RESUMO
The Assessment of Discomfort in Dementia (ADD) Protocol was developed to improve recognition and treatment of physical pain and affective discomfort in people with dementia who are no longer able to clearly or consistently report on their internal states. The purpose of this study was to describe use of each step of the ADD protocol with 143 residents of long-term care facilities. Of the subjects who received nonpharmacological comfort interventions, 37% showed improved symptoms. Of the 91 protocols in which an analgesic was administered, 83.5% showed improved symptoms. People who complained verbally received considerably more analgesics and other comfort interventions. Limitations inherent in this descriptive exploratory study do not permit conclusions regarding the effectiveness of the ADD protocol. Research with a control group, random assignment, and objective measures of discomfort level is planned.
Assuntos
Protocolos Clínicos , Demência/enfermagem , Medição da Dor/métodos , Dor/diagnóstico , Estresse Psicológico/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/complicações , Doença de Alzheimer/enfermagem , Demência/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Meio-Oeste dos Estados Unidos , Dor/complicações , Dor/enfermagem , Estresse Psicológico/complicações , Estresse Psicológico/enfermagemRESUMO
The purpose of the study was to describe nurses' perceptions regarding the assessment and treatment of pain in patients with late-stage dementia. Thirty nurses from six long-term care facilities were interviewed using a semistructured format for this qualitative study. Initial results were presented to a second group for validation and refinement of findings. The most commonly cited behaviors used to indicate discomfort were facial grimacing, restless body movement, change in behavior, moaning, and tense muscles. Psychotropic drugs were perceived to be commonly misused because behavior changes were seen as a psychiatric problem rather than a representation of the patient's unmet need. Nurses had positive feelings about using both narcotics and nonnarcotic analgesics with this population but believed both types of analgesics were underused. The most common concerns regarding the administration of narcotic analgesics to this population were falls, sedation, and constipation.
