PAIND Pain Assessment

As the dementia progresses the individual could be unable to communicate, but they may be able to express pain through noise I.e. screams, but these could be easily misinterpreted by care providers as a “normal” behaviour if these are regular occurrences.

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

What is the point in measuring something that is unique to every individual? In “The Pain Scale,” the author, Eula Biss, attempts to convey her pain to the reader. She tells the reader how she has tried to describe and measure her pain. There is a system set up for doing so, but it leaves much up to individual interpretation. The arbitrary process by which we are supposed to evaluate the level of pain we are experiencing doesn’t seem to accomplish much. Throughout the essay, Biss uses unique ways of comparing the suggested levels of pain to other “scales.” This raises the question, why can the scale, itself, doesn’t do adequate job of helping people understand pain.

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

Nearly 135 million people worldwide will be impacted by dementia by 2050 (Robinson, Tang, Taylor,. 2015). Dementia is not a disease, it is an overall term that describes a wide range of symptoms associated with the decline in memory and thinking skills. Dementia is a progressive illness that results in the loss of one’s sense of self (Burns, Byrne, Ballard, Holmes, 2002). The two most common forms of dementia are Alzheimer’s disease and Vascular dementia. Dementia is progressive and people with dementia experience complications with short-term memory, keeping track of personal items, paying bills, taking care of themselves and daily tasks (Haigh, Mytton, 2016). Due to the rising number of individuals developing dementia, it is causing major challenges in the healthcare systems and society (Angermeter, Luck, Then, Riedel-Heller, 2016). Utilizing psychotropic medications are often ineffective or harmful to the individual, therefore, many patients decide to utilize sensory therapy as a form of treatment instead (Livingston, Kelly olmes, et al., 2014). Caregivers of individuals with dementia can also experience health consequences related to caregiving at the end of life. Spousal caregivers are 40.5% higher odds of experiencing frailty as a result of caregiving (Carr, Dassel, 2017). Dementia does not only affect the individual, it affects those around them, society, and the healthcare system.

Conceptual analysis is integral in understanding nursing theory. According to Walker and Avant (1995), concept analysis allows nursing scholars to examine the attributes or characteristics of a concept. It can be used to evaluate a nursing theory and allows for examination of concepts for relevance and fit within the theory. The phenomena of pain will be discussed in this paper and how it relates to the comfort theory.

Several patients suffered from dementia and some had accompanying diagnoses, such as hip fracture from falling or upper and lower extremity weakness. Dementia is a decline in memory and greatly affects how activities

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.

Dementia is an extremely common disease among the elderly, with 4 million Americans currently suffering from the Alzheimer’s type alone. Figures show that 3% of people between the ages of 65-74 suffer from the disease, rapidly increasing to 19% for the 75-84 age bracket, and as high as 47% for the over 85s. Therefore, it is easy to see why Dementia is such a large part of many people’s lives, whether they are suffering from the condition themselves, or have an elderly relative who requires full time care just to undertake simple day to day tasks. The disease can be extremely traumatic for the patient and their families, as the person, who may have been extremely lively and bright throughout their

‘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’.

living tasks after a fall and hospital admission for example. Fundamentally, the majority of cases were people with a form of dementia, and each case was as complicated as the next. In order to highlight not only the physical but the emotional

VAS is formed by a 100 mm horizontal line anchored on both ends, with the left end denotes the minimum score and the other end as the maximum score. VAS anchors, time period of reporting and instructions of use vary depending on the intended use of the scale. For pain intensity, the left-most anchor indicates “no pain,” which is a score of 0 and the right-most anchor indicates “worst imaginable pain,” which is a score of 100 on a 100 mm scale. Pain VAS is self-completed by the participant where they are asked to draw a line perpendicular to the VAS line at the point that represents their pain intensity. Value of pain intensity is obtained by measuring the distance from the “no pain” anchor to the perpendicular line drawn by the participant.

The gold standard for determination of the absence and presence of pain has long been self-report. However, for patients with major cognitive or communicative impairments, it would be better if clinicians could quantify pain without having to rely on the patient’s self-description. Here, we present a newly pain intensity measurement method based on multiple physiological signals, including blood volume pulse (BVP), electrocardiogram (ECG) and skin conductance (SC), all of which are induced by external electrical stimulation. The proposed pain prediction system consists of signal acquisition and preprocessing, feature extraction, feature selection and feature reduction, and three types of pattern classifiers. Feature extraction phase is devised

Pain scores are documented in writing, making them readily available to all the health care professionals. There were many suggested assessment tools found in the literature and

Despite of all research and literature reviews, there is still a lack of standard and knowledge in reassessing and documenting patient’s pain. Therefore, it is important to follow proper standard protocols and skills to perform reassessment and documentation of pain management to improve quality of care.