scholarly journals Pain assessment and management in care homes: understanding the context through a scoping review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jan Pringle ◽  
Ana Sofia Alvarado Vázquez Mellado ◽  
Erna Haraldsdottir ◽  
Fiona Kelly ◽  
Jo Hockley
Keyword(s):  
Cognitive Impairment ◽  
Scoping Review ◽  
Pain Assessment ◽  
Care Home ◽  
Nursing Home Residents ◽  
Assessment Tools ◽  
Care Staff ◽  
Care Homes ◽  
Cochrane Library ◽  
Assessment And Treatment

Abstract Background Internationally, 2–5% of people live in residential or nursing homes, many with multi-morbidities, including severe cognitive impairment. Pain is frequently considered an expected part of old age and morbidity, and may often be either under-reported by care home residents, or go unrecognized by care staff. We conducted a systematic scoping review to explore the complexity of pain recognition, assessment and treatment for residents living in care homes, and to understand the contexts that might influence its management. Methods Scoping review using the methodological framework of Levac and colleagues. Articles were included if they examined pain assessment and/or management, for care or nursing home residents. We searched Medline, CINAHL, ASSIA, PsycINFO, EMBASE, Cochrane Library, and Google Scholar; reference lists were also screened, and website searches carried out of key organisations. Conversations with 16 local care home managers were included to gain an understanding of their perspective. Results Inclusion criteria were met by 109 studies. Three overarching themes were identified: Staff factors and beliefs - in relation to pain assessment and management (e.g. experience, qualifications) and beliefs and perceptions relating to pain. Pain assessment – including use of pain assessment tools and assessment/management for residents with cognitive impairment. Interventions - including efficacy/effects (pharmaceutical/non pharmaceutical), and pain training interventions and their outcomes. Overall findings from the review indicated a lack of training and staff confidence in relation to pain assessment and management. This was particularly the case for residents with dementia. Conclusions Further training and detailed guidelines for the appropriate assessment and treatment of pain are required by care home staff. Professionals external to the care home environment need to be aware of the issues facing care homes staff and residents in order to target their input in the most appropriate way.

scholarly journals Pain Assessment and Management in Care Homes: Understanding the Internal and External Context Through a Scoping Review

2020 ◽  
Author(s):  
Jan Pringle ◽  
Jo Hockley ◽  
Sofia Alvarado ◽  
Erna Haraldsdottir ◽  
Fiona Kelly
Keyword(s):  
Scoping Review ◽  
Pain Assessment ◽  
Care Home ◽  
Grey Literature ◽  
Nursing Home Residents ◽  
Care Staff ◽  
Care Homes ◽  
Cochrane Library ◽  
Relevant Evidence ◽  
Assessment And Treatment

Abstract Background: Internationally, 2-5% of people live in residential or nursing homes, many with multi-morbidities, including severe cognitive impairment. Pain is frequently considered an expected part of old age and morbidity, and may often be either under-reported by care home residents, or go unrecognized by care staff. We conducted a systematic scoping review to explore the complexity of pain recognition, assessment and treatment for residents living in care homes, and to understand the internal and external contexts that might influence its management.Methods: We conducted a scoping review using the methodological framework of Levac and colleagues. Articles were included if they examined pain assessment or management for care or nursing home residents. We searched Medline, CINAHL, ASSIA, PsycINFO, EMBASE, Cochrane Library, and Google Scholar; reference lists were screened, and website searches carried out of key organisations, to ensure relevant evidence was retrieved, including grey literature. As per the methodolocal framework, stakeholder evidence from 16 local care home managers was also accessed, to undertand their current perspectives.Results: Inclusion criteria were met by 109 studies. Three overarching themes were identified: staff variables and beliefs, pain assessment, and interventions. Evidence from the review indicated a lack of training and staff confidence in relation to pain assessment and management in care homes. This was particularly the case for residents with dementia, who cannot always verbalize their pain, and may resort to behavioral manifestations to try and communicate their distress.Conclusions: This review has highlighted that training and detailed guidelines for the appropriate assessment and treatment of pain are required by care home staff. Professionals external to the care home environment need to be aware of the issues facing care homes staff and residents in order to target their input in the most appropriate way. Internal and external contexts need further examination in order to integrate recognition and assessment of pain, and its management, to the benefit of residents.

