An Exploration of Pain Documentation for People Living with Dementia in Aged Care Services |
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| Institution: | 1. School of Health Sciences, College of Health and Medicine, University of Tasmania, Darlinghurst, New South Wales, Australia;2. Pre-hospital Emergency and Trauma Research Unit, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia;3. Dementia Centre, HammondCare, Sydney, New South Wales, Australia;4. Griffith Business School, Griffith University, Gold Coast, Queensland Australia;6. Pain Managment Service, Greenwich Hospital, HammondCare and Northern Clinical School, University of Sydney, New South Wales, Australia;5. Research and Aged Care Clinical Services, HammondCare, Hammondville, New South Wales, Australia;1. School of Nursing, University of Connecticut, Storrs, Connecticut, USA;2. Center for Advancement in Managing Pain, School of Nursing, University of Connecticut, Storrs, Connecticut, USA;3. University of Wisconsin Madison School of Nursing, Madison, Wisconsin, USA;1. Department of Women, Children and Family Health Science, University of Illinois at Chicago College of Nursing, Chicago, Illinois;2. Chang Gung University School of Nursing, College of Medicine, Taoyuan, Taiwan, ROC;3. National Taipei University of Nursing and Health Sciences, Department of Long-term Care, College of Health Technology, Taipei, Taiwan, ROC;4. Tokyo Ariake University of Medical and Health Sciences, Department of Acupuncture and Moxibustion, Tokyo, Japan;6. Boromarajonani College of Nursing Sawanpracharak Nakhonsawan, Paknampho, Maung, Nakhonsawan, Thailand;5. Department of Biobehavioral Nursing Science, University of Florida College of Nursing, Gainesville, Florida;1. Faculty of Medicine, McGill University, Montreal, Canada;2. Ingram School of Nursing, McGill University, Montreal, Canada;3. Centre for Nursing Research and Lady Davis Institute, Jewish General Hospital, Montreal, Canada;1. College of Nursing, University of Iowa, Iowa City, Iowa;2. Palliative Care Department, Medical University of South Carolina, Charleston, South Carolina;3. Department of Nursing Research, University of Chicago Hospitals, Chicago, Illinois;4. Ingram School of Nursing, McGill University, Montréal, Québec, Canada;6. Centre for Nursing Research and Lady Davis Institute, Jewish General Hospital – CIUSSS, Centre-West-Montréal, Montréal, Québec, Canada;5. Ann & Robert H. Lurie Children''s Hospital of Chicago, Chicago, Illinois |
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| Abstract: | BackgroundPain in people with dementia is a common occurrence. Providing evidence-based pain management for people with dementia in residential aged care services is imperative to providing quality care. However, it remains unclear from current research how various aged care staff (Registered Nurses (RNs), Enrolled Nurses (ENs), Personal Care Assistants (PCAs)) engage at specific points of the pain management pathway. With structural changes to the residential aged care workforce over the past two decades, understanding the relative contributions of these aged care staff to pain management practices is crucial for future practice development.AimTo investigate the quality and completeness of pain documentation for people living with dementia, and assess the extent to aged care staff are engaged in documentation processes.DesignA three-month retrospective documentation audit.Setting and ParticipantsThe audit was conducted on the files of 114 residents with moderate to very severe dementia, across four Australian residential aged care facilities.MethodsData was collected on each resident’s pain profile (n=114). One hundred and sixty-nine (169) pain episodes were audited for quality and completeness of pain documentation and the extent to which aged care staff (RNs/ENs and PCAs) were engaged in the documentation of pain management.ResultsTwenty-nine percent of pain episodes had no documentation about how resident pain was identified and only 22% of the episodes contained an evidence-based (E-B) assessment. At least one intervention was documented for 89% of the pain episodes, the majority (68%) being non-pharmacological. Only 8% of pain episodes had an E-B evaluation reported. Thirteen percent (13%) of episodes contained information across all four pain management domains (Identification/ problems, assessment, intervention and evaluation). Documentation by PCAs was evident at all points in the pain management pathway. PCAs were responsible for considerately more episodes of assessment (50% vs 18%) compared to nursing staff.Conclusion and Clinical ImplicationsDespite the high prevalence of pain in people with dementia in aged care settings, current pain management documentation does not reflect best practice standards. Future capacity building initiatives must engage PCAs, as key stakeholders in pain management, with support and clinical leadership of nursing staff. |
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