Nursing

Psychological intervention

Intensive care medicine

Statistics

Pain scale

Mann–Whitney U test

Pain management

Intraclass correlation

Developmental psychology

Psychometrics

Protocol (science)

Spearman's rank correlation coefficient

Alternative medicine

Pain assessment

Psychology

Mathematics

Physical therapy

Rating scale

Internal medicine

Wilcoxon signed-rank test

Dementia

Medicine

Physical medicine and rehabilitation

Clinical psychology

Disease

Pathology

Pain Management Nursing

Aim Develop and evaluate the implementation of a protocol for comprehensive management of pain in advanced dementia. Method Quasi-experimental study carried out between September 2015 and May 2016 in an acute geriatric unit. Following development of the protocol and nurse training, 22 participants were recruited through consecutive sampling to form the intervention group (IG). Pain assessment was performed using the Pain Assessment in Advanced Dementia Spanish version (PAINAD-Sp) instrument and by nurse report-rating using the Numeric Rating Scale (NRS) and control group, with pain assessment through nurse-report using an NRS. Interventions carried out following perception of pain were done according to the actions algorithm created for this purpose. Follow-up was carried out daily during the hospital stay. Results Some 98% of the actions were performed correctly following the protocol. All (100%) of patients had a scheduled prescription for analgesics. Significant differences between mean pain scores at admission and discharge were found through PAINAD-Sp using a Wilcoxon sign test of −2.9543 (p = .004). Analysis of pain perception scores revealed a statistically significant positive correlation between the number of nonpharmacological actions performed and the pain score values obtained in the IG (rho Spearman: 0.617, p < .001) and the control group (rho Spearman: 0.922, p < .001). A high correlation was also observed in the IG between assessments conducted using PAINAD-Sp and NRS (intraclass correlation coefficient: 0.921). Conclusions The implementation of an agreed-upon, standardized protocol for comprehensive pain management in advanced dementia, including nurse training, leads to systematic application of all the protocol stages, and therefore better pain management.

Integrated Management of Pain in Advanced Dementia