Abstract
Background
We aimed to explore the existing use of pain assessment tools and guidelines, and develop understanding of the practical considerations required to facilitate their use within the nursing home, hospital and community settings.
Methods
A self-administered web-based survey was conducted with nurses, health and social care workers with an interest in the assessment of pain in older adults with cognitive impairment. The survey was distributed to participants in Austria, Belgium, Denmark, Germany, The Netherlands, Switzerland and United Kingdom.
Results
Only a minority of staff reported use of (inter-)national or local standards or specific pain assessment tools in daily practice. A range of tools were reported as being used, which varied across country. While participants generally reported that these pain assessment tools were easy/very easy to use, many participants reported that they were difficult to interpret. Assessment is generally performed whilst providing nursing care. This was highlighted in 70–80% of all participating countries. While many of these tools rely on facial expression of pain, facial expressions were considered to be the least useful in comparison to other items. Furthermore findings showed that nurses employed in long-term care settings did not feel that they were educated enough in pain assessment and management.
Conclusion
Our findings suggest that pain education is required across all countries surveyed. This should include a focus on guidelines and standards for assessment and subsequent management of pain. Findings suggest that clinical staff find interpreting facial expressions in relation to pain more difficult.
Zusammenfassung
Hintergrund
Wir untersuchten die bestehende Anwendung von Schmerzeinschätzungsinstrumenten und -richtlinien, um ein Verständnis der Überlegungen in der Praxis zu entwickeln, die erforderlich sind, um die Anwendung in Pflegeheimen, Krankenhäusern und Gemeinden zu erleichtern.
Methoden
Eine selbstverwaltete, webbasierte Umfrage wurde mit Gesundheits- und Krankenpflegenden sowie Gesundheits- und Sozialarbeitern durchgeführt, die für die Einschätzung von Schmerzen bei älteren Menschen mit kognitiver Beeinträchtigung verantwortlich sind. Die Umfrage wurde an Teilnehmer in Österreich, Belgien, Dänemark, Deutschland, den Niederlanden, der Schweiz und Großbritannien verteilt.
Ergebnisse
Nur eine Minderheit der Mitarbeitenden berichtete über den Einsatz von (inter-)nationalen oder einrichtungsspezifischen Standards oder von spezifischen Schmerzeinschätzungsinstrumenten in der täglichen Pflegepraxis. Die Verwendung einer Reihe von Instrumenten wurde berichtet, diese unterscheiden sich von Land zu Land. Die Teilnehmenden berichteten, dass diese Schmerzeinschätzungsinstrumente generell einfach/sehr einfach zu bedienen, dass aber die Ergebnisse schwer zu interpretieren seien. Die Schmerzeinschätzung erfolgt in der Regel während pflegerischer Handlungen. Dies wurde in 70–80 % aller teilnehmenden Länder hervorgehoben. In den meisten Instrumenten erfolgt eine Einschätzung des Gesichtsausdrucks, doch wurde dieser als am wenigsten nützlich im Vergleich zu anderen Verhaltensmerkmalen/-kategorien angesehen. Darüber hinaus zeigten die Ergebnisse, dass Gesundheits- und Krankenpflegende, die in Pflegeeinrichtungen beschäftigt waren, sich nicht ausreichend in der Schmerzeinschätzung und dem Schmerzmanagement ausgebildet fühlten.
Schlussfolgerung
Unsere Ergebnisse lassen vermuten, dass in allen untersuchten Ländern Fort- und Weiterbildungen zum Schmerz erforderlich sind. Darin enthalten sein sollte ein Schwerpunkt auf Leitlinien und Standards für die Einschätzung und anschließende Behandlung von Schmerzen. Die Ergebnisse deuten darauf hin, dass klinisch tätige Pflegende die Interpretation des Gesichtsausdrucks in Bezug auf Schmerzen schwierig finden.
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All authors contributed to design the study. All authors discussed the results and commented on the manuscript.
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S. Zwakhalen, R.E. Docking, I. Gnass, E. Sirsch, C. Stewart, N. Allcock and P. Schofield declare that they have no competing interests.
This article does not contain any studies with human participants or animals performed by any of the authors.
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Zwakhalen, S., Docking, R.E., Gnass, I. et al. Pain in older adults with dementia. Schmerz 32, 364–373 (2018). https://doi.org/10.1007/s00482-018-0290-x
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DOI: https://doi.org/10.1007/s00482-018-0290-x