Pain assessment & management in residents with dementia : nurses’ knowledge, attitudes & reported practice

Abstract

Background: Older persons with dementia may lack the facility to self-report their pain sensations. When such self-reporting is not possible, nurses should assume the responsibility of observing, recognising and subsequently managing pain when caring for residents with dementia. In order to successfully do so, nurses need to have adequate knowledge in pain assessment and management, own sympathetic attitudes, and be supported with sufficient resources and adequate training on the subject. Objectives: To evaluate local long term care nurses’ knowledge, attitudes and reported practice related to pain assessment and management in residents with dementia, identify any barriers in the delivery of care and evaluate the extent to which participants’ characteristics influence their knowledge and attitudes. Design and Methods: A descriptive, cross sectional design, characterised by the collection of data through a questionnaire. A total of 321 questionnaires were distributed with a response rate of 64.2% (n=206). Participants: All nurses working in a local state nursing home and who provide a daily nursing care to elderly residents, including residents with dementia. Results: The study findings reveal poor knowledge and inappropriate attitudes among local nurses regarding pain in residents with dementia. The most inconsistent responses, were on aspects about pain management, analgesia administration and misconceptions about opioids. A positive correlation was found between the participants’ level of knowledge and attitudes and their nursing grade and level of education obtained in nursing. Main shortcomings identified include: lack of pain assessment tools, inadequate training and education on the subject and inadequate time to systematically assess and manage pain due to staff shortages. Conclusions: Local nurses are not adequately equipped to manage the complexity of pain assessment and management in residents with dementia. Provision of high-quality care within the local system for residents with dementia is threatened by the identified nurses’ and organisational related shortages.