Experience of Intensive Care Nurses in Assessment of Postoperative Pain in Patients with Hip Fracture and Dementia

Abstract

Introduction: Patients with hip fracture are one of the most demanding groups in the health-care system. One of the most important tasks for nurses is to assess pain and ensure the patients are pain free. Pain assessment in patients with dementia is a well-known challenge for health-care professionals due to the patients' difficulties in verbalising pain problems. Aim: The aim of this study was to explore the experience of intensive care nurses in assessment of pain in patients with hip fracture and dementia in the postoperative setting. Methods: Data were collected through five focus group discussions using open-ended questions and qualitative content analysis. Twenty-one intensive care nurses (6 men and 15 women) participated in the focus group interviews. Results: Analysis of the data resulted in three main categories: "Communication", "Visual assessment of pain", and "Practical issues" including a number of subcategories. Some of the factors which influence assessment of pain in patients with dementia are the lack of information and knowledge about the patients, which causes loss of time and increased stress. The different forms of communication and ways of assessing pain in these patients were other factors mentioned by nurses as hindrances regarding assessment of the pain. Conclusion: In order to improve assessment of pain, more knowledge and information about the patients are needed and better coordination between the pre-and postoperative departments regarding these patients. In this context, different intervention studies on patient's hip fracture and dementia are needed to increase knowledge and awareness regarding this group of patients.

Nurses’ Experience of Nursing Workload-Related Issues during Caring Patients with Dementia: A Qualitative Meta-Synthesis

“…Nurses in dementia care were under pressure from demanding workloads and time constraints [ 26 , 31 , 32 ]. As dementia care is time-consuming, nurses’ daily schedules were disrupted, and they experienced time shortages [ 32 ].…”

“…Nurses in dementia care were under pressure from demanding workloads and time constraints [ 26 , 31 , 32 ]. As dementia care is time-consuming, nurses’ daily schedules were disrupted, and they experienced time shortages [ 32 ]. Addressing the pain of dementia patients was particularly time-consuming, and nurses were occasionally faced with difficulties as they could not obtain sufficient information from the patients [ 31 ].…”

“…BPSD was another factor that disrupted nurses’ occupational duties [ 29 ]. Nurses in dementia care experienced increased workload due to BPSD [ 24 , 25 , 29 , 33 ]. If patients displayed repetitive speech or behaviors, nurses began speaking or behaving repetitively as they did; as this led to increased workload, some nurses became angry [ 29 ].…”

“…Nurses experienced difficulty with ambiguous communication from dementia patients [ 25 , 29 , 31 , 32 , 33 ]. Due to the difficulties in communication, nurses had trouble identifying dementia patients’ emotion or intent [ 29 ] and consequently found themselves in situations wherein they had no idea what they needed to do to satisfy their patients’ needs [ 29 ].…”

“…There were no articles that met all items of the CASP checklist; for instance, some articles did not address potential researcher bias and participant recruitment strategies. However, articles that remained in the final selection were all peer-reviewed, published in reputable academic journals, and included quality information on nurse experiences in dementia care [ 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ]; therefore, they were deemed to have ample value as data for the current study.…”