Factors that Influence Nurses’ Pain Management Practices in Hospitalized Older Persons Living with Dementia
Creators: Ingelson, Beverley Faye
Publisher: name: University of Alberta Library
Year: 2023

<p>Aim: To assess factors influencing nurses’ beliefs and knowledge when assessing and managing pain in hospitalized older persons living with dementia (PLWD). Background: Hospitalized PLWD often experience unrelieved pain. Pain is common in PLWD, and undermanaged pain accelerates changes in cognition, memory loss, and functional decline, underscoring the need for proper assessment and intervention. However, limited literature has explored nurses’ pain management practices in PLWD and what research is available suggests that nurses often underrecognize, underreport, misdiagnose, and undermanage pain in PLWD. Most of this research was conducted in long-term care facilities, which has left gaps in research into how nurses assess and manage pain in hospitalized PLWD. Additionally, past research has failed to determine if nurses’ age, gender, years of worked experience, beliefs, and knowledge influence pain management practices in this vulnerable population. Nurses are primarily responsible for pain assessment and management decisions. Nurses’ personal feelings and professional experiences with pain may lead to inaccurate knowledge and beliefs based on negative stereotypes of aging and dementia. Methods: This dissertation consists of three related studies and sequential papers that were theoretically informed by the concept of ageism: (1) a scoping review to assess the extent of available literature related to nurses’ pain management practices in hospitalized PLWD, (2) a quantitative cross-sectional survey study using a validated tool that measured nurses’ knowledge and beliefs about pain in hospitalized PLWD, and (3) a qualitative study that examined nurses’ knowledge, beliefs and experiences when assessing and managing pain in hospitalized PLWD. We designed the research conducted in Paper 2 and Paper 3 as a mixed method explanatory sequential study. Results: In Paper 1, our review findings revealed six articles indicating that hospital nurses experience many complex challenges managing pain in PLWD. This paper described the extent of literature available, pain assessment and management practices, the challenges that hospital nurses encountered, and knowledge – practice gaps. For Paper 2, we conducted research with a quantitative study using a validated survey tool, Knowledge and Beliefs about Pain in Elderly Patients with Dementia (KBPED). Nurses working in two hospitals located in Southern California, one of which was designated as a Nurses Improving Care for Healthsystem Elders (NICHE) site were surveyed. Results were analyzed to compare the association of the nurses’ age, gender, and years of experience on their general beliefs about pain, dementia, and aging; knowledge about pain management in PLWD; and beliefs about pain in older people. A multivariate analysis of variance did not support a statistically significant association. However, testing using an analysis of variance (ANOVA) revealed that male nurses of all ages and years of experience held less favorable beliefs about pain in older people. The third study for Paper 3, reported findings from a qualitative descriptive study of 12 nurses who worked in the NICHE designated hospital and participated in individual semi-structured interviews. The findings from the quantitative study informed construction of the interview guide for data collection. A content and thematic analysis resulted in two themes: nurses improvised pain assessment, and managed pain through trial and error. The nurses did not follow standardized pain assessment and management guidelines which led to various approaches when caring for PLWD. The nurses noted barriers and challenges based on communication with the patients and health care team, and perceived lack of organizational support for extra time and resources to care for PLWD. The results also indicated that knowledge deficits negatively influenced pain management strategies based partly on nurses’ experiences, negative beliefs, and stereotypes about older people and PLWD. Conclusions: Nurses’ knowledge, beliefs, and experience influenced pain assessment and management practices, potentially contributing to underrecognized, underreported, misdiagnosed, and undermanaged pain in hospitalized PLWD. These three studies imply that educational offerings thus far have not been sufficient for building adequate knowledge, or addressed negative stereotypes associated with hospitalized PLWD. The nurses’ relied on experience or tacit knowledge to inform pain management practices rather than evidence-based practice guidelines. We suggest interventional strategies using knowledge transfer and translation frameworks, to improve practice, and address negative stereotypes and improve nurses’ pain management practices in this population. </p>