title: Palliative care in dementia: literature review of nurses' knowledge and attitudes towards pain assessment.
abstract: BACKGROUND
  Pain is prevalent among older people, yet is often under-recognised and undertreated in people with dementia. The nurse has a central role in identifying and appropriately assessing pain in order to provide effective treatment. Research however suggests there are significant deficits in this area.
  
  
  OBJECTIVE
  To explore the evidence on nurses' knowledge and attitudes to pain assessment in older people with dementia.
  
  
  METHODS
  A systematic narrative review of peer-reviewed articles published between 2000 and 2014.
  
  
  METHODS
  Seven electronic data bases (CINAHL, MEDLINE, PsycInfo, Wiley, Pubmed, ProQuest and OVID) were searched and articles focusing on nurses knowledge and attitudes on pain assessment towards people with dementia.
  
  
  METHODS
  Research participants within the studies reviewed were to include registered nurses involved in the assessment and management of pain in older adults with dementia from across all healthcare settings (e.g. dementia units, nursing homes, community and acute settings).
  
  
  RESULTS
  Data were systematically analysed from 11 papers. Using an inductive approach for thematic content analysis informed by the theory of planned behaviour, five themes were identified. These included: 1) Challenges in diagnosing pain in dementia 2) Inadequacies of pain assessment tools 3) Time constraints and workload pressures 4) Lack of interdisciplinary teamwork and communication 5) Training and education.
  
  
  CONCLUSIONS
  Nurses play a key role in the effective management of pain through the use of pain assessment tools, behavioural observation, and analgesic choice. Pain assessment in dementia remains challenging for nurses due to the complexity and individualisation of pain behaviours. The accessibility of appropriate training, workforce stability and a standardised approach to pain assessment are key to the successful management of pain in older people with dementia.
authors: Macmillan Clinical Nurse Specialist, Belfast Health and Social Care Trust.
authors: Michelle
authors: M
authors: Burns
authors: Reader, Institute of Nursing and Health Research, University of Ulster, UK.
authors: Sonja
authors: S
authors: McIlfatrick
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D003704:Dementia / Q000451:nursing*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D064946:Hospice and Palliative Care Nursing / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D009723:Nurse-Patient Relations; D009741:Nursing Staff, Hospital / Q000523:psychology*; D059408:Pain Management / Q000451:nursing*; D010147:Pain Measurement / Q000451:nursing*; D010166:Palliative Care / Q000523:psychology*
keywords: Attitudes; Dementia; Knowledge; Older people; Pain assessment; Palliative care