Jonsdottir Thorbjorg, Gunnarsson Esther Christina
Faculty of Nursing, School of Health Sciences, University of Akureyri, Akureyri, Iceland; School of Health Sciences, Faculty of Nursing, University of Akureyriv/Nordurslod, Akureyri, Iceland.
Faculty of Nursing, School of Health Sciences, University of Akureyri, Akureyri, Iceland; The National University Hospital of Iceland, Eiriksgata, Reykjavik, Iceland.
Pain Manag Nurs. 2021 Jun;22(3):281-292. doi: 10.1016/j.pmn.2020.11.002. Epub 2020 Dec 14.
Pain is underrecognized and undertreated in patients with dementia. It has been suggested that nurses' attitudinal barriers may contribute to the challenges surrounding pain assessment and management in dementia.
This integrative literature review aims to identify and explore nurses' knowledge and attitudes towards pain assessment in older people with dementia and how it may affect pain management in this patient group.
Electronic searches were conducted in Web of Science, MEDLINE, Scopus, ProQuest, PubMed, and EBSCOhost from January 2008 to December 2018 for articles specifically focusing on nurses' knowledge and attitudes towards pain assessment in older patients with dementia.
Ten studies were included in the review after meeting the inclusion criteria. Data extracted from each study included study design, aims and objectives, setting/sample, findings, and limitations. Patients with dementia are at greater risk of experiencing underassessment, undertreatment, and delayed treatment of pain due to nurses' knowledge deficits and uncertainty in the decision-making process. Nurses see providing comfort and reducing pain as ethical obligation. However, they find pain assessment a challenge due to the complexity of recognizing painful behaviors, and difficulty differentiating between pain and behavioral disturbances in dementia. Poor multidisciplinary communication, time constraints, and workload pressure, as well as uncertainty about opioid use, are important barriers to effective pain assessment and management among patients with dementia.
It is essential that nurses gain confidence in distinguishing signs and symptoms of pain from behavioral changes in dementia. It is important to improve interdisciplinary communication and to get physicians to listen and prioritize pain assessment and management.
痴呆症患者的疼痛未得到充分认识和治疗。有人认为，护士的态度障碍可能导致痴呆症患者疼痛评估和管理方面的挑战。
本综合文献综述旨在确定并探讨护士对老年痴呆症患者疼痛评估的知识和态度，以及这可能如何影响该患者群体的疼痛管理。
于2008年1月至2018年12月在科学网、医学期刊数据库、Scopus、ProQuest、PubMed和EBSCOhost中进行电子检索，以查找专门关注护士对老年痴呆症患者疼痛评估的知识和态度的文章。
符合纳入标准的10项研究被纳入综述。从每项研究中提取的数据包括研究设计、目的、背景/样本、研究结果和局限性。由于护士的知识缺陷以及决策过程中的不确定性，痴呆症患者面临疼痛评估不足、治疗不足和治疗延迟的风险更高。护士将提供舒适和减轻疼痛视为道德义务。然而，由于识别疼痛行为的复杂性以及难以区分痴呆症中的疼痛和行为障碍，他们发现疼痛评估具有挑战性。多学科沟通不畅、时间限制和工作量压力，以及阿片类药物使用的不确定性，是痴呆症患者有效疼痛评估和管理的重要障碍。
护士必须有信心将痴呆症患者疼痛的体征和症状与行为变化区分开来。改善跨学科沟通并让医生倾听并优先考虑疼痛评估和管理非常重要。
