Nurse Practitioner Should Be Able to Recognize these Descriptors and Take Them as Potential Indicators of Pain and Clarify with Further Questioning

Peoples beliefs and culture can also have an affect on the amount of pain they are feeling. This can be from a feeling that they do not want to make a fuss. It is important that you create as many opportunities as possible for people to express their pain and create a atmosphere where people know it is acceptable to say they are in pain for example:-

Psychological factors are known to contribute to how people experience and cope with pain. However, as people age, they experience normative age-related changes in psychological functioning. Thus, much of what is known about psychology and pain may not necessarily apply to older adults, unless it has specifically been tested in older populations. This is a particularly important point, because pain remains a major problem for millions of older adults. Furthermore, it is expected that the populations of older adults in America will increase significantly in the coming years, as people are living longer now that at any other point in history. Given that psychology changes across the lifespan, and that pain is a problem in older populations, this

Appropriate assessment and management of pain should be paramount to nurses working in the elderly care sector.

Pain not only involves the physical reaction to damaged tissue, but also involves an emotional and cognitive response by the person experiencing the pain (Backer, 1994). A person's prior experience will influence how pain is managed. Pain is a signal that something is not

“Pain is much more than a physical sensation caused by a specific stimulus. An individual's perception of pain has important affective (emotional), cognitive, behavioral, and sensory components that are shaped by past experience, culture, and situational factors. The nature of the stimulus for pain can be physical, psychological, or a combination of both.” (Potter, Perry, Stockert, Hall, & Peterson, 2014 p. 141) As stated by Potter et al, the different natures of pain are dealt with differently depending on many factors. Knowing this, treating pain can be very difficult as there is no single or clear cut way of measuring it; “Even though the assessment and treatment of pain is a universally important health care issue,

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

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

There is a growing geriatric population of people with dementia 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 population. The existencee of multiple comorbidities, polypharmacy and the declinining cognition in this population result in a much more complex pain symptomology. Zwakhalen, Hamers, Abu-Saad, & Berger, (2006), explain that common behaviors associated with pain may be absent or difficult to interpret in this population 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 population is exceptionally challenging to evaluate and manage as a result of this difficulty.

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.

It seems like after a while I need stronger and stronger meds to make my pain go away. (P3) Participant looked genuinely concerned about the increase in pain and taking more pain meds. Participant’s voice inflections indicated they were more concerned with the pain getting worse versus having to take stronger

‘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’.

In recent years, chronic pain in the elderly (>65 years of age) is a significant problem.

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.