What Is the Most Effective Pain Management Strategy for Older Adults with Dementia - Research Proposal Example

What is the most effective pain management strategy for older adults with dementia? Name Institution Course Tutor Date What is the most effective pain management strategy for older adults with dementia? Introduction Pain is likely to be evenly rampant in people with dementia, though, only a small number are prescribed normal analgesics. This is a crucial concern since untreated pain leads to low value of life and at the same time increasing the likelihood of appearance of behavioural and psychological symptom such as agitation in future if untreated. Better evaluation and treatment of pain in this flimsy patient group are therefore very essential. Pain is a common condition and individual experience to a number of older adults. It is allied with a number of constant and acute conditions. In spite of its prevalence, reports suggest that pain is often poorly managed and poorly assessed as well, especially in older adults as (Lin 2011) notes. Cognitive destruction due to dementia and or delirium represents a scrupulous face up to pain management because older persons with these situations may not be capable to express their pain. Nurses as part of an essential part of the interdisciplinary care group, need to understand mythology related with pain management, including addiction and conviction that pain is a usual result of aging, to offer best possible care and to teach patients and families about managing pain. In addition, nurses must as well scrutinize their individual biases about pain and its management at all times. Untreated chronic pain is a distressing sign in older people with average to severe dementia that are not able to clarify their anguish as (Scherder 2009) states. Constant pain has been linked with a progressive decline of purposeful and mental capacity, social interaction, quality of life, appetite and sleep disorder as (Giron 2002) continues to explain. Also augmented behavioural disorder including agitation, anxiety and depression are felt. In essence, pain causes huge stress for the patient and their proper and casual care providers as well as increases health care costs. At any given time in Australia close to a third of Australians are in pain, with one in every five persons experiencing pain reporting that it is constant and severe. The frequency of pain increases as people get older and older with women being more likely to experience pain than men. Pain management strategies comprise but not limited to pain-relieving medications, occupational or physical therapy and complementary therapies such as acupuncture and massage. Studies imply that a person’s attitude and the way one emotionally handle with long-term or chronic pain can control their quality of life. Understanding the causes of pain can help decrease fear and anxiety from pain. Dementia result from loss of memory which interferes with normal activities of daily functioning of the mind; it’s a memory loss that affects thinking and social abilities. Dementia can be severe to an extent of interfering with the daily functioning. It is described by a group of symptoms which include judgement, loss of memory, complex motor skills and permanent damage to the brain nerve system or the neurons. The most common cause of dementia to older adults (persons over the age of sixty five years) is the Alzheimer disease. This disease represents more than sixty percent of all cases of dementia. Inclusion Types of participants Older adults who are aged 60years and above will be included in this research because they are at the high risk of developing dementia as a result of various risk factors. Having intervention at this level can be facilitative in the processing of information as well as ensure a comprehensive care provided by the nursing staff (Miller 2012) Focus of interest Dementia manifests itself in two major forms. The first one is the normal cognitive aging which is common among adults aged between seventy and eighty years as Miller (2012) observes. Secondly, as a result of various other conditions such as effects of some forms of medication, impaired hearing or vision, effects of emotional or physical stress and so on can prevalently cause dementia in old people compared to the young generation (Miller 2012). Due to the changes related to age, the patients will be allowed more time to process information, be given information in simple materials, either written or visual. They will also have information from one time to another given in small bits and reinforced by repetitions so that it may become relevant to them and their experiences. Those with impaired vision will have the various aids and precautions taken, for example, letters will have a good contrast as well as be large for easy reading (Miller 2012). Eyeglasses will also be kept in places where they can be accessed immediately. Amplifier devices will be used for those who have an impaired sense of hearing where necessary. Still standing in positions where the patients see the nurse clearly and articulately pronouncing words together with avoiding of background noises will be observed (Lipton & Marshall 2013). Regular checks of those using hearing aids will be availed and kept in good conditions. Instances that provoke physical stress such as pain, being hungry, tiredness and discomfiture among others will be overseen to ensure a comfortable environment (Miller 2012). Emotional stress will also be reduced by ensuring that patients are encouraged to express their feelings. Good communication such as listening will be emphasized too (Lipton & Marshall 2013). On top of all, simple exercises for reducing stress will be taught to the patients as well as bringing supportive family members or friends to them. Context The study will be carried out in various places where older people with dementia are taken care of. Such places will include hospitals both private and public. According to National Institute for