Palliative care in dementia: literature review of nurses' knowledge and attitudes towards pain assessment.

BACKGROUND: Pain is prevalent among older people, yet is often under-recognised and undertreated in people with dementia. The nurse has a central role in identifying and appropriately assessing pain in order to provide effective treatment. Research however suggests there are significant deficits in this area.

AIM: To explore the evidence on nurses' knowledge and attitudes to pain assessment in older people with dementia.

DESIGN: A systematic narrative review of peer-reviewed articles published between 2000 and 2014.

DATA SOURCES: Seven electronic data bases (CINAHL, MEDLINE, PsycInfo, Wiley, Pubmed, ProQuest and OVID) were searched and articles focusing on nurses knowledge and attitudes on pain assessment towards people with dementia.

METHODS: Research participants within the studies reviewed were to include registered nurses involved in the assessment and management of pain in older adults with dementia from across all healthcare settings (e.g. dementia units, nursing homes, community and acute settings).

RESULTS: Data were systematically analysed from 11 papers. Using an inductive approach for thematic content analysis informed by the theory of planned behaviour, five themes were identified. These included: 1) Challenges in diagnosing pain in dementia 2) Inadequacies of pain assessment tools 3) Time constraints and workload pressures 4) Lack of interdisciplinary teamwork and communication 5) Training and education.

CONCLUSION: Nurses play a key role in the effective management of pain through the use of pain assessment tools, behavioural observation, and analgesic choice. Pain assessment in dementia remains challenging for nurses due to the complexity and individualisation of pain behaviours. The accessibility of appropriate training, workforce stability and a standardised approach to pain assessment are key to the successful management of pain in older people with dementia.