Exploring ways to enhance pain management for older people with dementia in acute care settings using a Participatory Action Research approach.
Deirdre Harkin, Vivien Coates, Donna Brown
PMID 35761509WHAT IT FOUND
Staff in acute care described older patients with dementia not having pain assessed because dementia was not identified, families were not asked, and busy targets pushed pain assessment down the list.
They agreed to use visual prompts and ask families about usual pain signs.
Key findings
01Pain management for older patients with dementia was made low priority by competing pressures in busy acute care.
02In the two case studies, neither patient had pain assessed in the emergency department, despite spending up to 8 hours there, and the dementia diagnosis went unnoticed until after ward admission.
03Staff identified actions including asking families about usual pain signs, using a recognised pain assessment tool routinely, identifying people with dementia at emergency department triage, and reviewing analgesic prescriptions.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study took place in one acute hospital, so the themes may not fit other services. Only two case-study patients were followed in detail, which gives a narrow view of pain management practice. The audit covered only two weeks, and the exact number of patients with dementia admitted and discharged daily was unknown. The researcher had previously worked as a nurse in the same Trust, so insider relationships may have shaped what staff said and did. Medical staff were not included in the focus groups, although they were represented in the steering group and case studies. The paper reports reflections and agreed actions, not tested outcomes, so it does not show that these actions improved pain management.
Declared interests
No conflict of interest has been declared by the authors.
The easy way to misread this
Do not read the agreed actions as proven improvements. The study reports themes and next steps from staff reflection, not outcomes showing better pain management.