- Title
- Communicating about pain in dementia care: nurses' practices, perspectives and experiences
- Creator
- Tsai, I-Pei
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2022
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Background: Pain is an essential expression of a person’s discomfort and distress. Unlike cognitively intact older adults, cognitive deficits from dementia result in difficulties communicating about pain. Assessing and managing pain in dementia involves a series of encoding and decoding of pain messages to allow communication between individuals. This communication process is complex and research that approaches pain assessment and management in dementia care from the core communication barriers in nurses’ practices, perspectives and experiences is lacking. Objective: This research aims to investigate how pain is communicated by nurses when undertaking pain assessment and management for people with dementia in hospitals through nurses’ practices, perspectives and experiences. Methods: A two-stage exploratory-descriptive study using a mixed-methods design was used, underpinned by a human communication process model. In stage one, the study used a retrospective medical record review to evaluate nursing documentation practices. In stage two, in-depth interviews were used to explore individual nurses’ perspectives and experiences. Participants were recruited from a local health district in the east coast of Australia. Data were analysed using descriptive and inferential statistics and integrated with qualitative thematic analysis. Results: Records from patients hospitalised with dementia were reviewed (n=100) and eight registered nurses were interviewed. Approximately 66% of patients were documented to have pain at least once during hospitalisation, with 58% reporting moderate to severe pain intensity. The higher the pain frequency, the longer the patients remain in hospital. Nurses’ pain reports via scores had no association with patients’ cognition levels, patients’ pain reports, and their analgesic pain management. Nurses estimated pain using their intuitional judgement and observations and there was a variation of pain scores for dementia care. The practice limitations for nurses to efficiently manage pain in dementia care were related to the availability of prescriptions for analgesia. The integration of quantitative and qualitative findings led to the development of a care concept model for pain in dementia care. Conclusion: The findings from this thesis suggest that pain tools be used as a complementary method to assess and manage pain for people with dementia in hospitals in addition to nurses’ intuition and observation. Fragmented pain reporting can be improved by carefully distinguishing patient-self reports from nurses’ observational pain reports. Care policies need to emphasise the high frequency and impact of pain in people with dementia during hospitalisation. A collaborative care approach between clinicians would minimise limitations that have been encountered among the current nursing practice. Finally, the care concept model developed from applying the communication process model and incorporating the research findings provides evidence-based recommendations supported by the theoretical framework for future nursing practice of pain in dementia care in hospitals.
- Subject
- pain assessment and management; dementia care; nurses' practices and perspectives
- Identifier
- http://hdl.handle.net/1959.13/1505052
- Identifier
- uon:55613
- Rights
- Copyright 2022 I-Pei Tsai
- Language
- eng
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| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | ATTACHMENT01 | Thesis | 2 MB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Abstract | 368 KB | Adobe Acrobat PDF | View Details Download |