about pain recognition,assessment and management and how they have impacted on patient-centeredness care. Therefore,nurses could utilize some evidence from this research for adopting some best practices to overcomeany such identified barriers. This is basically to improve the quality of care to this group of patientsduring their stay in the hospital. Seven research articles will be used for the purpose of analysing thefindings that will be discussed to implement in the undertaken nursing practice as an evidence toimprove the quality of care that are being received by this particular group of patients. Aconclusion, limitation and recommendation will also be presented to clearly enlighten the acquiredfindings of this report.Aims and objectives This paper firstly aims to explore and identify the method of pain recognition, its assessmentand management to be carried out for eradicating the issues faced by the patients with dementia innursing practice in an acute hospital care setting. Secondly, it will be examining the evidence todevelop decision support interventions, which is to assist the nurses in their practice of effectively

recognising pain in dementia patients. Also, it is expected to assess and improve the management ofpain for such population in acute care settings of the hospital.Background Dementia have significant effects on not only the person’s own self who live withdementia but also on their families, carers and other significant associations, personally,emotionally, economically and socially (Madsen and Birkelund, 2012). Approximately, 47 millionpeople all across the world are affected by dementia, from which, nearly 50% population haveregularly experienced some degree of pain. The nature of dementia can directly impact ontoindividual’s memory, thinking, intelligence and daily activities (Kooten et al., 2015; World HealthOrganization, 2017). In UK, there are more than 800,000 people living with dementia, where thisnumber is expected to increase by 1 million, by the end of 2025 (Parkin and Baker, 2016). Therising prevalence of dementia will have a significant impact on the costs of health and social care.The cost of providing care, treatment, research, education, training and support to peoplewith dementia, their families and carers isestimated to be £26 billion a year(Department ofHealth, 2015). Hunt (2014) has stressed that further, 250,000 NHS staff would have receivedtraining in dementia care to ensure that the patients are getting the best possible care. Despite of theefforts that are being been made to help improving the services for people living with dementia bythe government, the quality of care that are being received by the patients with dementia in acutecare settings of hospital is still questioned by some authorities. Some recent evidence demonstratesthat the staff working in hospital acute care settings are lacking skills and knowledge to deliver careto this population. It is with a special aspect of pain recognition, assessment and management (Surrand Gates, 2017). Dementia is a disease that is continually rising at a higher pace and whose symptoms arelikely to worsen over time, in which the patients are likely to have a gradual decline in theircognitive function (Prince and Jackson, 2009 and Royal College of Nursing, 2017). Individualsliving with dementia may suffer from various symptoms with a most common symptom of memoryloss (Holme, 2012). Others include difficulties with reasoning, expressing themselves andcommunicating and socialising with others (Wang et al., 2013). Due to such reduced capability of aperson in their overall skills and functioning to take part in daily life activities, they find itchallenging to perform their daily chores that involve preparing a cup of tea or coffee, cooking,washing, bathing, getting dressed up, shopping and cleaning, etc., (Potkins et al., 2003). Peopleliving with dementia could exhibit some common psychological symptoms of depression, anxiety,hallucinations and delusions, etc., (Holmes and Amin, 2016). Carers and family members who look