scholarly journals Adherence of Pain Assessment to the German National Standard for Pain Management in 12 Nursing Homes

2014 ◽  
Vol 19 (3) ◽  
pp. 133-140 ◽  
Author(s):  
Jürgen Osterbrink ◽  
Zsuzsa Bauer ◽  
Barbara Mitterlehner ◽  
Irmela Gnass ◽  
Patrick Kutschar
Keyword(s):  
Nursing Home ◽  
Cognitive Impairment ◽  
Pain Management ◽  
Nursing Homes ◽  
Pain Assessment ◽  
Survey Methodology ◽  
Nursing Home Residents ◽  
Assessment Tools ◽  
National Standard ◽  
Severe Cognitive Impairment

BACKGROUND: Pain is very common among nursing home residents. The assessment of pain is a prerequisite for effective multiprofessional pain management. Within the framework of the German health services research project, ‘Action Alliance Pain-Free City Muenster’, the authors investigated pain assessment adherence according to the German national Expert Standard for Pain Management in Nursing, which is a general standard applicable to all chronic/acute pain-affected persons and highly recommended for practice.OBJECTIVES: To evaluate the state of pain assessment and to identify need for improvement in 12 nursing homes in a German city.METHODS: In the present study, the authors used an ex-post-facto design (survey methodology). Available written policies for routine pain assessment in residents ≥65 years of age were reviewed and a standardized online survey completed by 151 of 349 nurses in 12 nursing home facilities was conducted between September 2010 and April 2011.RESULTS: Most of the included nursing homes provided written policies for pain assessment, and the majority of nurses reported that they assess and regularly reassess pain. However, observational tools for residents with severe cognitive impairment and written reassessment schedules were lacking in many facilities or were inconsistent.CONCLUSIONS: Essentially, pain assessment appeared to be feasible in the majority of the German nursing homes studied. However, the absence or inconsistency of reassessment schedules indicate that pain management guidelines should include a detailed and explicit reassessment schedule for the heterogenic needs of nursing home residents. For residents with severe cognitive impairment, assessment tools are needed that are simple to use and clearly indicate the presence or absence of pain.

scholarly journals Digital technologies to support people living with dementia in the care home setting to engage in meaningful occupations: protocol for a scoping review

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Nicholas Luscombe ◽  
Sarah Morgan-Trimmer ◽  
Sharon Savage ◽  
Louise Allan
Keyword(s):  
Scoping Review ◽  
Care Home ◽  
Digital Technologies ◽  
Mechanisms Of Action ◽  
Barriers And Facilitators ◽  
Care Staff ◽  
Care Homes ◽  
Intervention Design ◽  
Diverse Range ◽  
Home Setting

Abstract Background People living with all stages of dementia should have the opportunity to participate in meaningful occupations. For those living in care homes, this may not always occur and residents may spend significant parts of the day unengaged, especially those living with more advanced dementia. Digital technologies are increasingly being used in health care and could provide opportunities for people living with dementia (PLWD) in care homes to engage in meaningful occupations and support care staff to provide these activities. With technology advancing at a rapid rate, the objective of this scoping review is to provide an up-to-date systematic map of the research on the diverse range of digital technologies that support engagement in meaningful occupations. In particular, focus will be given to barriers and facilitators to inform future intervention design and implementation strategies, which have not yet been clearly mapped across the full range of these digital technologies. Method A scoping review will be conducted to systematically search for published research using a comprehensive search strategy on thirteen databases. Published, peer-reviewed studies that focused on PLWD in the care home setting and assessed any form of digital technology that supported a meaningful occupation will be included. All methodologies which meet the criteria will be included. Data will be extracted and charted to report the range of digital technologies, underlying mechanisms of action, facilitators and barriers to implementation. Discussion Mapping the range of technologies to support PLWD to engage in meaningful occupations will identify gaps in research. The systematic search will include a diverse range of technologies such as software to enhance care planning, tablets devices, smartphones, communication robots and social media platforms, rather than focussing on a specific design or interface. This will enable comparison between mechanisms of action, barriers and facilitators to implementation which will be useful for future research and intervention design. Trial registration Open Science Framework 10.17605/OSF.IO/7UDM2

scholarly journals Recognition of the complexity facing residential care homes: a practitioner inquiry

