Aims: To synthesize and evaluate the effectiveness of interventions for nurses to improve the assessment and management of pain in people living with dementia.
Design: Systematic review and meta-analyses of randomized controlled trials.
Data sources: CINAHL, Joanna Briggs Institute (JBI) EBP, Cochrane Library, PubMed, and Scopus databases were searched for all journal articles published between 2009 -2019.
Review methods: Papers were included under population intervention comparator outcome (PICO) framework for: (a) people living with dementia aged 65 years and over; (b) interventions developed for nurses or other health professionals; (c) comparison group of standard care or control; and (d) outcome that measures the intervention effects on nurses and people living with dementia. Independent reviewers undertook critical appraisal, data abstraction, and synthesis. Meta-analyses were performed to determine the effectiveness of interventions.
Results: Of 2099 titles and abstracts screened, six interventions with low-to-moderate risk of bias met inclusion criteria. Studies that implemented a routine pain assessment tool showed no effect on nurses' analgesic management. Studies that developed a comprehensive pain model involving multidisciplinary health professionals showed overall effects on pain assessment and management in dementia care. Physician involvement had an impact on analgesic management.
Conclusion: Comprehensive pain models improve nurses' pain assessment and management. A lack of balance between analgesia use and non-pharmacological pain management in dementia care is evident. Multidisciplinary health professionals' involvement is essential for effective intervention design for pain management in dementia.
Impact: Various pain assessment tools have been considered to assist identification and management of pain in people living with dementia. Nevertheless, challenges exist when caring for people living with dementia in pain. These findings support the development of a comprehensive pain model, which may be a more effective strategy than routine use of a pain tool alone for nurses to improve pain management in dementia care.
目的: 综合评价护理对改善痴呆症患者疼痛评估和管理的干预效果 设计: 随机对照试验的系统评估和荟萃分析。 数据来源: 对CINAHL、Joanna Briggs Institute (JBI) EBP、Cochrane Library、PubMed和Scopus 数据库中2009~2019年间发表的所有期刊文章进行了检索。 评估方法: 论文被纳入“人群、干预、对照干预、结局” (PICO) 框架, 内容包括: (a)65岁及以上的痴呆症患者; (b)为护士或其他卫生专业人员制定的干预措施; (c)标准护理比较组或对照组; 以及 (d)衡量干预对护理人员和痴呆症患者影响的结果。独立评估员进行了批判性评估、数据抽象和综合。为确定干预的有效性, 进行了荟萃分析。 结果: 在筛选的2099篇标题和摘要中, 有6项偏倚风险低至中等的干预符合纳入标准。实施常规疼痛评估工具的研究显示, 该等干预对护理人员的镇痛管理没有影响。开发了涉及多学科卫生专业人员的综合疼痛模型的研究显示, 该等干预对痴呆症护理中的疼痛评估和管理有总体影响。医生的参与对镇痛管理有影响。 结论: 综合疼痛模型可改善护理人员的疼痛评估和管理。痴呆症护理中镇痛剂使用和非药物疼痛管理之间明显缺乏平衡。多学科卫生专业人员的参与对于有效设计痴呆症疼痛管理的干预至关重要。 影响: 各种疼痛评估工具被认为有助于识别和管理痴呆症患者的疼痛。不过, 在照顾患有疼痛性痴呆症患者时, 仍然存在挑战。这些研究结果支持开发一个全面的疼痛模型, 与护理人员仅常规使用疼痛工具以改善痴呆症护理中的疼痛管理的方式相比, 这可能是一项更有效的策略。.
Keywords: dementia care; intervention; nursing; pain assessment; pain management; systematic review.
© 2020 John Wiley & Sons Ltd.