| BACKGROUNDPain is the common problem in senile dementia.The consequences of untreated pain include physiological risks,depression,sleep disturbance,impaired cognitive function,impaired functional abilities;and increased health care utilization and costs have each been associated with the problem of pain in elderly patients, Deconditioning,gait disturbances,falls,slow rehabilitation,polypharmacy,cognitive dysfunction,and malnutritionare among the many common geriatric conditions that are potentially worsened by the experience and treatment of pain.Despite the high prevalence and consequences of pain among older adults with dementia,health care professionals remain ineffective at both pain assessment and treatment,lacking knowledge,non-use of adequate and appropriate assessment tools for measuring pain had been identified as two main reasons for lack of attention towards pain in senile dementia.Nurses play an important role in decision-making processes and effective pain management among patients.In daily practice,it is often a nurse assess pain,provide pain medication and observe analgesic effect.Previous research has identified certain knowledge deficits and incorrect beliefs among nurses with regard to pain assessment and management,and lack of knowledge about pain and its treatment has been mentioned as an important barrier to effective pain management.In China,many studies indicate that the nurses lack of pain-related knowledge, nurses'characteristics,such as work experience and educational level,have been reported to relate to what nurses know and believe about pain,but these surveys are based on cancer pain,surgical pain,and elderly Pain.Therefore,it is necessary to gather information about knowledge of nursing staff regarding various aspects of pain in elderly patients with dementia.Correct assessment is the first step in pain treatment.In recent years,Pain assessment methods have been gradually applied in clinical practice in our country. Commonly used pain assessment scale,including quoted abroad pain questionnaire, numeric rating scale,verbal descriptor scale and specially designed pain scale for some diseases(such as cancer).Because of impaired cognitive function,there is a significant portion of patients with senile dementia can not understand and answer self-descriptive pain assessment tools,especially moderate and severe cognitive impairment in patients.Therefore,the observation of pain-related behavior are the main methods for pain assessment in patients with senile dementia.Over the past decade a number of observational tools for use with nonverbal older adults with dementia have been developed.However,there is lack of pain assessment tool with good reliability and validity and specialized for senile dementia patients in our country.It is necessary to introduce a pain assessment tool widely used in foreign countries and with good reliability and validity.Through the use of scientific and effective assessment tool that allows nurses to correctly understand the patient's pain, and take effective measures to alleviate the pain of dementia patients and even far away from the pain,improve quality of life.Through literature retrieval and review, these systematic review demonstrate that Abbey Scale,PADE,PAINAD,PACSLAC and Doloplus-2 show the best psychometric qualities.Based on the psychometric qualities and criteria regarding sensitivity and clinical utility,pain experts conclude that PACSLAC and Doloplus-2 are the most appropriate scales currently available.OBJECTIVES(1) To investigate the knowledge and behavior of nursing staffs from Neurology department and gerontism department towards pain in elderly patients with dementia and to provide basis of establishing measures for pain management. so as to make a full play of the nurses in pain management for elderly patients with dementia.(2)To validate the translated chinese version of Doloplus-2 scale for its clinical application in assessing the pain of elders with dementia.That would accelerate the research steps of pain assessment in older people with dementia and provide a scientific pain assessment tool.METHODS(1) A total of 132 nursing staffs working in Neurology department and Gerontism department in Guangzhou were investigated with self-designed questionnaire for knowledge and behavior about pain in elderly patients with dementia.All data were analyzed by SPSS13.0.The statistical methods were: Cronbach'sα,Spearman correlation,Descriptive and Constituent ratio,One-way ANOVE.(2) A three-phase process,including translation,back-translation,and consensus and equivalence testing,was employed in translating and validating the Chinese version of Doloplus-2 after obtained the permission from Doloplus group.Nurses at four community hospitals and one nursing home,administered the Doloplus-2 to 100 patients with dementia from February 2008 to June 2008.All data were analyzed by SPSS13.0.Descriptive analysis,Paired t test,Cronbach's a,Pearson correlation, Spearman correlation,Component analysis and Factor analysis were undertaken to examine the reliability and validity of Doloplus-2 scale(Chinese version).There was statistical significance according to the P＜0.05 in all results.RESULTS(1) A large majority of nursing staffs were convinced that senile dementia can feel pain(84.8%) and it is necessary to assess pain in patients with dementia(71.3%).Except for item7,8,9 and item 11,the other items answer accuracy rate were lower than 60%,the lack of knowledge regarding issues of pain treatment and general knowledge was reflected in the large variety in responses and the high number of "no opinion"scores.There were no significant differences among nurses in terms of hospitals and clinical areas(P＞0.05),However,there were statistically significant differences among scores of nurses at different educational backgrounds, technical titles,work experience,and the time working in Neurology department or gerontism department(P＜0.012).only a small number of nursing home staff were convinced that pain was being correctly assessed(7.6%)and treated(29.6%)at their ward,and that there was a great deal of attention paid to pain in dementia patients(75%).(2) The Chinese version of Doloplus-2 scale demonstrated high internal Consistency(Cronbach's alpha 0.813 )and split-half reliability was 0.777(P=0.000).The correlated coefficient was 0.6-0.9(P=0.000),which was the content validity.There was significant correlation between Doloplus-2 and VDS,The correlated coefficient was 0.816(P=0.000).Component analysis revealed 3 factors account for 61.274 percent of the sample variance,and every item was more satisfied with the load factor(≥0.4) in the corresponding factor.CONCLUSIONS(1)Most nurses agreed that elderly patients with dementia can feel pain,The nurses demonstrated had a positive attitude and lacked knowledge toward pain management,especially lack of knowledge regarding issues of pain treatment and general knowledge.The train program was effective in changing the nurses' knowledge and behavior about pain in elderly patients with dementia.(2) This survey suggested that most nurses are more attention to pain in patients with dementia,but as high as 92.4 percent of nurses are not properly assess pain in patients with dementia.Non-use of adequate and appropriate assessment tools for measuring pain has been identified as an impediment to accurate pain assessment in people with dementia.Therefore,it is crucial to find a standardized pain assessment tool. (3) Chinese version of Doloplus-2 scale was a simple,reliable and effective pain assessment instrument for measuring pain level of non-communicative patients like advanced dementia.Further research is deemed necessary to use another validated observational pain assessment tool as a pain criterion and conduct with a pre - and post-test of analgesic prescriptions prior to wider clinical application.
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