Julie Gregory

‘Getting to Know Me’: the development and evaluation of a training programme for enhancing skills in the care of people with dementia in general hospital settings

Objective: The aims of the study were to report on the development and evaluation of a staff training intervention in dementia care designed for use in the general hospital setting: the ‘Getting to Know Me’ training programme. The study also aimed to undertake initial psychometric analysis on two new outcome scales designed to measure knowledge and confidence in dementia care.Methods: The study comprised two phases. The first phase comprised the design of two questionnaires which are shared within this paper: Confidence in Dementia (CODE) Scale and Knowledge in Dementia (KIDE) Scale. In phase two, staff undertook the ‘Getting to Know Me’ training programme (n = 71). The impact of the programme was evaluated using a pre–post design which explored: (1) changes in confidence in dementia; (2) changes in knowledge in dementia; and (3) changes in beliefs about challenging behaviour.Results: The psychometric properties of the CODE and KIDE scales are reported. Statistically significant change was identified pre–post training on all outcome measures. Clinically meaningful change was demonstrated on the CODE scale.Conclusions: The ‘Getting to Know Me’ programme was well received and had a significant impact on staff knowledge and confidence. Our findings add to a growing evidence base which will be strengthened by further robust studies, the exploration of the impact of staff training on direct patient outcomes, and further identification of ways in which to transfer principles of care from specialist dementia environments into general hospital settings.

‘Getting to Know Me’: The second phase roll-out of a staff training programme for supporting people with dementia in general hospitals

Objectives The aims were to evaluate a second phase roll-out of a dementia care training programme for general hospital staff and to further develop two outcome scales: the Confidence in Dementia scale for measuring confidence in working with people with dementia and the Knowledge in Dementia scale for measuring knowledge in dementia. Method Following a ‘training the trainers’ phase, the study involved the delivery of the ‘Getting to Know Me’ training programme to a large number of staff (n = 517) across three National Health Service (NHS) Trusts situated in North-West England. The impact of the programme was evaluated using a pre–post design which explored: (i) changes in confidence in dementia, (ii) changes in knowledge in dementia, and (iii) changes in beliefs about behaviours that challenge. Results Statistically significant change was identified between pre–post training on all outcome measures (Confidence in Dementia: eight point increase, p < 0.001; Knowledge in Dementia: two point increase p < 0.001; controllability beliefs scale: four point decrease, p < 0.001). Medium to large effect sizes were demonstrated on all outcome measures. The psychometric properties of the Confidence in Dementia and Knowledge in Dementia scales are reported. Conclusion Staff knowledge in dementia and confidence in working with people with dementia significantly increased following attendance at the training sessions. The findings are consistent with preliminary findings and strengthen current knowledge about the impact of dementia care training in general hospitals. The Confidence in Dementia and Knowledge in Dementia scales continue to demonstrate psychometrically sound properties and demonstrate utility in the field of dementia research.

Initial testing of a behavioural pain assessment tool within trauma units

Pain is common in trauma patients who may be older and also may have cognitive impairment leading to reduced communication about their pain. A number of observational pain assessment tools are available and have been found to have limited clinical usefulness. The Bolton Pain Assessment Tool (BPAT) was developed following a trial of three established tools and includes a section to involve family and/or close carers in the pain assessment process. The aim of this paper is to present the findings of initial testing of BPAT. BPAT was used and evaluated by clinical staff in four trauma units in the UK. Forty-six staff evaluations were completed and 98% indicated it was easy to use; it took between one and two minutes to complete by 69.5% and led to pain management interventions by 93.5% of the respondents. It was rated highly by the clinical staff, but the involvement of families and close carers in the assessment process was different at each unit, with one unit not involving the family/close carer. There remains the need for a simple and practical way of assessing pain. This initial testing of the clinical feasibility of BPAT suggests that it is easy to use and helps to identify pain, but further testing of its reliability and validity is required.

