Abstract
Abstract
Introduction
This paper presents findings from an exploratory study in which undergraduate paramedic students’ trialled the use of two pain assessment tools as part of an interprofessional learning experience in residential aged care facilities. The research sought to identify the potential utility of the Abbey Pain Scale and PAINAD tools for use by paramedics with people with advanced dementia who have limited ability to communicate.
Methods
Thirty-one final year undergraduate paramedic students completed a 5-day clinical placement in in four residential aged care facilities in Tasmania, Australia. While on placement students used the two tools to assess pain in residents with known pain issues, under the supervision of nursing staff and paramedic tutors. A mixed methods approach, utilising a quantitative survey and a qualitative open-ended questionnaire, was adopted to ascertain students’ views on the potential for the tools to be used in paramedic practice.
Results
The research found both tools had potential for use in paramedic practice. Feedback from students indicated both pain assessment tools had strengths and weaknesses. Recommendations were made for how each of the tools could be adapted to make them suitable for use by paramedics.
Conclusion
Forecast increases in the number of people living with dementia, and the changing nature of paramedic practice, means that paramedics are more likely to be called on to assess pain in this population in community settings. Further research is needed to inform the development of pain assessment tools specifically for use by paramedics in these settings.
References
Cadogan MP. Assessing pain in cognitively impaired nursing home residents: The state of the science and the state we're in. J Am Med Dir Assoc 2003;4:50–1.
Corbett A, Husebo B, Malcangio M, et al. Assessment and treatment of pain in people with dementia. Nat Rev Neurol 2012;8:264–74.
Lichtner V, Dowding D, Esterhuizen P, et al. Pain assessment for people with dementia: a systematic review of systematic reviews of pain assessment tools. BMC Geriatr 2014;14:138.
Harvey C. Is there scope for an observational pain scoring tool in paramedic practice? Journal of Paramedic Practice 2014;6:84–8.
Lord B. Paramedic assessment of pain in the cognitively impaired adult patient. BMC Emerg Med 2009;9:20.
Lord B, Nicholls T. A brief history of analgesia in paramedic practice. Journal of Paramedic Practice 2014;6:400–6.
McLean SA, Maio RF, Domeier RM. The epidemiology of pain in the prehospital setting. Prehosp Emerg Care 2002;6:402–5.
Lord B, Deveson M. Assessment and management of chronic pain in adults: implications for paramedics. Journal of Paramedic Practice 2011;3:166–72.
Arendts G, Lowthian J. Demography is destiny: An agenda for geriatric emergency medicine in Australasia. Emerg Med Australas 2013;25:271–8.
Hagihara A, Hasegawa M, Hinohara Y, Abe T, Motoi M. The aging population and future demand for emergency ambulances in Japan. Intern Emerg Med 2013;8:431–7.
Health Workforce Australia. Extended Care Paramedics 2014. Available at: www.hwa.gov.au/our-work/expanded-scopes-practice-program/extended-care-paramedics [Accessed 16 June 2014].
Abbey J. Putting pain scales to the test. Aust Nurs J 2007;14:43.
Goucke R, Scherer S, Katz B, Gibson S, Farrell M, Bradbeer M. Pain in residential aged care facilities: management strategies. Sydney, NSW, Australian Pain Society. 2005 s: Management strategies. Sydney, NSW, Australian Pain Society. 2005.
Husebo BS, Strand LI, Moe-Nilssen R, BorgeHusebo S, Aarsland D, Ljunggren AE. Who suffers most? Dementia and pain in nursing home patients: a cross-sectional study. J Am Med Dir Assoc 2008;9:427–33.
Reynolds KS, Hanson LC, DeVellis RF, Henderson M, Steinhauser KE. Disparities in pain management between cognitively intact and cognitively impaired nursing home residents. J Pain Symptom Manage 2008;35:388–96.
McAuliffe L, Nay R, O’Donnell M, Fetherstonhaugh D. Pain assessment in older people with dementia: literature review. J Adv Nurs 2009;65:2–10.
Sampson EL, Blanchard MR, Jones L, Tookman A, King M. Dementia in the acute hospital: prospective cohort study of prevalence and mortality. Br J Psychiatry 2009;195:61–6.
World Health Organization, Alzheimer's Disease International. Dementia: A Public Health Priority. Geneva: World Health Organization, 2012.
Abbey J, Piller N, De Bellis A, et al. The Abbey pain scale: a 1-minute numerical indicator for people with end-stage dementia. Int J Palliat Nurs 2004;10:6–13.
Warden V, Hurley AC, Volicer L. Development and psychometric evaluation of the Pain Assessment in Advanced Dementia (PAINAD) scale. J Am Med Dir Assoc 2003;4:9–15.
Lucas P, McCall M, Lea E, et al. Clinical placements in residential care facilities part 1: positive experiences. Journal of Paramedic Practice 2013;5:400–6.
Lucas P, McCall M, Lea E, et al. Clinical placements in residential care facilities part 2: negative experiences. ibid. 2013;5:462–8.
Lucas PV, McCall MJ, Ecclestone C, et al. Prioritising the development of paramedic students’ interpersonal skills. ibid. 2015;7:245.
IBM Corp. IBM SPSS Statistics for Windows, Version 20.0. Armonk, New York: IBM Corp; 2011.
Ezzy D. Qualitative Analysis: Practice and innovation. Crows Nest: Allen & Unwin; 2002.
Williams B, Onsman A, Brown T. The changing Australian healthcare landscape: implications for paramedics. Journal of Paramedic Practice 2010;2:580–4.
Cohen-Mansfield J, Lipson S. The utility of pain assessment for analgesic use in persons with dementia. Pain 2008;134:16–23.
Robinson AL, Andrews-Hall S, Fassett M. Living on the edge: issues that undermine the capacity of residential aged care providers to support student nurses on clinical placement. Aust Health Rev 2007;31:368–78.
Marek KD, Popejoy L, Petroski G, Mehr D, Rantz M, Lin W-C. Clinical outcomes of aging in place. Nurs Res 2005;54:202–11.
Royal College of Physicians, British Geriatrics Society, and British Pain Society. The assessment of pain in older people: national guidelines. Concise guidance to good practice series, No 8. London: RCP; 2007.