Palliative care in dementia: literature review of nurses' knowledge and attitudes towards pain assessment

Burns, Michelle; McIlfatrick, Sonja

doi:10.12968/ijpn.2015.21.8.400

Cited by 46 publications

(44 citation statements)

References 40 publications

(88 reference statements)

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“…However, evidence has suggested that overreliance on personal knowledge and collateral information alone may also prove an inadequate approach to pain assessment if attitudes towards the patient population are negative, the patient is unknown or unfamiliar to the care team, or staff are inexperienced in recognising the behavioural indicators of pain in people dying with dementia . Other studies have identified a need for nursing home staff to receive ongoing, regular training, and support in developing pain assessment protocols, conducting pain assessments and responding appropriately to the outcome …”

Section: Discussionmentioning

confidence: 99%

“…[35][36][37] Other studies have identified a need for nursing home staff to receive ongoing, regular training, and support in developing pain assessment protocols, conducting pain assessments and responding appropriately to the outcome. [38][39][40] Participants believed that health policy and other clinical directives were misdirected in focusing on simple tools in a clinical area widely recognised as challenging and highly complex. Failure to highlight the benefits of using OPTs and lack of guidance on how they might be integrated with existing practice were other criticisms raised.…”

Section: Phys015 Male Consultant Palliative Medicine Hospicementioning

confidence: 99%

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“A tool doesn't add anything”. The importance of added value: Use of observational pain tools with patients with advanced dementia approaching the end of life—a qualitative study of physician and nurse experiences and perspectives

Jansen

Brazil

Passmore³

et al. 2018

Int J Geriat Psychiatry

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Section: Discussionmentioning

confidence: 99%

Section: Phys015 Male Consultant Palliative Medicine Hospicementioning

confidence: 99%

“A tool doesn't add anything”. The importance of added value: Use of observational pain tools with patients with advanced dementia approaching the end of life—a qualitative study of physician and nurse experiences and perspectives

Jansen

Brazil

Passmore³

et al. 2018

Int J Geriat Psychiatry

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“…Pain in people with dementia, with and without intellectual disability, is often underdetected and undertreated (Burns & McIlfatrick, 2015;Cohen-Mansfield, 2014). A self-report of pain is the gold standard in pain management (McCaffery & Beebe, 1989;Pasero & McCaffery, 2010;Twycross, Voepel-Lewis, Vincent, Franck, & Baeyer, 2015).…”

Section: Backg Rou N Dmentioning

confidence: 99%

Nursing people with intellectual disability and dementia experiencing pain: An integrative review

Dillane¹,

Doody

2019

Journal of Clinical Nursing

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Aims and objectives To explore the current evidence of nurses caring for people with intellectual disability and dementia who experience pain. Background People with intellectual disability are ageing and are experiencing age‐related health conditions including dementia and conditions associated with pain, but at an earlier age. Addressing the needs of people with intellectual disability who develop dementia is a new challenge for nurses. Design An integrative literature review. Methods A systematic search of databases: CINAHL, MEDLINE, PsycINFO, Cochrane, EMBASE, Academic Search Complete, Scopus and Web of Science between 27 October 2017–7 November 2017. Hand searching and review of secondary references were also undertaken. Quality appraisal (Crowe Critical Appraisal Tool), thematic data analysis (Braun and Clarke, Qualitative Research in Psychology, 3, 2006, 77) and reporting using the PRISMA guidelines. Results Seven papers met the inclusion criteria, and three themes emerged from this review: nurses knowledge of ageing, dementia and pain; recognising pain in people with intellectual disability and dementia; and the role of nurse education. People with intellectual disability and dementia have difficulty communicating their pain experience compounded by pre‐existing communication difficulties. Conclusions A pain experience can present similar to behavioural and psychological symptoms of dementia, and diagnostic overshadowing often occurs whereby a pain need is misinterpreted as behavioural and psychological symptoms resulting in inappropriate treatment. Nurses need greater knowledge about the presence of pain and potential causes in people with intellectual disability and dementia, and education can be effective in addressing this knowledge deficit. Relevance to clinical practice Pain assessment tools for people with intellectual disability and dementia need to include behavioural elements, and baseline assessments are required to identify changes in presentation. Nurses need to recognise and respond to pain based on the evidence in order to deliver quality care.

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“…Pain behaviours can be complex and individualised and can be associated with depression, functional impairment and agitated behaviour 15. Clinically, recognising distress is an important first step 16.…”

Section: Assessment and Management Of Symptomsmentioning

confidence: 99%

Challenges in end-of-life dementia care

Fetherston

Rowley²,

Allan³

2018

Evid Based Mental Health

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Dementia is a chronic, progressive disease that is now much more widely recognised and treated. Patients with dementia may require palliative care when they reach the end stage of their illness, or they may have mild-moderate cognitive symptoms comorbid with a life-limiting illness. The variety of presentations necessitates a highly individual approach to care planning, and patients should be encouraged to set their own goals and contribute to advanced care planning where possible. Assessment and management of distressing symptoms at the end of life can be greatly helped by a detailed knowledge of the individuals' prior wishes, interdisciplinary communication and recognition of changes in presentation that may result from new symptoms, for example, onset of pain, nutritional deficits and infection. To navigate complexity at the end of life, open communication that involves patients and families in decisions, and is responsive to their needs is vital and can vastly improve subjective experiences. Complex ethical dilemmas may pervade both the illness of dementia and provision of palliative care; we consider how ethical issues (eg, providing care under restraint) influence complex decisions relating to resuscitation, artificial nutrition and treatment refusal in order to optimise quality of life.

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Palliative care in dementia: literature review of nurses' knowledge and attitudes towards pain assessment

Cited by 46 publications

References 40 publications

“A tool doesn't add anything”. The importance of added value: Use of observational pain tools with patients with advanced dementia approaching the end of life—a qualitative study of physician and nurse experiences and perspectives

“A tool doesn't add anything”. The importance of added value: Use of observational pain tools with patients with advanced dementia approaching the end of life—a qualitative study of physician and nurse experiences and perspectives

Nursing people with intellectual disability and dementia experiencing pain: An integrative review

Challenges in end-of-life dementia care

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