Development Of A Service Innovation

Dementia is a progressive disorder that will affect how you’re brain functions and particularly your ability to remember, think and reason. Dementia usually affects older people and are approximately 820,000 people in the UK with the disorder, and around 15,000 are under the age of 65. If the dementia is recognised early enough that are a lot of things that you can be done to make the quality of life better. In a lot of dementia cases the symptoms and quality of life will progress and get worse over a number of years. The most common symptoms of a dementia patient are:

The term ‘dementia’ describes a set of symptoms which can include loss of memory, mood changes and problems with communication and reasoning. These symptoms occur when the brain is damaged by certain conditions and diseases, including Alzheimer’s disease, vascular dementia and Creutzfeldt-Jakob disease. 
Age is the greatest risk factor for dementia. Dementia affects one in 14 people over the age of 65 and one in six over the age of 80. However, dementia is not restricted to older people: in the UK, there are over 17,000 people under the age of 65 with dementia, although this figure is likely to be an underestimate.

Research conducted by the Australian government in 2011, estimated that 298,000 Australians have been diagnosed with dementia and based on current projections, this number will exceed 400,000 by 2020. (1) Although forecast methods vary, the number of people with dementia is expected to triple between 2011 and 2050 and is estimated to reach approximately 900,000 by 2050. (1)

“The control of pain is the key to all other care”(Raiman 1998). This is especially true within old age psychiatry as if a client is in pain it may be impossible to recognise a pure diagnosis of agitation or depression and intervene accordingly when there is the possibility that these symptoms may be reactive due to inadequate pain relief. The key to therapeutic success is how well are the symptoms being relieved. Untreated pain in the client with dementia can delay healing, disturb sleep and daily activity, reduce quality of life and prolong hospitalisation (Horgas 2003).

Dementia refers to a syndrome which results in deterioration in thinking, memory, behavior, and ability to execute everyday activities and duties. Despite the fact that the syndrome is mainly associated with the older people, it is not a normal aspect or part of ageing. One of the major causes of dementia is the aspect of Alzheimer's disease. This disease contributes to about 60 to 70 percent of the cases of dementia. Dementia possesses psychological, physical, economic, and social impacts in relation to the family, caregivers, and the entire society. Dementia affects each individual in a diverse or different way with reference to the impact of the disease and personality following the development of the syndrome (Gao et al, 2013 p. 447).

Horgas et al. (2009) is an in-depth examination of the various factors that can be used to report pain within these specific groups of patients. The journal is from the American Geriatrics Society, and thus is clearly peer-reviewed. It is a thorough examination into how dementia patients report their own pain, as well as how their pain can be observed within actual practice. The data was then coded according to the American Hospital Formulary Service System (Horgas et al 2009). This clearly shows that the research supports evidence-based practices for it uses real observations from patients actually being in the field today in combination with commonly held patterns from prior research.

1.1 Dementia is a progressive disease where an individual’s brain functions deteriorate and affects their mental capabilities. This disease is incurable which is similar to another terminal illness such as cancer. Symptoms of dementia will affect an individual’s memory leading to loss and confusing, language/ communication, understanding and judgement. Medication can be prescribed to help slow down the progression of symptoms.

Pain is a condition that is determined and described by the person reporting it. There are several components to pain including the emotional, psychological, and physical aspects. Many health professionals struggle to understand this phenomenon and thereby insert their own perspectives into the pain assessment of patient reporting pain. The Affordable Care Act (ACA) (2010), also titled the Patient Protection and Affordable Care Act H.R. 3590, was passed by Congress and signed into law on March 23, 2010 (U.S. Department of Health and Human Services (DHHS), 2013). Hospital value based purchasing programs (VBP) were developed to align patient quality care and outcomes to the support initiatives from the ACA. A component of the VBP includes patient satisfaction. Patient satisfaction is a self-reported response to questionnaire administered by a third party. Many hospitals utilize Press Ganey to administer the survey for the inpatient and outpatient patients. One component the survey includes patient’s self-reporting how well their pain was managed during their hospitalization. This measure of satisfaction can have an adverse effect on patient outcomes and increase opioid use in this setting. Patient satisfaction and pain management are both subjective however pain management while within scope of healthcare professionals should not be included in the patient satisfaction survey.

The following represents the level of compliance in the pain assessment area of patient care that was audited for Nightingale Community Hospital:

This Network is dedicated towards providing a truly interactive patient care experience where the patient, family and their partners in care are active, engaged and empowered participants in their care continuum. By engaging the patient throughout their care, we improve: patient satisfaction, quality and safety, and finance & operations. It allows patients and their families to take a more active role in the care process by learning more about their condition, communicating with caregivers, preparing for discharge and caring for themselves at

There is a growing geriatric population of people with dementia (the subpopulation) throughout the world that are living in pain constantly. Because dementia as a condition with multifaceted symptomology manifested by advancing overall decline of cognitive ability, it causes severe and distinctive barriers to pain assessment and pain management in this subpopulation. The existence of multiple comorbidities, polypharmacy and the declining cognition in this subpopulation results in a much more complex pain symptomology. Zwakhalen, Hamers, Abu-Saad, and (replaced & with and) Berger, (2006), explain that common behaviors associated with pain may be absent or difficult to interpret in this subpopulation because some dementia symptoms may be an indication of pain, but such behavior, however, might also be incorrectly interpreted as a symptom of dementia. Therefore, pain in this subpopulation is exceptionally challenging to evaluate and manage as a result of this difficulty.

Dementia is not a specific disease. It is a descriptive term for a collection of symptoms that can be caused by a number of disorders that affect the brain. In England alone, there are currently 570,000 people living with dementia. Dementia usually affects the individual’s memory, thinking, language development and understanding.

Therefore the innovation being introduced in the report will focus on the pain management tool for assessing chronic conditions in service users with dementia in hospital settings. As pain is a very subjective experience it is important that the tool is specifically based on the individual’s own way of expressing and communicating their pain in relation to their chronic conditions.

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).

The International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage” (1979). Pain is actually the culprit behind warranting a visit to a physician office for many people (Besson, 1999). Notoriously unpleasant, pain could also pose a threat as both a psychological and economic burden (Phillips, 2006). Sometimes pain does happen without any damage of tissue or any likely diseased state. The reasons for such pain are poorly understood and the term used to describe such type of pain is “psychogenic pain”. Also, the loss of productivity and daily activity due to pain is also significant. Pain engulfs a trillion dollars of GDP for lost work time and disability payments (Melnikova, 2010). Untreated pain not only impacts a person suffering from pain but also impacts their whole family. A person’s quality of life is negatively impacted by pain and it diminishes their ability to concentrate, work, exercise, socialize, perform daily routines, and sleep. All of these negative impacts ultimately lead to much more severe behavioral effects such as depression, aggression, mood alterations, isolation, and loss of self-esteem, which pose a great threat to human society.