Health and Clinical Excellence (2011), dementia is common among old people and most of them are admitted in hospitals mostly for specialized care. As a result, they need more attention at this age for support and comfort (National Institute for Health and Clinical Excellence 2011). Other sicknesses such Alzheimer's and Parkinson’s diseases are also known to have more cases of dementia (Lipton & Marshall 2013). As a result, these patients will mostly be found in the hospital undergoing another treatment. On the same note, Lipton & Marshall 2013 and Miller 2012 observe that the same patients may have cardiovascular diseases, therefore at any stage of the sickness will need deep and concerted care to the patients. Though patients with dementia have been observed to take a long time in remembering short term events (Miller 2012), extended watching and noticing of the various signals by nurses can help in understanding and giving care from other care givers such as family members and friends (National Institute for Health and Clinical Excellence 2011). This will have a long term advantage to the caregivers in the family when no nurses are available to understand the aged and what they really need (Miller 2012). Outcomes According to the National Institute for Health and Clinical Excellence (2011), caring for people with dementia is a sign of non-discrimination to them which enables a good coexistence with those who are not suffering from the disease. This study therefore will ensure that campaigns both in seminars or in written materials are published to support the care for the demented. The study will ensure that palliative care to the demented patients is to be improved as observed by Volicer (2005), that demented patients are usually treated aggressively and the treatment is mostly ineffective. The study will also will emphasize a more practical knowledge in dealing with patients with advanced dementia and the barriers that to this knowledge laid bare (Volicer 2005). Types of study Both qualitative and quantitative researches will be considered in this study for the sake of information pertinent to the research question. The publication utilized will essentially be in English. To make the research be up to date, the materials used will be those published between 2009 and 2013. Exclusion The study will exclude people below the age of 60 even if they are demented. It will also exclude demented people in their homes in preference to those in hospital because they cannot be easily accessed and for the sake of time factor. Patients who are seriously ill in intensive care unit will not be included in this research. Search strategy The two electronic databases that will help in research about the topic are Medline and Pudmed databases. Pudmed is the right database for conducting research related on the topic because it contains approved publications in the field of nursing and healthcare. Among the publications contained in Pudmed database include medical dissertations, drug records, and instructions on research, health care books and Evidence-Based Care Sheets among others. Since the research focuses on old people, the Pudmed electronic database will be the right avenue for accessing the related information on the topic (Moyle et al, 2008). On the other hand, Medline also comprise of appropriate publications on biomedicine which can be applied to the research topic. The database contains various medical journals, books, nursing dissertations that are well references making it the right database to be used in the research. A part from the publications, Medline is designed as a user friendly database, with clearly established user guide and Online Help that makes research easier. The most interesting feature of Medline is that its content is updated often making it a more reliable source of research material (Hersh et al, 2002). Key words Research question: What is the most effective pain management strategy for older adults with dementia? Based on the topic above, the key concepts of research will be most effective, pain management strategy, older adults and dementia. These words form part of the entire topic and when entered to the search engines will provide information related to the topic. The research topic or key words should be designed in a way that helps the researcher access information necessary to solve the research problem (Tenopir 2003). Other key words that may be useful for the research are chronic confusion and cognitive impairment since they associated with dementia. The researcher will also consider widening the search synonyms of the search concepts so as to accommodate the various versions of words presented by the authors. Although the wordings may be different, they communicate the same idea, and therefore by applying both of them will not limit the researcher to particular synonyms (Häyrinen et al 2008). For instance the synonyms for most effective would be adequate, efficient and emphatic. Those for pain management strategy would be pain relief and pain treatment strategies. The researcher would also try words like elderly, aged, older people, aging and older patients as an alternative to the key word older adults. On the other hand, insanity would be used as a synonym for dementia. Furthermore, the researcher will combine some key words like older adults and dementia with Boolean operators, connoted as AND and OR. The intention of the researcher will be to narrow down the research and access related materials for the research faster. OR is a connector of words which reflect the same concepts and is used to broaden the search while AND will be useful to the research since it will help narrow the research thus getting the most appropriate materials (Boswell, 2012). A simple search string will have the following will have the following words indicated in the table and combinations for search below the table. Most effective Pain management strategy Older adults Dementia Adequate Efficient Emphatic Pain relief Pain treatment strategies