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.].

Impacto de la primera ola de la COVID-19 en los profesionales de la salud / Impact of the first wave of Covid-19 on healthcare professionals

Objetivo: Describir el impacto de la primera ola de la pandemia por COVID-19 en los profesionales sanitarios. Metodología: Estudio descriptivo, retrospectivo y multicéntrico. Los datos se recogieron mediante un cuestionario autoadministrado con preguntas cerradas y abiertas. El cuestionario tenía unas variables comunes para todos los profesionales y unas exclusivas para COVID-19 positivos. Resultados: Fueron completados 599 cuestionarios. El 83% eran mujeres con una media de edad de 45,6 ± 11,0 años, el 33,4% eran enfermeras y el 21,7% técnicos. Un 65,8% de los trabajadores había recibido formación sobre los Equipos de Protección Individual (EPI) y, el 35,4% respondió que habían dispuesto de EPI el 75% de las veces y el 48,3%, siempre. Un 42,1% (n = 252) de los profesionales refirieron fatiga física, el 38,1% (n = 228) fatiga emocional, el 33,7% (n = 202) estrés y un 30,2% (n = 181) insomnio, como síntomas derivados de la situación vivida durante la pandemia. Los profesionales positivos a SARS-CoV-2 (n = 91) no tenían más antecedentes patológicos de riesgo que los negativos (p = 0,077), eran técnicos u otros profesionales asistenciales (p = 0,001) y trabajaban en el socio-sanitario (p = 0,001). La mayoría eran considerados nivel de riesgo 3 (p = 0,001) y habían estado en contacto con un paciente positivo (p = 0,012) o con otro profesional positivo (p = 0,05). Conclusiones: La primera ola de la pandemia por COVID-19 ha tenido un impacto en la salud física y mental de los trabajadores, especialmente en los de primera línea. (AU)

Objective: To describe the impact of the COVID-19 pandemic first wave on the healthcare professionals. Methodology: Descriptive, retrospective and multicenter study. Data were collected through a self-administering questionnaire with closed and open questions. The questionnaire had common variables for all professionals and exclusive ones for positive COVID-19 professionals. Results: 599 questionnaires were completed. The 83% were women, with a mean of 45.6±11.0 years and 33.4% were nurses and 21.7% technical. The 65.8% of the healthcare professionals affirmed that they had received training on the Personal Protective Equipment (PPE) and 35.4% responded that 75% of the times they had available PPE and 48.3%, always. The 42.1% (n=252) of the professionals reported physical fatigue, 38.1% (n=228) emotional fatigue, 33.7% (n=202) stress and 30.2% (n=181) insomnia, as symptoms derived from the situation experienced during the pandemic. The professionals who were positive for COVID-19 (n=91) had no more risk pathological antecedents than negatives ones (p=0.077); they were technical or other healthcare professionals (p=0.001) and they worked at a socio-sanitary center (p=0.001). Most of the positive professionals were considered to be at risk level 3 (p=0.001) and had been in contact with a positive patient (p = 0.012) or with another positive professional (p=0.05). Conclusions: The first wave of the COVID-19 pandemic has had an impact on the physical and mental health of the health professionals, especially in the first-line ones. (AU)

Impacto de una investigación-acción participativa en el manejo del dolor de mayores con demencia (AU) / Impact of a participatory action research on pain management in older adults with dementia

Objetivo: Evaluar el impacto del uso de la investigación-acción participativa como método de investigación en la mejora del manejo del dolor de las personas mayores con demencia atendidos en una unidad de geriatría de agudos. Metodología: Estudio descriptivo-interpretativo enmarcado en las fases 3 y 4 de una investigación-acción participativa según el modelo propuesto por Kemmis y McTaggart. Las participantes fueron las enfermeras de la unidad de geriatría de agudos que habían participado en las 2 fases anteriores. Para la recolección de datos se usó un cuestionario con preguntas cerradas y preguntas abiertas. Para los datos cuantitativos se utilizó un análisis descriptivo y para los cualitativos, análisis del contenido. Resultados: El programa formativo, como intervención investigación-acción participativa, mejoró el conocimiento de las enfermeras. Este aprendizaje podría contribuir a modificar su práctica y a mejorar los resultados en los pacientes. Además, las enfermeras manifestaron que el programa les motivó a reflexionar sobre su práctica tanto a nivel individual como colectivo y les ha hecho tomar conciencia de la importancia que tiene un óptimo manejo del dolor en los mayores con demencia. El hecho de participar en las reuniones y discutir con sus compañeras sobre su práctica contribuyó a aprender nuevas formas de llevar a cabo acciones en relación con el manejo del dolor y promocionó el trabajo en equipo. Conclusiones: Un proceso de investigación-acción participativa puede ser una buena metodología para introducir y mantener cambios en la práctica enfermera para la mejora del manejo del dolor en personas mayores con demencia (AU)

Objective: To evaluate the impact of the use of participatory action-research as a research method to improve pain management in older people with dementia treated in a Geriatric Acute Unit. Methodology: Descriptive-interpretive study framed in phases three and four of a participatory action-research according to the Kemmis and McTaggart's model. Participants were the nurses from the acute geriatrics unit who had participated in the 2 previous phases. For data collection, a questionnaire with closed questions and open questions was used. Descriptive analysis was used for quantitative data and content analysis for categorical data. Results: The training program, as a participatory action research intervention, improved the nurses’ knowledge. This learning could help modify nurses’ practice and improve patient outcomes. In addition, the nurses stated that it motivated them to reflect on their practice both individually and collectively and made them aware of the importance of optimal pain management in the elderly with dementia. The fact of participating in the focus group and discussing their practice with their colleagues contributed to learning new ways of carrying out actions in relation to pain management and promoted teamwork. Conclusions: A participatory action-research process can be a good methodology to introduce and maintain changes in nursing practice to improve pain management in older people with dementia (AU)

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.

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.