The complexity of pain assessment in older people

Pain is common in older people and its assessment is an important part of the nurses role. Asking people about their pain is considered the most accurate and reliable assessment because of the subjective nature of pain. A number of simple and easy-to-administer self-rating scales are available to measure pain intensity. To rate their pain, however, people need to understand the request, as well as recall and interpret the painful signal. Observing specific behaviours associated with pain is advocated when communication and cognitive function are impaired, for example, in people with advanced dementia. A number of pain assessment tools have been developed that involve observation of some or all of the behaviours. The aim of this article is to highlight the importance of pain assessment, discuss the various pain assessment scales and tools available and identify some of the factors that can make comprehensive assessment of pain in older people and those with cognitive impairment complex.

Observing pain management practice on a medical unit following changes arising from an action research study

AIM To describe pain assessment practice within a medical unit, to identify factors that may affect the assessment of pain and evaluate changes in practice. BACKGROUND Pain is a problem for patients in all areas of a hospital, but its assessment and management on medical units had not been investigated. An initial assessment of practice found that pain was not consistently assessed and managed on the unit. A variety of activities have been employed during an action research study to change pain management practice. METHOD Naturalistic unstructured participant observation of nurses and structured patient interviews were conducted. RESULTS The need to communicate with many people led to interruptions, multi-tasking and practical problems were observed which appeared to affect the provision of nursing care, in particular, the administration of medications. These factors also prevented a comprehensive assessment of pain, although the assessment of pain intensity appeared to have increased. DISCUSSION The constant activity and interruptions observed may make it difficult for patients to discuss their experience of pain in detail. These accepted, every day and taken-for-granted aspects of nursing observed appeared to reduce opportunities for comprehensive pain assessment. CONCLUSION Pain assessment is one of a number of nursing activities, obtaining a pain score appears to have become routine practice. Nursing takes place in a complex environment, which may disrupt the provision of nursing care and impede communication. RELEVANCE TO PRACTICE To increase nurses awareness of the complexity of every day practice, the numerous tasks required, interruptions to the provision of care and the resultant effect on pain assessment and management. They need to then identify and reflect on these factors prior to attempting to change their practice.

The assessment and management of pain in an orthopaedic out-patient setting: A case study

The management of pain is an important aspect of an orthopaedic nurses role. The aim of this paper is to use an individual case study to demonstrate the role of an out-patient orthopaedic nurse in the identification, assessment and management of pain. This paper describes how pain was identified and managed for a patient in the orthopaedic outpatient department, highlighting that pain and its management are not isolated to the in-patient setting. The case study illustrates the importance of recognising pain and taking into account the numerous factors that can influence pain perception. The assessment of an individual patients pain led to obtaining help from the Acute Pain Team which led to improvement in the patients pain management and quality of life. The nursing team reflected and discussed the issues identified by this case study which led to changes in practice being introduced. This has resulted in an increased knowledge of and confidence in pain management within the nursing team and development and improvement of pain management practice within the orthopaedic out-patient department.

The Use Of Pain Assessment Tools In Clinical Practice: A Pilot Survey

The aim of this study was to identify which pain assessment tools are used in clinical practice. The recognition and assessment of pain is essential to ensure appropriate pain management. There are a number of pain assessment scales and tools available for healthcare professionals to assist patients describe and rate their pain intensity and to help clinicians assess pain, observe behaviours associated with pain and monitor the effectiveness of pain interventions. A short self-administered questionnaire survey of nursing staff was completed by nurses attending a pain management study day at the university and a pain meeting completed the questionnaire. Although no one pain assessment rating scale was used across all the healthcare organisations represented all the nurses indicated that they used one or a number of self-report pain assessment scales in their clinical practice. The Numerical Rating Scales and the Verbal Descriptor Scale were used by the majority of nurses. The use of behavioural pain assessment scales, such as the Abbey pain assessment scale, were used by 42% of the respondents This small survey indicates that verbal self-report pain assessment scales appear to be embedded into clinical practice, but the use of observational pain assessment tools for people with communication difficulties (including dementia) have not been adopted by the majority of organisations represented. This suggests that there is a need toincrease their use in everyday clinical practice. It is important that clinical staff are aware which pain assessment scale is used in their organisation to ensure consistency. Where different pain assessment scales are used for individual patients the scale chosen for an individual patient needs to be documented and communicated to all members of the health care team to ensure consistent use.