2018 ◽  
Vol 19 (6) ◽  
pp. 584-590 ◽  
Author(s):  
Jenny Dudman ◽  
Julienne Meyer ◽  
Cheryl Holman ◽  
Wendy Moyle
Keyword(s):  
Residential Care ◽  
Care Home ◽  
Assessment Tools ◽  
Care Staff ◽  
Care Homes ◽  
Structured Interviews ◽  
Care Home Staff ◽  
Healthcare Needs ◽  
Health And Social Care

AbstractAimTo explore the experiences and challenges for residential care home staff when managing the healthcare needs of their residents, in particular those living with dementia.BackgroundIncreasing number of older people, with complex health and social care needs are living in residential care homes. Yet there is limited appreciation of why staff sometimes struggle to manage residents’ healthcare needs, or understanding of their working relationship with district nurses (DNs), whose responsibility it is to provide nursing support.MethodsThis PhD study, in a metropolitan area in the United Kingdom, was conducted by an experienced DN and involved three phases. This paper focuses on the first two phases. Phase 1 data included: semi-structured interviews (n=8), reflective field notes based on non-participant observation, documentary analysis of policies, procedures and assessment tools and other contextual data from one care home (case study site). The practitioner researcher reflected on the findings from the case study, in relation to her own knowledge and experience as a DN, focusing in particular on findings that were familiar, or which surprised. In Phase 2 she fed these findings back to other care homes (n=11) to check whether the findings from the single case study were unique or resonated with others. She gathered their feedback through semi-structured interviews with senior care staff (n=14). Data were analysed using thematic data analysis.FindingsFindings highlight the complexity facing residential care homes: high levels of healthcare needs amongst residents, the demands of caring for residents living with dementia, variations in the knowledge and skill set of care staff, inequity in the level of healthcare support, the challenges of building a good relationship with DNs, and funding pressures facing care homes.ImplicationsAny, or all of these factors can prevent care home staff from managing the healthcare needs of their residents.

scholarly journals How hospitalized patients evaluate and report their pain together with nurses: A scoping review

2021 ◽  
pp. 205715852110134
Author(s):  
Bente Dale Malones ◽  
Sindre Sylte Kallmyr ◽  
Vera Hage ◽  
Trude Fløystad Eines
Keyword(s):  
Scoping Review ◽  
Pain Assessment ◽  
Health Professionals ◽  
Clinical Care ◽  
Hospitalized Patients ◽  
Assessment Tools ◽  
Post Surgery ◽  
Reliable Assessment ◽  
Scoping Reviews ◽  
The Relationship

Pain assessment tools are often used by patients to report their pain and by health professionals to assess patients’ reported pain. Although valid and reliable assessment of pain is essential for high-quality clinical care, there are still many patients who experience inappropriate pain management. The aim of this scoping review is to examine an overview of how hospitalized patients evaluate and report their pain in collaboration with nurses. Systematic searches were conducted, and ten research articles were included using the PRISMA guidelines for scoping reviews. Content analysis revealed four main themes: 1) the relationship between the patient and nurse is an important factor of how hospitalized patients evaluate and report their post-surgery pain, 2) the patient’s feelings of inconsistency in how pain assessments are administered by nurses, 3) the challenge of hospitalized patients reporting post-surgery pain numerically, and 4) previous experiences and attitudes affect how hospitalized patients report their pain. Pain assessment tools are suitable for nurses to observe and assess pain in patients. Nevertheless, just using pain assessment tools is not sufficient for nurses to obtain a comprehensive clinical picture of each individual patient with pain.

scholarly journals Hearing Loss Treatment in Older Adults With Cognitive Impairment: A Systematic Review

2018 ◽  
Vol 61 (10) ◽  
pp. 2589-2603 ◽  
Author(s):  
Sara K. Mamo ◽  
Nicholas S. Reed ◽  
Carrie Price ◽  
Dona Occhipinti ◽  
Alexandra Pletnikova ◽  
...  
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Hearing Loss ◽  
Cognitive Impairment ◽  
Hearing Aids ◽  
Controlled Trial ◽  
Controlled Vocabulary ◽  
Assessment Tools ◽  
Cochrane Library ◽  
Full Text Review

