Role of a nurse in pain management of patients affected with dementia
Among the estimated 35 million people living with dementia across the world, more than 50% experience mild to chronic pain regularly. Unfortunately, despite the high numbers, the prevalence of pain in demented patients is often underrated and ignored, leading to inadequate pain assessment and management for this vulnerable group. Unmanaged pain can impact the health of a demented patient significantly. On top of the discomfort and distress it creates, pain is also a major underlying cause for various behavioral problems that can result in inappropriate treatment and prolonged hospital stay.
Nurses are always on the frontline in caring for and managing pain for patients diagnosed with dementia. The first and most important step in pain management is assessing the pain. The subjective nature of pain makes the assessment process a challenging endeavor. Pain is signaled through verbal communication, which can be very deteriorated in people living with dementia. Many cases of pain in individuals living with dementia, therefore, often goes unrecognized and unmanaged. Thus, to effectively assess pain, nurses have to be very careful and particular on how they approach and handle the assessment process.
After correctly assessing and diagnosing pain, nurses are also involved in managing pain and other behavioral symptoms common in dementia patients. But even after successfully diagnosing pain, nurses are also faced with other concerns when choosing a treatment plan. While pharmacological treatment is often the first and the most effective way to treat pain, nurses often end up starting with non-pharmacological options due to the fear of drug addiction and other consequences like respiratory complications associated with analgesics. A nurse may have a problem gauging the intensity, duration, and location of pain, and the right dosage to administer. As a result, even though analgesics are available for pain management, many nurses often end up not prescribing them to their patients or administering a smaller dosage than required. This is particularly common with patients who cannot verbally communicate and report the presence and intensity of their pain.
The nurse may also choose the wrong treatment options, like prescribing antipsychotics drugs instead of analgesics. Administering antipsychotic drugs has been linked closely with serious side effects such as increased cardiovascular complications, reduced level of functioning, and decreased quality of life. Because of all these concerns, proper treatment and pain management of pain in people living with dementia relies on the critical thinking, level of judgment, and decision-making skills of a nurse.