after them often suffers from certain behavioural and psychological symptoms associated withdementia that causes physical and emotional strain and frustration in them. Also, they find it timeconsuming to provide care to their loved ones suffering from dementia that leads to reduce theiroverall working hours (Ferri et al., 2004).Most of these symptoms are related to pain that is being experienced by people and they areunable to clearly express it to their carers or family members as their care giver and familymembers are not much educated in pain recognition (Monroe et al., 2015). Evidence suggests thatthe carers and family members may not be able to cope with such behaviours and get exhausted.This in turn results in the admittance of people with dementia to acute care hospitals (Vugt et al.,2005 and Huntley et al., 2017). The quality of care that is being received by these patients in acutecare hospitals has been a vital area of concern (Alzheimer’s Society, 2009). Health care outcomesfor this population are often inferior on comparing with their counter parts who are having an intactcognitive endurance (Royal College of Psychiatrists, 2011). Griffiths et al. (2014) have argued thatnurses have inadequate sessions of on-going training, insufficient resources, time constrain, overworkload and lack of confidence to take care of the older individuals living with dementia. It isparticularly to those who are exhibiting agitated and aggressive behaviour and have communicationdeficit. In their study, there existsa high staff turnover due to low satisfaction from their job rolewhere the nursing staff reports their reluctant emotional and behavioural response where lookingafter these patients is mostlyfrustrating, stressful and empathetic (Griffiths et al., 2014). In UK hospitals, it is common that in acute medicinal wards, there exists up to 45% ofoccupied beds by patients aged over 65 years with various degree of dementia (Sampson et al.2009; Tadros, 2012; Royal College of Nursing, 2013). A quarter of these patients with severecognitive impairment are having a high risk of dying whilst being hospitalised (Sampson et al.2009). An early study shows that 16% of the patients with dementia have experienced pain whilebeing on rest and 57% expressed pain while making movements on at least an occasion. It is with16% of patients suffering from dementia who have reported an ongoing pain during their stay athospital (Sampson et al., 2015). Pain is commonly undetected and undertreated in people withdementia due to poor pain recognition, assessment and management ability. Patients often find itdifficult to express their pain and present it in a way that people who are non-dementia fails to getit clearly and misinterpret it as language deficits, memory problems and a growing state ofdementia in patients (Timmons et al., 2016). Lichtner et al. (2016) have highlighted that patients with dementia who are admitted tohospital often exhibit some symptoms of agitation, disorientation, aggression and anxiety, etc., bytogether screaming and shouting. This may be due to the fact that patients are in an unfamiliar

environment which is often distressing for them, such as noises, limited space and lighting,unfamiliar staff members of healthcare (Dowding et al., 2015). Further, evidences have suggestedsome neuropsychiatric symptoms like for instance, aggression and anxiety that are possibly theways in which the patients try to express their pain. Although, it is often misinterpreted by thenurses and they tend to manage it inadequately, in the acute care hospital settings (Sampson et al.,2015 and Dowding et al., 2016). Managing these symptoms and behaviour is particularlychallenging for the nursing staff and results in sub-optimal care. Patients’ challenging behaviourand symptoms shows that the patients with dementia have inappropriate prescription ofantipsychotic medications (Ballard et al., 2011).An early study by Mukadam and Sampson (2011) have presented that a large proportion ofthe patients with these symptoms are more likely to have an increased length of hospitaladmittance with a reduced cognitive function and discharge. Few sources have also suggested thatthis particular group of patients are more likely to have an increased risk of mortality during theirhospital stay and post discharge as compared to their counterparts whose cognition is unimpaired(Sampson et al, 2009; Reynish et al., 2017). This suggests that the nurses are urged to find out andutilise most recent evidence to improve their nursing practices by considering to recognise, assessand manage patients who are indicating pain through such behaviour. This is basically to manageit effectively by reducing unnecessary medical treatment, shorten the period of hospitalisation byimproving the quality of care to acquire optimised outcomes and make an effective use ofhealthcare resources. Challenges for the nursing staff to recognise, assess and manage the pain experience ofdementia patients are significant. This is mainly due to the nature of dementia that makes itdifficult for the patients to memorise or recall the experience of pain where they are also not ableto accurately verbalise and identify the occurrence of pain. It may become a problem when thestaff who are assessing the patients’ pain statutes as the patient have broken down the languageand are unable to describe their pain clearly and accurately (Manias, 2012). It therefore increasesthe risk of those patients whose pain is neither detected nor assessed adequately and ineffectivelymanaged (Sampson et al., 2015). An early study by Leong and Nuo (2007) demonstrates thatsome dementia patients may express to staff when asked about any occasional pain.However,the experience of occasional pain is mostly misinterpreted by the patient itselfwhen they are unable to recall the last episode of pain, the type and severity of pain due to theirshort-term memory. Moreover, some signs of pain that patients with dementia can bemisunderstood for involves an unexpected way of exhibiting physical and emotional withdrawand they may quietly sit still and shows no willingness to engage in daily activities (Morris and

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