Emergency nurses' evaluation of observational pain assessment tools for older people with cognitive impairment

Fry, M; Arendts, G; Chenoweth, L

Emergency nurses' evaluation of observational pain assessment tools for older people with cognitive impairment

Fry, M

Arendts, G Chenoweth, L

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Publication Type:: Journal Article
Citation:: Journal of Clinical Nursing, 2017, 26 (9-10), pp. 1281 - 1290
Issue Date:: 2017-05-01

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Field	Value	Language
dc.contributor.author	Fry, M https://orcid.org/0000-0003-1265-7096	en_US
dc.contributor.author	Arendts, G	en_US
dc.contributor.author	Chenoweth, L https://orcid.org/0000-0002-1783-9289	en_US
dc.date.available	2016-09-22	en_US
dc.date.issued	2017-05-01	en_US
dc.identifier.citation	Journal of Clinical Nursing, 2017, 26 (9-10), pp. 1281 - 1290	en_US
dc.identifier.issn	0962-1067	en_US
dc.identifier.uri	http://hdl.handle.net/10453/115340
dc.description.abstract	© 2016 John Wiley & Sons Ltd Aims and objectives: To explore emergency nurses’ perceptions of the feasibility and utility of Pain Assessment in Advanced Dementia tool in people over 65 with cognitive impairment. The Pain Assessment in Advanced Dementia tool was then compared with The Abbey Pain Scale, Doloplus-2 and PACSLAC. The objective was to determine which observational pain assessment tool was the most appropriate for the emergency department context and the cognitively impaired older person. Background: The number of older people with cognitive impairment conditions, such as dementia, presenting to the emergency department is increasing. Approximately 28% of people over 65 years who present will have cognitive impairment. Older people with cognitive impairment often receive suboptimal pain management in the ED. There is limited evidence of the use and/or appropriateness of dementia-specific pain observation assessment tools in the ED. Design: This was a multicentre exploratory qualitative study, which was conducted within a constructivist paradigm. Methods: Focus group interviews were conducted with nurses across three hospital emergency departments. Data were subject to thematic analysis. Results: Six focus groups were conducted with 36 nurses over a 12-week period. Four themes emerged from the analysis: 1) cognitive impairment is a barrier to pain management; 2) PAINAD gives structure to pain assessment; 3) PAINAD assists to convey pain intensity; and 4) selection of an appropriate observational pain assessment tool. Conclusions: This study identified that emergency nurses find it challenging to detect, assess and manage pain in cognitively impaired people. While the use of the PAINAD helped to address these challenges compared to other tools, nurses also identified the important role that family and carers can play in pain assessment and management for older people with cognitive impairment. Relevance to clinical practice: This study has generated new knowledge that has broad application across clinical settings, which can assist to transform pain management practice and reduce human suffering. The use of an observational pain assessment tool can provide for greater practice consistency for patients with communication difficulties. Pain management for older people with cognitive impairment is best achieved by the use an appropriate observational pain assessment tool and with a multidisciplinary approach that includes the person and their family/carer.	en_US
dc.relation.ispartof	Journal of Clinical Nursing	en_US
dc.relation.isbasedon	10.1111/jocn.13591	en_US
dc.subject.classification	Nursing	en_US
dc.subject.mesh	Humans	en_US
dc.subject.mesh	Pain Measurement	en_US
dc.subject.mesh	Focus Groups	en_US
dc.subject.mesh	Emergency Nursing	en_US
dc.subject.mesh	Aged	en_US
dc.subject.mesh	Emergency Service, Hospital	en_US
dc.subject.mesh	Nursing Assessment	en_US
dc.subject.mesh	Female	en_US
dc.subject.mesh	Male	en_US
dc.subject.mesh	Pain Management	en_US
dc.subject.mesh	Acute Pain	en_US
dc.subject.mesh	Cognitive Dysfunction	en_US
dc.title	Emergency nurses' evaluation of observational pain assessment tools for older people with cognitive impairment	en_US
dc.type	Journal Article
utslib.citation.volume	9-10	en_US
utslib.citation.volume	26	en_US
utslib.for	1110 Nursing	en_US
utslib.for	1117 Public Health and Health Services	en_US
utslib.for	1701 Psychology	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/Nursing
pubs.organisational-group	/University of Technology Sydney/Strength - CHSP - Health Services and Practice
utslib.copyright.status	closed_access
pubs.issue	9-10	en_US
pubs.publication-status	Published	en_US
pubs.volume	26	en_US

Abstract:

© 2016 John Wiley & Sons Ltd Aims and objectives: To explore emergency nurses’ perceptions of the feasibility and utility of Pain Assessment in Advanced Dementia tool in people over 65 with cognitive impairment. The Pain Assessment in Advanced Dementia tool was then compared with The Abbey Pain Scale, Doloplus-2 and PACSLAC. The objective was to determine which observational pain assessment tool was the most appropriate for the emergency department context and the cognitively impaired older person. Background: The number of older people with cognitive impairment conditions, such as dementia, presenting to the emergency department is increasing. Approximately 28% of people over 65 years who present will have cognitive impairment. Older people with cognitive impairment often receive suboptimal pain management in the ED. There is limited evidence of the use and/or appropriateness of dementia-specific pain observation assessment tools in the ED. Design: This was a multicentre exploratory qualitative study, which was conducted within a constructivist paradigm. Methods: Focus group interviews were conducted with nurses across three hospital emergency departments. Data were subject to thematic analysis. Results: Six focus groups were conducted with 36 nurses over a 12-week period. Four themes emerged from the analysis: 1) cognitive impairment is a barrier to pain management; 2) PAINAD gives structure to pain assessment; 3) PAINAD assists to convey pain intensity; and 4) selection of an appropriate observational pain assessment tool. Conclusions: This study identified that emergency nurses find it challenging to detect, assess and manage pain in cognitively impaired people. While the use of the PAINAD helped to address these challenges compared to other tools, nurses also identified the important role that family and carers can play in pain assessment and management for older people with cognitive impairment. Relevance to clinical practice: This study has generated new knowledge that has broad application across clinical settings, which can assist to transform pain management practice and reduce human suffering. The use of an observational pain assessment tool can provide for greater practice consistency for patients with communication difficulties. Pain management for older people with cognitive impairment is best achieved by the use an appropriate observational pain assessment tool and with a multidisciplinary approach that includes the person and their family/carer.

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http://hdl.handle.net/10453/115340