Exploring healthcare assistants' role and experience in pain assessment and management for people with advanced dementia towards the end of life: a qualitative study.
AuthorsJansen, Bannin De Witt
McIlfatrick, Sonja J
Morgan, Sharon M
AffiliationOur Lady's Hospice & Care Services
HEALTH CARE ASSISTANTS
Local subject classificationEND-OF-LIFE CARE
Allied Health Personnel
Behavior Observation Techniques
MetadataShow full item record
CitationExploring healthcare assistants' role and experience in pain assessment and management for people with advanced dementia towards the end of life: a qualitative study. 2017, 16 (1):6 BMC Palliat Care
JournalBMC palliative care
AbstractPain assessment and management are key aspects in the care of people with dementia approaching the end of life but become challenging when patient self-report is impaired or unavailable. Best practice recommends the use of observational pain assessments for these patients; however, difficulties have been documented with health professionals' use of these tools in the absence of additional collateral patient knowledge. No studies have explored the role, perspectives and experiences of healthcare assistants in pain assessment and management in dementia; this study provides insight into this important area.
A qualitative approach was adopted, using key informant interviews with healthcare assistants caring for people with advanced dementia approaching the end of life in hospice, nursing home and acute care settings. Thematic analysis was the analytic approach taken to interpretation of interview data. Data were collected between June 2014 and September 2015.
Fourteen participants took part in the study. Participants' average length of caring experience was 15.4 years and most were female. Three key themes emerged: recognising pain, reporting pain, and upskilling. Participants were often the first to notice obvious causes of pain and to detect changes in patient norms which signified hidden causes of pain. Comprehensive knowledge of resident norms enabled participants to observe for behavioural and nonverbal indicators of pain and distinguish these from non-pain related behaviours. Pain reporting was heavily impacted by relationships with professional staff and the extent to which participants felt valued in their role. Positive relationships resulted in comprehensive pain reports; negative relationships led to perfunctory or ambiguous reporting. Participants emphasised a desire for further training and upskilling, including in the use and reporting of basic pain tools.
Healthcare assistants are frontline staff who have a key role in direct patient care, spending a considerable amount of time with patients in comparison to other health professionals. These staff are often first to notice changes in patients that may signify pain and to alert professional staff. However, to ensure the quality of these reports, further efforts must be made in reversing stigma attached to this role and in upskilling these members of the healthcare team.
- Evaluation of the impact of telementoring using ECHO© technology on healthcare professionals' knowledge and self-efficacy in assessing and managing pain for people with advanced dementia nearing the end of life.
- Authors: De Witt Jansen B, Brazil K, Passmore P, Buchanan H, Maxwell D, McIlfatrick SJ, Morgan SM, Watson M, Parsons C
- Issue date: 2018 Apr 2
- "A tool doesn't add anything". The importance of added value: Use of observational pain tools with patients with advanced dementia approaching the end of life-a qualitative study of physician and nurse experiences and perspectives.
- Authors: De Witt Jansen B, Brazil K, Passmore P, Buchanan H, Maxwell D, McIlfatrick S, Morgan SM, Watson M, Parsons C
- Issue date: 2018 Oct
- Nurses' experiences of pain management for people with advanced dementia approaching the end of life: a qualitative study.
- Authors: De Witt Jansen B, Brazil K, Passmore P, Buchanan H, Maxwell D, McIlfactrick SJ, Morgan SM, Watson M, Parsons C
- Issue date: 2017 May
- End of life care for people with dementia: The views of health professionals, social care service managers and frontline staff on key requirements for good practice.
- Authors: Lee RP, Bamford C, Poole M, McLellan E, Exley C, Robinson L
- Issue date: 2017
- Home healthcare teams' assessments of pain in care recipients living with dementia: a Swedish exploratory study.
- Authors: Karlsson CE, Ernsth Bravell M, Ek K, Bergh I
- Issue date: 2015 Sep