Purpose The purpose of this systematic review was to assess studies of treating hearing loss in older adults with cognitive impairment. Of interest to this review is identifying clinical adaptations that may be used to tailor hearing loss treatment to older adults with cognitive impairment in order to better serve this vulnerable population. Method A systematic search with controlled vocabulary and key word terms was applied to PubMed, the Cochrane Library, Embase, CINAHL, and PsycINFO. Search concepts included terms related to hearing loss and cognitive impairment. The overall search resulted in 4,945 unique references, 50 of which were eligible for full-text review and 13 of which were included in the final review. Included manuscripts were categorized according to the American Speech-Language-Hearing Association's levels of evidence and the National Institutes of Health Quality Assessment Tools. Results Only 1 study implemented a randomized controlled trial design to assess cognitive function and behavioral symptoms after treatment with hearing aids. Other quasiexperimental studies evaluated dementia-related symptoms and/or auditory function after treating hearing loss in pre/post research designs. Finally, evidence from case studies suggested that hearing loss treatment is feasible, reduces stressful communication for caregivers, and improves dementia-related behavior problems. Conclusion Based on the systematic review, evidence suggests that treating hearing loss in persons with cognitive impairment can have benefits to communication and quality of life. Because of the quasi- and nonexperimental nature of most of the evidence found in this review, further studies are necessary to understand the effect of treatment in the context of a variable and progressive disease.

scholarly journals A qualitative study exploring therapists’ experiences of implementing a complex intervention promoting meaningful activity for residents in care homes

2018 ◽  
Vol 33 (3) ◽  
pp. 575-583 ◽  
Author(s):  
Raymond Smith ◽  
Julia Wood ◽  
Fiona Jones ◽  
Sue Turner ◽  
Michael Hurley
Keyword(s):  
Care Home ◽  
Complex Interventions ◽  
Occupational Therapists ◽  
Care Staff ◽  
Care Homes ◽  
Complex Care ◽  
Meaningful Activity ◽  
Qualitative Interview Study ◽  
Home Intervention ◽  
Trusting Relationships

Objectives: To explore the experiences of occupational therapists and physiotherapists and to reveal any factors that can facilitate delivering a complex care home intervention promoting meaningful activity. Design: Qualitative interview study using data from three focus groups conducted longitudinally post intervention implementation. Data were analysed thematically. Setting: Three residential care homes in South London, UK. Subjects: All therapists involved in the implementation of the intervention: three occupational therapists and three physiotherapists. Results: Three interconnected themes emerged from the analysis: (1) developing trusting relationships, (2) empowering staff and (3) remaining flexible. Therapists described how successfully implementing a complex care home intervention was dependant on developing trusting relationships with care staff. This enabled the therapists to empower care staff to take ownership of the intervention and help embed it in care home culture, facilitating long-term change. The therapists described how remaining flexible in their approach helped keep care staff engaged for the duration of implementation. Conclusion: This study has revealed several important factors that can help facilitate therapists delivering complex interventions in care homes.

Cognitive assessment tools in Asia: a systematic review

2015 ◽  
Vol 28 (2) ◽  
pp. 189-210 ◽  
Author(s):  
Roshaslina Rosli ◽  
Maw Pin Tan ◽  
William Keith Gray ◽  
Pathmawathi Subramanian ◽  
Ai-Vyrn Chin
Keyword(s):  
Systematic Review ◽  
Cognitive Impairment ◽  
Cognitive Assessment ◽  
De Novo ◽  
Assessment Tools ◽  
Screening Tools ◽  
Cochrane Library ◽  
Future Research ◽  
Asian Populations ◽  
Keywords Dementia

