Literature Review of Pain Management in Dementia.

2. Address Mrs. Thomas’s Physical pain and decline. Explore Mrs. Thomas’s attitudes and feelings about the use of narcotics. Some patient’s choose to forgo pain medications because they fear decreased alertness and want presence with family and friends. Non-narcotic and non-sedating medication options should be explored and discussed. Help Mrs. Thomas verbalize her fears about the medications. Explain the difference between addiction and dependence. Explore Mrs. Thomas’s openness to alternative methods of pain control such as visualization, music therapy, self-hypnosis and mediation. Encourage her to listen to her body by resting when needed and participating in life when she has the energy. Mr. and Mrs. Thomas both require education about palliative care options for management of symptoms associated with her disease.

This results in the following PICO question: In terminally ill patients, does early admission into a hospice program, versus those who are admitted later, result in more effective pain control at the end of life? The focus of this question is therapy (Sackett, 1997).

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

According to Allen et al. (2012), “millions of people with chronic illnesses endure unrelieved pain, uncontrolled physical symptoms and unresolved psychosocial or spiritual problems.” This issue occurs because palliative care is often considered a form of end-of-life care. Palliative care is a treatment that can be used for patients who suffer from chronic illnesses and diseases while receiving curative treatment. (Horowitz, Grambling & Quill, 2014) purposely states the misconceptions of palliative care and advocated for seriously ill patients that education must bring under control the misconceptions. Some patients do not receive appropriate symptom management because the palliative care treatment needed is often confused with end-of-life care. However, end-of-life care attempts to relieve pain and suffering when a disease is no longer responsive to curative treatment. Pain and suffering could ultimately be controlled or even eliminated through the proper utilization of palliative care. Patients who are not referred to palliative care in a timely manner is more likely to have poor quality of life, uncontrolled symptom management and increased amounts of visits to the emergency room during the disease process. Patients with life limiting illnesses bear the burden of increased discomfort and increased suffering. Nurses experience clinical practice issues and difficulties in the clinical setting during the delivery of comfort and symptom management. These issues

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.

This essay discusses the core principles of long-term conditions and management. Government guidelines and standards are also discussed in relation to how these will impact the care of the patients who are experiencing long term conditions. The reports, guidelines and plans that play an important role in directing the current nursing system today, are discussed with regard to the management of chronic conditions and lastly, palliative care and outcomes from the publication “Together for Health – Delivering End of Life Care” (2013)

The World Health Organization (WHO, 2017) defines palliative care as a care that improves quality of life of patients and families who are facing problems associated with their life-threatening illness. This is by preventing and relieving suffering by the early identification, immaculate assessment, treatment of pain, and other problems like physical, psychosocial and spiritual issues. The goal to palliative care is to not only treat the patient but also provide comfort to both the patient and family members. Therefore the review of these literatures will provide insight on the barriers and specific needs that a patient with dementia may have.

JCAHO (2011) also stated that patients and their families needed to be educated about pain and how the patients’ pain is going to be managed. Every patient perceives and exhibits pain in a different manner and if nurses do not assess the patient thoroughly they can miss it. For instance, Engebretson et al. (2006) acknowledged that, patients manifest pain in different ways and this resulted in nurses performing an inadequate assessment of their patients’ pain. Also, Engebretson et al. recognized that patients often conceal their pain because they do not want to be viewed by staff as complainers or addicts, and if patients decide to speak up the nurses frequently view their patients’ statements from their own cultural, moral and ethical belief system and not their patients which leaves the patients’ pain untreated.

Nursing assessment is a substantial way of gathering physiological, psychological, spiritual, and emotional condition of the patient. It creates a whole picture of an individual and assist the health care providers to formulate a diagnosis. Assessing the comfort of the patient is equally important as taking the blood pressure or temperature. Pain is the fifth (5th) vital sign that is subjective in nature when performing an assessment of a patient. Various studies were conducted in finding the most appropriate evidence-based nursing practice in assessing and managing the pain of a cognitively impaired patient, whether it is acute or chronic or the underlying cause is cancer or post-operative incision. As emphasized by Song, Eaton, Gordon, Hoyle, and Doorenbos (2015), it is vital to ensure that “pain management is based on the best evidence” (p. 456). Perhaps knowing the causes of inability to assess and manage the pain in a cognitively impaired patient would give a clearer understanding of the practice.

Pain is one of the most influential symptoms that leads individuals to reach out to health care professionals to seek relief. Pain is subjective and unique to each person. Some individuals may have a higher pain tolerance than others. According to Frandsen (2014), “Pain is an unpleasant, sensory, emotional sensation associated with actual or potential tissue injury” (p. 889). Pain may be caused by a variety of elements, such as tissue or nerve damage and surgery. There are three main categories that pain is classified by, which are origin, duration, and cause. The main focus of this paper is on acute pain, chronic pain, and phantom pain. It is crucial to know how to assess each type of pain, as well as how to enhance it, or decrease the pain.

Outcomes and Key Results: Likely that people with dementia are often under medicated because they are not able to adequately describe their pain symptoms. Age and age related pain are the highest factors for both dementia and pain; pain management, though, may be skewed.

Provision of pain relief is a shared responsibility of the interdisciplinary health care team. For example it may initially form part of the oncologist’s remit to determine the most effective pain management plan for the patient. After treatment has been initiated, oncology nurses may then adopt responsibility for ensuring that pain relief is adequate via regular assessment and action (NICE, 2004, p.80).

Pain and comfort as a rule are considered opposing in the needs of human beings. Pain is defined as an unpleasant sensory or emotional experience associated with potential tissue damage. Pain can be divided into categories of long-term pain or short-term pain and by the type of pain, level of pain, location of pain, and ease of solving the pain. Frequently, there is no way to completely manage pain, specifically in end-of-life care. Pain is at

I have been a registered nurse at UCLA for 18 months. One particular issue that has captured my attention is the utilization of palliative care in health care. Because nurses are generally at the bedside all the time, they have an important role to play in voicing the importance of its utilization and implementation in the patient’s care.

The case study based on the palliative patient Mrs. Mavis looks at issues both the family and the patient are dealing with in regards to the end of life treatment Mrs. Mavis is receiving. Mrs. Mavis is a palliative patient, currently unconscious, who is dying and only wants comfort measures within her nursing care. This was made clear through her advanced care directive, which was made weeks before beginning to receive her end of life care. Mrs. Mavis’ comfort measures include pain relief, hygiene and keeping her comfortable. Mrs. Mavis’ family want her to have fluids and medications to help improve her health. They also want oxygen and pain relief to help with her breathing. Issues such as educating and supporting the family, pain management, the effectiveness of having an advanced care directive and pain assessment will be evaluated to determine the best effective interventions for Mrs. Mavis and her families care. Interventions that will be discussed through-out this essay include the use of analgesia medication, the use of subcutaneous injections and syringe drivers, emotional support for the family, effective communication, educating the family on Mrs. Mavis’ wishes and the importance of having an advanced care directive. These interventions will be evaluated to ensure they are the best practice for Mrs. Mavis’ care.