Korean J Adult Nurs.  2019 Apr;31(2):176-189. 10.7475/kjan.2019.31.2.176.

Development and Effect of Evidence-based Nursing Practice Guidelines for Pain Management in Patients with Dementia

• Ryu YS
• Park JS

• KMID: 2444136
• DOI: http://doi.org/10.7475/kjan.2019.31.2.176

Abstract

PURPOSE
This study aimed to develop evidence-based nursing practice guidelines for pain management in patients with dementia and to verify their effects.
METHODS
Guidelines were developed according to the Clinical Practice Guideline Adaptation Manual. Additionally the quality of six guidelines was evaluated using the AGREE (Appraisal of Guidelines for Research & Evaluation) tool. Subsequently, the guidelines were translated into Korean and a preliminary set of guidelines was established. After a group of experts confirmed the content validity of the guidelines, the Korean version was applied to clinical settings for 4 weeks, to examine their applicability. Data was collected from April to August 2017. The dependent variables were nurses' knowledge and attitudes about pain management in patients with dementia, pain assessment frequency, use of pharmacological and nonpharmacological intervention to reduce pain, and subjective and objective pain scores of patients with dementia. Data were analyzed using an independent t-test, Mann-Whitney U test, Wilcoxon Signed Ranks test, and analysis of covariance with SPSS/WIN 22.0.
RESULTS
Nurses in the experimental group had a higher degree of knowledge and more positive attitudes regarding pain management, and they reported a higher frequency of pain assessment as compared to those in the control group. As compared to patients in the control group, those in the experimental group had more days of regular treatment with analgesics and were provided with a higher analgesics dose as well as more frequently received physical and relaxation therapies. The two groups did not show significant differences in subjective and objective pain scores.
CONCLUSION
The present findings indicates that the evidence-based guidelines for pain management developed in this study were effective in helping nurses and patients with dementia to resolve their pain for which they were currently seeking treatment.

MeSH Terms

Analgesics
Dementia*
Evidence-Based Nursing*
Humans
Pain Management*
Pain Measurement
Relaxation
Analgesics

Reference

1. World Health Organization and Alzheimer's Disease International. Dementia: a public health priority [Internet]. Genèva: World Health Organization;2012. cited 2016 Aug 20. Available from: https://www.who.int/mental_health/publications/dementia_report_2012/en/.

2. Herr K, Bjoro K, Decker S. Tools for assessment of pain in nonverbal older adults with dementia: a state-of-the-science review. Journal of Pain and Symptom Management. 2006; 31(2):170–192. DOI: 10.1016/j.jpainsymman.2005.07.001.

3. Pautex S, Michon A, Guedira M, Emond H, Le Lous P, Samaras D, et al. Pain in severe dementia: self-assessment or observational scales? Journal of American Geriatrics Society. 2006; 54(7):1040–1045. DOI: 10.1111/j.1532-5415.2006.00766.x.

4. Rantala M, Kankkunen P, Kvist T, Hartikainen S. Barriers to postoperative pain management in hip fracture patients with dementia as evaluated by nursing staff. Pain Management Nursing. 2014; 15(1):208–219. DOI: 10.1016/j.pmn.2012.08.007.

5. Kim EJ. Nurses' attitudes and perceptions of pain in patients with severe dementia. Clinical Nursing Research. 2006; 12(1):159–167.

6. Zhang C-H, Hsu L, Zou B-R, Li JF, Wang H-Y, Huang J. Effects of a pain education program on nurses' pain knowledge, attitudes and pain assessment practices in China. Journal of Pain and Symptom Management. 2008; 36(6):616–627. DOI: 10.1016/j.jpainsymman.2007.12.020.

7. The American Geriatrics Society. American geriatrics society panel on persistent pain in older persons: The management of persistent pain in older persons. Journal of American Geriatrics Society. 2002; 50:suppl 6. 205–224. DOI: 10.1046/j.1532-5415.50.6s.1.x.

8. Gu MO, Cho MS, Cho YA, Jeong JS, Eun Y, Jeong IS, et al. A prioritizing for the evidence-based nursing practice guidelines development. Journal of Korean Clinical Nursing Research. 2012; 18(1):39–51.

9. Lee MH, Park MH. Geriatric hospital nurses' empathy, attitude and pain management for patients with dementia. Korean Journal of Adult Nursing. 2016; 28(4):388–398. DOI: 10.7475/kjan.2016.28.4.388.

10. Son HJ. Evaluating the NGC evidence based acute pain management guideline in elderly for use in Korea [master's thesis]. Daegu: Keimyung University;2004. 1–93.

11. British Pain Society and British Geriatrics Society. The assessment of pain in older people [Internet]. London: The Lavenham Group Ltd;2007. cited 2016 Aug 20. Available from: https://www.britishpainsociety.org/static/uploads/resources/files/book_pain_older_people.pdf.

12. Herr K, Coyne PJ, McCaffery M, Manworren R, Merkel S. Pain assessment in the patient unable to self-report [Internet]. Overland: American Society for Pain Management Nursing;2011. cited 2016 Aug 20. Available from: http://www.saskpain.ca/images/pdf/patient_unable_clinical_practice.pdf.

