Faisal Mahama

Aim: To establish a comprehensive pre‐implementation baseline of pain management for people living with dementia (PLWD) in acute hospitals by exploring behavioural, contextual, organisational and clinical practice factors to inform the implementation of the DOTS approach. Background: Pain is common yet frequently under‐recognised and inconsistently managed in PLWD in acute care. Behaviour change frameworks, such as COM‐B, may help identify determinants of practice and inform implementation strategies. Design: Multiple‐methods study, underpinned by the COM‐B framework and guided by the Medical Research Council framework for developing and evaluating complex interventions. Methods: The study was conducted across five wards in two acute hospitals in the United Kingdom. Healthcare staff ( n = 148) completed an adapted 6‐item COM‐B self‐evaluation scale (0–10). Semi‐structured interviews with ward managers and a pain management specialist nurse ( n = 6) were analysed using deductive thematic analysis. A retrospective review of patient documentation ( n = 50) assessed compliance with the National Institute for Health and Care Excellence dementia guidelines. Results: Staff reported high perceived capability, opportunity and motivation, suggesting strong self‐reported readiness to deliver effective pain management. However, qualitative findings highlighted barriers across the COM‐B domains, including knowledge gaps and inconsistent use of pain assessment tools. Documentation review highlighted deficits in recording acute pain, chronic pain history and usual pain management strategies. Only five patients received analgesia within 60 min of admission, despite many presenting with fractures or serious infections. Conclusion: A discrepancy exists between self‐reported behavioural determinants and documented clinical practice, indicating inconsistent pain management for PLWD in acute care. Implications for Clinical Practice: Interventions should prioritise strengthening healthcare staff's capability and embedding structured, system‐level processes to support timely person‐centred pain management. Reporting Methods: STROBE guidelines were followed. Patient or Public Contribution: A multidisciplinary steering group, including clinical leaders and dementia representatives, contributed to the study.

Aim: To determine which pain management approaches have been implemented in an acute hospital setting and gauge the extent to which they effectively assess and manage pain among patients with dementia. Design: The review followed the Joanna Briggs Institute framework, guided by the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis extension for scoping reviews (PRISMA‐ScR). Method: The search strategy was designed to locate published and unpublished studies through online databases such as MEDLINE (Ovid) and CINAHL, as well as relevant grey literature sources, such as the WHO database. The review included primary and secondary research publications from 2005 to 2023 relating to patients with dementia in an acute hospital setting. The study focused on overall pain management approaches, including pain assessment, processes, and interventions to manage pain. Tables were used to extract and synthesise results using descriptive statistics. Results: Fourteen studies met the inclusion criteria. They included a range of designs: five cross‐sectional and two cohort studies; five interventional studies; one action research project; and one quality improvement programme. The interventions identified in the review mainly involved validating pre‐existing pain assessment tools, such as the Pain Assessment in Advanced Dementia Scale (PAINAD). Overall, the authors' primary strategy for implementing their respective interventions was organising participant awareness‐raising and training sessions. Conclusions: There is a lack of standardised, person‐centred protocols for managing pain in patients with dementia and a dearth of evidence relating to pain reduction among this client group. While valid pain assessment tools exist, their use alone does not guarantee timely or effective pain relief. Although studies reported the development of interventions to promote effective pain management, they did not consistently demonstrate a systematic reduction in pain among the patient groups. Whilst education on pain management is vital, it has been shown that education alone is insufficient to improve care. Implications for Practice: The review identified several validated instruments for assessing pain in people living with dementia; however, the availability of tools alone is not enough to change practice. A broader shift in pain management is required. Nurses need organisational support not only to incorporate observational pain assessment tools into routine workflows but also to connect assessments to clear clinical actions and adopt a proactive, holistic approach. This includes preventing diagnostic overshadowing by recognising pain as a potential cause of behavioural change and ensuring that pain management strategies go beyond assessment to deliver timely, person‐centred interventions. Health care providers need to support nursing staff beyond providing training and updates to encourage evidence‐based practice and to engender a culture in which pain management is a priority. Patient or Public Contribution: No patient or public contribution was made towards this review.

Background. Postoperative pain remains one of the greatest concerns for patients following surgical procedures. Nurses play an essential role in postoperative pain assessment and management, especially within the first few days after surgery. Objective. The study investigated how nurses in a resource-constraint hospital in Ghana assessed and managed postoperative pain. Methods. This was an explorative qualitative study involving 12 registered nurses practising in the largest referral hospital in Ghana. Data was gathered using a semistructured interview guide. Demographic characteristics of participants were summarized using descriptive statistics. Data were analysed using Kvales three phases for analysing qualitative data. First, the entire text was read again to identify meaning units which were then condensed. Second, the condensed texts were read again and interpreted. Finally, the condensed data containing similar meaning were coded and then sorted into subthemes. Results. It was found that some nurses have never used any pain assessment tool due to lack of standard tool for assessing postoperative pain. The majority of nurses reported that managing pain by using medication was the norm especially in the first 24 hours after surgery. Conclusion. Although participants may have some knowledge of assessing and managing postoperative pain, this knowledge was not largely used to manage postoperative pain effectively, partly because of resource constraints. Therefore, there is the need for adequate training and with provision of resources, it is imperative that the use of standardized pain assessment scales could help in the proper assessment and management of postoperative pain in this setting.