Elderly Older people Aging Older patients Insanity 1. Most effective and pain management 2. Most effective and pain relief 3. Most adequate and pain treatment strategies 4. Adequate and pain management 5. Adequate and pain relief 6. Adequate and pain treatment strategies 7. Efficient and pain treatment strategies 8. Efficient and pain relief 9. Efficient and pain treatment 10. Efficient and pain treatment strategies 11. Emphatic and pain management strategy 12. Emphatic and pain relief 13. Emphatic and pain treatment strategies 14. Effect* pain manag?ment strateg* 15. Adequ* pain manag?ment strategy 16. Effic*pain rel?ief 17. Emph* pain rel?ef 18. Pain* man* older adults* 19. Pain* manag* elderly* 20. Pain* manag* older people* 21. Dement* 22. Dement* and Older adults * 23. Dementia and older adults 24. Dementia and elderly 25. Dementia and older people 26. Dementia and aging 27. Dementia and older patients 28. Dementia or insanity 29. Dement* or Insan* 30. Dementia* or Insanity* and pain management 31. Dement* insan* elder* pat* 32. Dementia not insanity 33. Dementia and aging 34. Dementia and elderly not pain relief 35. Pain relief and older adults 36. Pain management and elderly or older adults 37. Pain relief and aging or older people 38. Pain* treat* strateg* and old* peop* 39. Pain manag* old* peop* dement* 40. Pain* manag?ment strateg* and dementia or insanity 41. Pain relief* age* and dementia or insanity 42. Pain relief* age* and insane* 43. Efficient* pa?in Reli?ef 44. Adequ* pain* reli?ef and dement* 45. Effici* pain* relief* elderly 46. Effi?cient pain* relief* 47. Pain relief and insanity* 48. Pain relief or pain treatment and dementia 49. Older people or patients and dementia 50. Old* peop* or patient* and dement* Impact of the review process and the search strategy on the understanding of the research area The entire review process has helped the researcher develop a better understanding of the research problem in a number of ways. It is through this process that the researcher has learnt how to search for the right information in respond to the research questions. According to the review process, it is important for a potential researcher to develop a clear plan before embarking on actual research to be able to collect accurate and relevant information; something the researcher has so much benefited from (University of Oxford, 2005). The researcher is now aware that research question has to be phrased in a clear manner considering the Population, Intervention, Comparison and Outcomes. The formulation of the research question to reflect the PICO will help the researcher to make informed decisions in the research work. The inclusion and exclusion criteria have helped me understand what should and should not form part of the research question. The inclusion criteria, in particular as identified above, clearly identify what I should consider including in my research for better results. Exclusion criteria on the other hand, has enabled me know what I should not include in the research in order to get the right information to my research problem (Boswell, 2012). On the search strategy, I have learned how to use the electronic databases in conducting my research especially in designing the research question by use of key words. The two databases that will help me carry out the research are the Pudmed and Medline Databases because of their appropriate features. I also learned that the key words are got from the research topic and sometimes they are researched in connection by use of Boolean operators so as to access more relevant information faster. Having learnt how to create a search string will help me conduct the research comfortably (Tenopir, 2003). Generally, the review process and search strategy has provided useful information and helped improve my level of understanding as far as conducting research is concerned. References Boswell , W, 2012, Boolean search – What does Boolean search mean. retrieved on July 2, 2013. Giron, M, Forsell, Y, Bernstein, C, & Fastbom, J, 2002 Sleep problems in a very old population: Drug use and clinical correlates Journals of Gerontology A-Biological Science and Medical Science. Häyrinen, K., Saranto, K., & Nykänen, P 2008 “Definition, structure, content, use and impacts of electronic health records: a review of the research literature”, International journal of medical informatics, 77(5), p.291. Hersh, W. R., Crabtree, M. K., Hickam, D. H., Sacherek, L., Friedman, C. P., Tidmarsh, P., & Kraemer, D 2002 “Factors associated with success in searching MEDLINE and applying evidence to answer clinical questions”, Journal of the American Medical Informatics Association, 9(3), pp.283-293. Lin, P C, Lin, L.C., Shyu, Y. I. L. & Hua, M, 2011 Predictors of pain in nursing home residents with dementia: a cross-sectional study journal of Clinical Nursing, 20, 1849– 1857. Lipton, A. M., & marshall, C. D, 2013, The common sense guide to dementia for clinicians and caregivers, New York, NY, Springer. Miller, C. A, 2012, Fast facts for dementia care what nurses need to know in a nutshell. New York, Springer Pub. Co. Retrieved on July 2, 2013.Top of Form Moyle, W., Olorenshaw, R., Wallis, M., & Borbasi, S, 2008, Best practice for the management of older people with dementia in the acute care setting: a review of the literature. International Journal of Older People Nursing, 3(2), 121-130. National Institute for Health and Clinical Exellence (NICE), 2011, Dementia: Supporting people with dementia and their carers in health and social care, November, 2006. Accessed on July 2, 2013. Scherder, E, Herr, K, & Lautenbacher, S, 2009 Pain in dementia Pain. Tenopir, C 2003 “Use and users of electronic library resources: An overview and analysis of recent research studies”. University of Oxford, 2005, PICO: Formulating an answerable question. Retrieved from: retrieved on July 2, 2013. Volicer , L, 2005, End-of-life care for people with dementia in residential care settings. Alzheimer’s association, (1)1-35.Bottom of Form Read More