de Wolf-Linder Susanne, Reisinger Margarete, Gohles Elisabeth, Wolverson Emma L, Schubert Maria, Murtagh Fliss E M
School of Health Science, Institute of Nursing, Zurich University of Applied Sciences, Winterthur, Switzerland.
Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK.
BMC Nurs. 2022 Jul 20;21(1):194. doi: 10.1186/s12912-022-00947-6.
People with dementia are most at risk of experiencing serious health related suffering, if they do not have a palliative care approach introduced early enough in the illness. It can be challenging for nurses to assess experienced needs of people, who are thought no longer able to self-report such as people with dementia. Assessment help to understand the care the patient and their family need promptly. It is unknown how nurses recognise holistic palliative care needs in people with dementia during routine care.
Scoping review where EMBASE, MEDLINE, CINAHL, PsycInfo databases, and references were searched with an advanced search strategy, which was built on three concepts (nurses, dementia, and nursing assessment) using corresponding Medical Subject Headings. Data were charted in a piloted extraction form, based on the assessment domains within the nursing process followed by summarise and synthesise results narratively.
37 out of 2,028 qualitative and quantitative articles published between 2000 and 2021, and relating to 2600 + nurses, were identified. Pain was sole focus of assessment in 29 articles, leaving 8 articles to describe assessment of additional needs (e.g., discomfort). Nurses working in a nursing home assess pain and other needs by observing the persons with dementia behaviour during routine care. Nurses in the acute care setting are more likely to assess symptoms with standard assessment tools at admission and evaluate symptoms by observational methods. Across settings, about one third of pain assessments are supported by person-centred pain assessment tools. Assessments were mostly triggered when the person with dementia vocalised discomfort or a change in usual behaviour was observed. Nurses rely on family members and colleagues to gain more information about needs experienced by people with dementia.
There is a scarcity of evidence about techniques and methods used by nurses to assess needs other than pain experienced by people with dementia. A holistic, person-centred screening tool to aid real-time observations at the bedside and used in conversations with health care professionals and families/friends, may improve need recognition other than pain, to ensure holistic needs could then be addressed timely to improve care in people with dementia.
如果痴呆症患者在疾病早期没有引入姑息治疗方法，他们最有可能遭受与健康相关的严重痛苦。对于护士来说，评估那些被认为不再能够自我报告的人群（如痴呆症患者）的实际需求可能具有挑战性。评估有助于及时了解患者及其家人所需的护理。目前尚不清楚护士在日常护理中如何识别痴呆症患者的整体姑息治疗需求。
进行范围综述，使用基于三个概念（护士、痴呆症和护理评估）并采用相应医学主题词的高级搜索策略，对EMBASE、MEDLINE、CINAHL、PsycInfo数据库及参考文献进行检索。根据护理过程中的评估领域，以预先试验的提取表格记录数据，随后对结果进行叙述性总结和综合。
在2000年至2021年间发表的2028篇定性和定量文章中，识别出与2600多名护士相关的37篇文章。29篇文章将疼痛作为评估的唯一重点，其余8篇文章描述了对其他需求（如不适）的评估。在养老院工作的护士通过在日常护理中观察痴呆症患者的行为来评估疼痛和其他需求。急性护理环境中的护士更有可能在入院时使用标准评估工具评估症状，并通过观察方法评估症状。在所有环境中，约三分之一的疼痛评估得到以患者为中心的疼痛评估工具的支持。评估大多在痴呆症患者表达不适或观察到其日常行为发生变化时触发。护士依靠家庭成员和同事来获取更多关于痴呆症患者所经历需求的信息。
关于护士用于评估痴呆症患者除疼痛之外的需求的技术和方法，证据匮乏。一种全面的、以患者为中心的筛查工具，有助于在床边进行实时观察，并用于与医疗保健专业人员以及家人/朋友的交谈中，可能会改善对除疼痛之外的需求的识别，从而确保能够及时满足整体需求，以改善痴呆症患者的护理。
