Facilitators, Barriers, and Solutions in Pain Management for Older Adults with Dementia.

BACKGROUND: Although qualitative studies have been conducted to identify barriers and facilitators that influence the pain management of older adults with dementia, as far as we know, only a very recent study (Andrews et al., 2019) has used participatory action research (PAR) as a methodology for studying pain management. It allows nurses to examine and improve their practice based on their realities and within their context. AIM: To reflect on nursing practice and identify facilitators and barriers in the management of pain in older adults with dementia and to propose actions for improvement. DESIGN: We used qualitative participatory action research. PARTICIPANTS/SETTINGS: Ten nurses from the geriatric acute care unit of a university hospital in Spain were recruited through convenience sampling. METHODS: Data were generated through a written questionnaire and three focus groups. RESULTS: One of the main facilitators the participants identified was professional experience. The main barriers they identified were lack of knowledge and skills and lack of time. The participants proposed two main improvements: (1) a training program consisting of three courses (pain evaluation and management, dementia and pain, and pharmacology) and (2) the creation of a specific register for nurses to record patients' pain. CONCLUSIONS: Involving nurses directly in research on their practices can result in precise proposals for improvements based on their needs and oriented toward improving the quality of care. Moreover, our results confirm previous findings in other countries.

Translation and validation of 'The Knee Society Clinical Rating System' into Spanish.

PURPOSE: The Knee Society Clinical Rating System (KSS) is a questionnaire evaluating knee function itself and the patient's ability to walk and climb stairs. The aim of our study is to present the validated translation of KSS into Spanish. METHODS: The validated method of translation-retrotranslation was used to translate KSS into Spanish. Three hundred and sixteen patients undergoing primary knee arthroplasty, before surgery and 6 months postoperative, completed the questionnaire (with an orthopedist's help). Psychometric properties of feasibility (percentage of no answers), validity and sensitivity to change (test's ability to detect change in patients' functional status over time) were assessed. In the second part of the study, the translated version of KSS was compared with two already validated questionnaires (SF-36 and WOMAC). RESULTS: During the translation process, item 3 (ROM) presented low appropriateness and null comprehensibility. The alternative writing proposed was 'for every 5°, we sum up 1 point, as if 8° were 1 point, to obtain the maximum scoring of 25 points you should bend more than 200°'. Feasibility: the item 'malalignment' obtained 15 % of missing item at visit 1. The percentage of invalid items was high in both visits (60 and 47 %). VALIDITY: the coefficients of convergent correlation with WOMAC and SF-36 scales confirm the questionnaire's validity. Sensitivity to change: significant differences were found in all cases between the mean scores comparing both visits. CONCLUSION: The translated version 1.1 of KSS (final version) has shown to be feasible, valid and sensible to changes within the clinical practice of patients undergoing primary knees arthroplasty.

Nursing Practice Variations in Pain Management in Older Adults With Dementia Admitted to an Acute Geriatrics Unit During the COVID-19 Pandemic.

The current retrospective descriptive study evaluated nursing practice variations on pain management in older adults with dementia admitted to an acute geriatrics unit (AGU) before (2018) and during (2021) the coronavirus disease 2019 (COVID-19) pandemic. Data were gathered from electronic health records. Pain intensity was evaluated a median of 1.9 times per day of stay in the pre-COVID-19 sample, whereas in the COVID-19 sample, the median was 0.7 times per day of stay. Median number of analgesic administrations per day of stay and mean percentage of clinical care records that mentioned pain were higher in patients admitted during the pandemic. Variations in nursing care organization in the AGU due to the COVID-19 pandemic had an impact on the patterns of pain management nursing practice in older adults with dementia. [Research in Gerontological Nursing, 16(4), 173-182.].

Pain management nursing practice assessment in older adults with dementia.

AIM: To assess pain management nursing practice in older adults with dementia through electronic health records (EHR). DESIGN: Retrospective study. METHODS: Data were collected from EHR related to pain management in older adults with dementia treated at the Acute Geriatrics Unit (AGU) of a university hospital in early 2018. RESULTS: EHR related to the pain of 111 patients were reviewed. Pain intensity was assessed at admission in 88% of patients and a median of 1.9 times per day of stay. A disproportionate number of the assessments (39%) occurred during the late shift. A median of 1 drug per day was administered. Pain was recorded in 28% of patients' care plans, and non-pharmacological interventions were recorded in 12%. In conclusion, exist variability in pain management nursing practice in older adults with dementia. Admission diagnosis correlated with the analgesic administration schedule, the number of drugs administered and the number of pain nursing annotations.