The use of comprehensive pain assessment tools when assessing pain in patients with advanced dementia: an exploration of the nurse decision-making process

Abstract

AIM: The aim of this study is to find out whether there is a relationship between the nurse decisionmaking process in assessing pain in severe dementia and elevated levels of salivary alpha amylase which is a known indicator of pain (Shirisaki et al. 2007; Nater and Rohleder 2009; Tsuchiya et al. 2014). BACKGROUND: In 2010 there were approximately 71,000 people in Scotland living with dementia of whom 2,300 were under the age of 65. Over the next 25 years this figure is expected to double as a result of an ageing population and an increase in life expectancies (The Scottish Government 2010). In 2013 there were an estimated 83,000 people living with dementia in Scotland, this demonstrates a trend of increasing cases (Alzheimer Scotland 2013). Pain in people with dementia is commonly under-assessed and under-treated. People living with severe dementia are often not able to communicate their pain which can lead to pain being overlooked by staff (Monroe et al.2012). This can induce stress and unnecessary suffering. Pain can also alter people's behaviour which highlights the importance of assessing pain if there is a change in behaviour out with the norm when providing care for someone with dementia (Care Quality Commission 2014). Prevalence of chronic pain in this patient group has been reported as 43% ( Leong et al. 2006), 47% (Torvik et al. 2010) and 68% (Zwakhalen et al. 2009). In light of this it can be seen that treating pain in dementia is increasingly important. METHODS: This descriptive correlational study will explore nurse decision-making processes in assessing and treating pain in dementia. This study will be conducted to explore if there is a correlation between salivary á-amylase levels and nurses' responses to the questionnaire on personal valuation of differing observational signs of pain and use/non-use of comprehensive pain assessment. The salivary á-amylase levels will serve as a non-invasive objective measure of pain in this patient population. Elevated levels of salivary á-amylase have been shown to be an effective, non-invasive indication of pain (Shirisaki et al. 2007; Nater and Rohleder 2009; Tsuchiya et al. 2014).