ABSTRACTBackground:The prevalence of dementia is increasing in Asia than in any other continent. However, the applicability of the existing cognitive assessment tools is limited by differences in educational and cultural factors in this setting. We conducted a systematic review of published studies on cognitive assessments tools in Asia. We aimed to rationalize the results of available studies which evaluated the validity of cognitive tools for the detection of cognitive impairment and to identify the issues surrounding the available cognitive impairment screening tools in Asia.Methods:Five electronic databases (CINAHL, MEDLINE, Embase, Cochrane Library, and Science Direct) were searched using the keywords dementia Or Alzheimer Or cognitive impairment And screen Or measure Or test Or tool Or instrument Or assessment, and 2,381 articles were obtained.Results:Thirty-eight articles, evaluating 28 tools in seven Asian languages, were included. Twenty-nine (76%) of the studies had been conducted in East Asia with only four studies conducted in South Asia and no study from northern, western, or central Asia or Indochina. Local language translations of the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) were assessed in 15 and six studies respectively. Only three tools (the Korean Dementia Screening Questionnaire, the Picture-based Memory Intelligence Scale, and the revised Hasegawa Dementia Screen) were derivedde novofrom Asian populations. These tools were assessed in five studies. Highly variable cut-offs were reported for the MMSE (17–29/30) and MoCA (21–26/30), with 13/19 (68%) of studies reporting educational bias.Conclusions:Few cognitive assessment tools have been validated in Asia, with no published validation studies for many Asian nations and languages. In addition, many available tools display educational bias. Future research should include concerted efforts to develop culturally appropriate tools with minimal educational bias.

The ambulance service advanced practitioner's role in supporting care homes: a qualitative study of care staff experiences

2021 ◽  
Vol 27 (8) ◽  
pp. 1-8
Author(s):  
Chris Harvey ◽  
Simon Froggatt ◽  
Bryan Lightowler ◽  
Andrew Hodge
Keyword(s):  
Qualitative Study ◽  
Care Home ◽  
Community Services ◽  
Ambulance Service ◽  
Care Staff ◽  
Care Homes ◽  
Service Demand ◽  
Staff Members ◽  
Care Home Staff ◽  
Advanced Practitioner

Background/Aims The demand from care homes on NHS services continues to rise, with little evidence of ambulance service contribution in this area. The Yorkshire Ambulance Service provides an advanced practitioner model to support care homes in Sheffield, as an alternative to calling 999. This study investigated the experiences and needs of the care home staff who use the ambulance service advanced practitioner model. Methods This qualitative study conducted semi-structured, face-to-face interviews with 19 staff members from 10 different care home settings. Thematic analysis using a combination of NVivo and manual coding was undertaken. Results The three key themes from the interviews were variations in service demand, the service user's expectations and experience, and benefits to residents. Participants reported that good community services reduced the need to call 999, empowering carers to support residents to remain in the community. Conclusions Care homes require comprehensive services that meet their needs. The advanced practitioner model provided by the ambulance service supports this, preventing unnecessary 999 calls and fitting with other community service provision.

scholarly journals A Novel Approach to Reduce Sedentary Behaviour in Care Home Residents: The GET READY Study Utilising Service-Learning and Co-Creation

2019 ◽  
Vol 16 (3) ◽  
pp. 418 ◽  
Author(s):  
Maria Giné-Garriga ◽  
Marlene Sandlund ◽  
Philippa Dall ◽  
Sebastien Chastin ◽  
Susana Pérez ◽  
...  
Keyword(s):  
Service Learning ◽  
Sedentary Behaviour ◽  
Undergraduate Students ◽  
Care Home ◽  
End Users ◽  
Care Staff ◽  
Care Homes ◽  
Novel Approach ◽  
Inductive Thematic Analysis ◽  
Individual Service

The GET READY study aimed to integrate service-learning methodology into University degrees by offering students individual service opportunities with residential care homes, to co-create the best suited intervention to reduce the sedentary behaviour (SB) of residents throughout the day, with researchers, end-users, care staff, family members and policymakers. Eight workshops with care home residents and four workshops with care staff, relatives and policymakers, led by undergraduate students, were audiotaped, transcribed verbatim and analysed with inductive thematic analysis to understand views and preferences for sustainable strategies to reduce SB and increase movement of residents. Perspectives about SB and movement in care homes highlighted four subthemes. Assets for decreasing SB included three subthemes, and suggestions and strategies encapsulated four subthemes. There is a need to include end-users in decision making, and involve care staff and relatives in enhancing strategies to reduce SB among residents if we want sustainable changes in behaviour. A change in the culture at a policymaker and care staff’s level could provide opportunities to open care homes to the community with regular activities outside the care home premises, and offer household chores and opportunities to give residents a role in maintaining their home environment.

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