13. Douglas C, Haydon D, Wollin J. Supporting staff to identify residents in pain: a controlled pretest-posttest study in residential aged care. Pain Management Nursing. 2016; 17(1):25–37. DOI: 10.1016/j.pmn.2015.08.001.

14. Ghandehari OO, Hadjistavropoulos T, Williams J, Thorpe L, Alfano DP, Bello-Haas VD, et al. A controlled investigation of continuing pain education for long-term care staff. Pain Research and Management. 2013; 18(l):11–18. DOI: 10.1155/2013/395481.

15. Kaasalainen S, Brazil K, Akhtar-Danesh N, Coker E, Ploeg J, Donald F, et al. The evaluation of an interdisciplinary pain protocol in long term care. Journal of the American Medical Directors Association. 2012; 13(7):664.e1–664.e8.

16. Baier RB, Gifford DR, Patry G, Banks SM, Rochon T, DeSilva D, et al. Ameliorating pain in nursing homes: a collaborative quality-improvement project. Journal of American Geriatrics Society. 2004; 52:1988–1995. DOI: 10.1111/j.1532-5415.2004.52553.x.

17. Manias E, Gibson SJ, Finch S. Testing an educational nursing intervention for pain assessment and management in older people. . Pain Medicine. 2011; 12:1199–1215.

18. Savvas SM, Toye CM, Beattie ERA, Gibson SJ. An evidence-based program to improve analgesic practice and pain outcomes in residential aged care facilities. Journal of American Geriatric Society. 2014; 62(8):1583–1589. DOI: 10.1111/jgs.12935.

19. Ryu YS, Seo JM. Nurses' perceptions of pain management and its performance for patients with dementia. Global Health and Nursing. 2016; 6(1):40–50.

20. Kim EK, Kim SY, Eom MR, Kim HS, Lee EP. Validity and reliability of the Korean version of the pain assessment checklist for seniors with limited ability to communicate. Journal of Korean Academy Nursing. 2014; 44(4):398–406. DOI: 10.4040/jkan.2014.44.4.398.

21. Ryoo EN. Validity, reliability and efficiency of pain self-report scale in elderly with dementia [dissertation]. Seoul: Chung-Ang University;2008. 1–88.

22. Chang SO. Development and effect of pain management protocol for nursing home patients with dementia. The Korean Journal of Fundamentals of Nursing. 2007; 14(1):29–43.

23. Kim SY, Choi MY, Shin SS, Jee SM, Park JJ, You JH, et al. Handbook for Clinical Practice Guideline Developer ver 1.0. 1st ed. Seoul: National Evidence-Based Healthcare Collaborating Agency;2011. p. 112–162.

24. The AGREE next steps consortium. Appraisal of guidelines for research and evaluation II [Internet]. Hamilton: Canadian Institutes of Health Research;2013. cited 2016 Jun 15. Available from: https://www.agreetrust.org/wp-content/uploads/2013/10/AGREE-II-Users-Manual-and-23-item-Instrument_2009_UPDATE_2013.pdf.

25. The ADAPTE collaboration. The ADAPTE process: Resource toolkit for guideline adaptation version 2.0. Scotland: Guideline International Network;2009.

26. Fitch K, Bernstein SJ, Aguilar MD, Aguilar MS, Burnand B, LaCalle JR, et al. The RAND/UCLA appropriateness method user's manual. Santa Monica: RAND Corporation;2001. BMH4-CT96-0212.

27. Fetherstonhaugh D, Lewis V, McAuliffe L, Bauer M. Pain in older adults: development of a tool for measuring knowledge of residential aged care staff. International Journal ofGeriatric Psychiatry. 2016; 31:428–434. DOI: 10.1002/gps.4364.

28. Ryu YS, Park JS. Factors affecting nurse's pain management for patients with dementia. Journal of the Korea Academia-Industrial cooperation Society. 2016; 17(9):253–264. DOI: 10.5762/KAIS.2016.17.9.253.

29. Wong DL, Hockenberry-Eaton M, Wilson D, Winkelstein ML, Schwartz P. Wong's essentials of pediatric nursing. 6th ed. St Louis: Elsevier/Mosby;2001. p. 1301.

30. Warden V, Hurley AC, Volicer L. Development and psychometric evaluation of the pain assessment in advanced dementia (PAINAD) scale. Journal of the American Medical Directors Association. 2003; 4(1):9–15. DOI: 10.1097/01.JAM.0000043422.31640.F7.

31. Harden RN, Weinland SR, Remble TA, Houle TT, Colio S, Steedman S, et al. Medication quantification scale version III: update in medication classes and revised detriment weights by survey of American Pain Society physicians. The Journal of Pain. 2005; 6(6):364–371. DOI: 10.1016/j.jpain.2005.01.350.

32. Ministry of Health and Welfare. 2013 Elderly health and welfare business guide. Seoul: Ministry of Health and Welfare;2013.

33. Chen Y-H, Lin L-C. Ability of the pain recognition and treatment (PRT) protocol to reduce expressions of pain among institutionalized residents with dementia: a cluster randomized controlled trial. Pain Management Nursing. 2016; 17(1):14–24. DOI: 10.1016/j.pmn.2015.08.003.