Observational Pain Assessment

Chronic pain is often defined as pain lasting more than 12 weeks. It may arise from initial injury, such as a back sprain, or there may be an ongoing issue such as illness. The assignment given consisted of finding a person who suffers from chronic pain to explore the ideas of illness classification, the experience of pain and explanatory models. The interview process was executed on September 17, 2016 via face time lasting approximately 45 minutes in length. She gave me her oral consent for this interview. I explained that this information would be used for a chronic pain paper. (American Chronic Pain Association) The subject is a 53 year old, Caucasian, upper middle class female currently in treatment for melanoma cancer. Currently, no disease

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

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

To provide the best care for their elderly patients, nurses must incorporate pain assessment into their daily care of patients. Pain assessment is a key aspect of the nurse’s role. There are many factors to consider when assessing patients’ pain such as if they are verbal or non-verbal, what language they speak, their age and their cultural background. There are many tools that a nurse can use to assess a patient’s pain but one of the most common tools is the 0-10 scale. This tool can be asked verbally by asking what

In order to identify and prevent persistent pain in elderly population with dementia, Monacelly et al. (2013) conducted a study in a nursing home in Italy by using Doloplus-2 pain assessment tool. The participants were patients (n=23) with moderate to severe dementia and were unable to express the feeling of pain. Researchers obtained consent from the management and designated legal guardians of the patients. The purpose of the study was to observe the pain symptoms of the same group of elderly population for a period of one year and evaluate the effectiveness of the pain management by using the Doloplus-2 diagnostic pain assessment tool. As an initial part of the study, presence of pain was confirmed in participated patients by using the Doloplus-2

“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.

(REARDON, ANGER & SZUMITA, 2015.). There are two ways to assess pain which they have been used for long time. The first way is Visual analog Scale. The second way is Numeric Rating Scale which means patient should rate their pain in scale of (0-10) zero is no pain and 10 is the worst pain. REARDON, D. P., ANGER, K. E., & SZUMITA, P. M. (2015). However, “the nurse also judged patiens’ pain based on their appearance and mobility, and investigated any potential complications by conducting physical examination. The nurses often rechecked the pain levels in order to clarify and ensure that the recorded pain levels corresponded to the causes of the pain and suffering” (Chatchumni, Namvongprom, Eriksson, & Mazaheri, 2016) patients also may report no improvement for their pain even though with high dose of opioid and ask for high dose of opioid while the nurses noticed them sleeping or

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.

Kedziera (2001) discusses pain management in elderly patients. In this article she urges clinicians to

Gregory, J. (2014). Dealing with acute and chronic pain part one assessment. Journal of Community Nursing, 28(4), 83-86. Retrieved from http://www.jcn.co.uk/journal/08-2014/pain-management/1666-dealing-with-acute-and-chronic-pain-part-one-assessment/

Research design: Descriptive quantitative analysis was carried out so as to ascertain the degree of knowledge acquired by patients regarding pain agreement. 28 questions were designed so as to analyze the situation in detail (Przybelinski & Ball, 2015).

The most common reason that people seek medical care is pain, and pain is the leading cause of disability (Peterson & Bredow, 2013, p. 51; National Institute of Health, 2010). Pain is such an important topic in healthcare that the United States congress “identified 2000 to 2010 as the Decade of Pain Control and Research” (Brunner L. S., et al., 2010, p. 231). Unfortunatelly, patients are reporting a small increase in satisfaction with the pain management while in the hospital (Bernhofer, 2011). Pain assessment and treatment can be complex since nurses do not have a tool to quantify it. Pain is considered the fifth vital sign, however, we do not have numbers to guide our interventions. Pain is a subjective expirience that cannot be shared easily. Since nurses spend more time with patients in pain than any other healthcare provider, nurses must have a clear understanding of the concept of pain (Brunner, et al., 2010). Concept analysis’ main objective is to clarify ideas, to enhance critical thinking, and to promote communication (Rodgers & Knafl, 2000). This paper will examine the concept of pain using Wilson’s Steps of Concept Analysis (Rodgers & Knafl, 2000).