Analgesic and Facilitator Pain Assessment

5. Zwakhalen, S., Hof, C., & Hamers, J. (2012). Systematic pain assessment using an observational scale in nursing home residents with dementia: exploring feasibility and applied interventions. Journal Of Clinical Nursing, 21(21/22), 3009-3017. doi:10.1111/j.1365-2702.2012.04313.x

As with all older adults, clients with dementia present with chronic conditions such as arthritis and acute pain experienced in the aging and the end of life process. Moss (2002) gives evidence that most elderly clients who move into long-term care will die in an institution either a nursing home or a hospital many of whom will have dementia. She states that 91% have a strong co morbid condition likely to cause pain.

Dealing with aging dementia patients can be a challenge in and of itself. However, when healthcare providers need to include regulating pain as well, the challenge becomes even greater. Pain management with cognitively impaired patients is a constant problem within geriatric care in modern healthcare facilities (Zwakhalen et al 2006). The reduced self capacity to report pain in its true degrees then makes pain management a challenge for physicians and healthcare providers (Husebo et al. 2007). Thus, research aims to explore effective measures for observing and reporting pain management within aging dementia patients.

Unfortunately, many clinicians and older adults wrongfully assume that pain should be expected in aging, which leads to less aggressive treatment. Older adults have additional fears about becoming dependent, undergoing invasive procedures, taking pain medications, and having a financial burden. The most common pain-producing conditions for aging adults include

A great deal of investment in terms of research has yielded copious information regarding the individual phenomena of sleep and pain. These two subjects have even been studied to a substantial degree in specific populations, the older adult population being one of these. However, study of the interaction between these two phenomena has only recently begun to be of great notice. This interaction, though lately established in the literature, has not been adequately studied in many populations. In particular this inadequacy is notable for the older adult population. A search of the database Academic Onefile using keywords “older adults”, “sleep” and “pain” produced no literature involving all three. The literature used in this review was found with individual searches of “sleep” and “pain”, “older adults” and “sleep”, and “older adults” and “pain”. This issue is of great importance to nurses and other clinicians due to the increasing age of the patient population seen in practice (Berman, Snyder, Kozier, & Erb, 2012), and due to the pervasive difficulties with sleep and pain faced by older adults.

Aim/ purpose of study: Conglomeration of current data on pain and pain management for patients with dementia.

The Pain Assessment Survey was developed to assess whether registered nurses are using evidence-based standards to assess and manage pain for special populations. Descriptive statistics were used in this study. The sample group surveyed included registered nurses currently enrolled in an on-line Baccalaureate program. A quasi-non-experimental study was utilized to allow the collection of a large amount of data at one time, while allowing the researches to compare and contrast the use of evidence based practice standards when preventing medication errors. This study contained both dependent and independent variables. The independent variable present is the use of evidence-based practice standards in the assessment of pain in special populations. The dependent variable is the management of pain in special populations of different cultures and chronic pain syndromes. The researchers concluded that out of the 50 participants of the survey, the majority use the verbal pain scale. The researchers concluded that registered nurses are using evidence-based standards of practice when assessing pain in special populations such as those with different cultural backgrounds and those with chronic pain

The proper way to ensure that this is not a constant problem is to make sure that initial pain assessments as well as re-assessments are done in a timely manner. It seems as though the initial pain assessment was completed using the pain scale but the re-assessment was not complete and documented in the proper amount of time. In order to ensure proper documentation of the re-assessment once the first pain assessment has been completed and an intervention has properly been administered, the first action step will be to make sure that the reassessment is complete within one hour of pain intervention. With electronic mars it is easy to build in a recheck into the system to alert the nurse that a reassessment is needed once the pain medication has been administered to the patient. When a pain intervention is done, a flag will come up to remind the nurse taking care of the patient that a reassessment is due. This will also resolve the issue on the tracer audit of how does the nurse know the intervention worked. Another issue on the audit was if no pain intervention was done what was the reason for it not being done.

“Pain is a complex, multidimensional experience that can cause suffering. [While] pain is inevitable, suffering is optional” (Kinder, 2014, p. 114). The control of pain is, as Kinder puts it very complex, without appropriate measures it can be easily side stepped especially in the elderly. To ensure patient center care it is important that all aspect of one’s quality of life is address, this is emphasizing by pain being a component of vital signs. Being a vulnerable population the elderly is often under assessed as they minimized their problems so as not to be a burden in addition to the fact that they may believe that their pain is a normal part of aging.

Jack has advanced Alzheimer’s disease (AD) stage, which is a neurogenerative disorder with cerebral cortex atrophy from neurons and synapses loss (de Tommaso, Kunz & Valeraini, 2017). Common symptoms include memory and language deficits, orientation problems, mood changes and unable to perform activities of daily living (Kilmova & Kuca, 2016). Jack is non-fluent, has comprehension difficulties and unable to verbally express himself (Kilmova & Kuca, 2016) Research has shown residents with poor mobility generally have a high occurrence of pain and there is an interaction between pain, cognitive impairment and behavioural disturbances (Miu, & Chan, 2014). Consequently, Jack after his fall three months ago, may be being resistance to staff due to pain. David is concerned about his dad’s behavioural change and wondering if pain is the cause.

Pain is defined as an “unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage. Pain is always subjective.” (Jarvis, 2016) In our society today, the older adults and older adults who suffer from dementia are poorly assessed in terms of pain assessment. Studies have shown that about 35-48% of older adults living at home suffer from chronic pain, another 45-85% of older adults living nursing homes lives with chronic. Older adults suffer from chronic pain as most suffer from conditions that can lead to chronic pain. The health care professional with the proper pain assessment skills can better manage and treat pain in the older adult. The assessment

According to Horgas & Miller (2008), older adults with cognitive or physical limitations, have difficulty expressing details about their pain. These include pain location, duration, onset, type, precipitating factors, and relieving factors of pain. Pain is a subjective experience without valid and reliable objective tests to measure it. The existence and intensity of pain are measured by patient self-report. Unfortunately, older populations with cognitive disability may have difficulty expressing pain via verbal or body language. In some cases, it is astounding to know that pain in older

‘Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage’ (International association for the study of pain 2014). Pain can be made up of complex and subjective experiences. The experience of pain is highly personal and private, and can not be directly observed or measured from one person to the next (Mac Lellan 2006). According to the agency for health care policy and research 1992, an individuals self-report of pain is the most reliable indicator of its presence. This is also supported by Mc Caffery’s definition in 1972, when he said ‘Pain is whatever the experiencing patient says it is, existing whenever he says it does’.

Pain behaviour studies suggest there is a need to be cautious of ethnic or cultural stereotypes. Therefore, even though there are findings of general cultural differences it is considered very important to evaluate the pain of each person individually.

Pain is a common cause of disability in older adults.7, 9-13 Among its consequences are risk of future fall injuries, reduced life satisfaction and quality of life, increased use of health and home care services, impairments in activities of daily living, increased mood disturbances and increased health care costs.6, 9, 11, 14-17 Previous studies on pain in older adults have reported prevalence from 24% to 72%,5, 7, 16, 18-20 a variability that may be due to methodological dissimilarities, case definitions, and culture differences across studies.5, 15, 21-22 Several authors state that pain prevalence is higher in elderly than in younger ages,23, 24 but a recent review concluded that it was impossible to provide a general estimate of pain