Bakgrund: Studier visar att barns smärta underskattas av sjuksköterskor samtidigt som smärtskattningsskalor används i för liten utsträckning inom barnsjukvården.Syfte: Att undersöka hur smärtbedömning skedde på en postoperativ barnavdelning och hur smärtskattningsskalor användes samt barnens erfarenheter av smärtlindringen. Utöver det var syftet att undersöka hur barnens ålder påverkade dessa faktorer. Metod: Studien är en kvantitativ tvärsnittsstudie baserad på ett enkätunderlag och ett konsekutivt urval. Enkäter delades ut postoperativt till 30 barn i åldrarna 5-17 år som genomgått olika typer av operationer. Barnen svarade på enkäterna själva eller med stöd av sina vårdnadshavare. Resultat: Smärtskattningsskalorna Visuell Analog Skala (VAS) och Faces Pain Scale-revised (FPS-r) användes i mycket liten utsträckning (3% vardera) medan Numerisk Skala (NRS) användes i hög utsträckning (78%). Endast 20% av barnen fick information om någon smärtskattningsskala preoperativt. Barnen var generellt nöjda med hur ofta de hade blivit tillfrågade om sin smärta (73%) och majoriteten (80%) tyckte att de alltid (43%) eller oftast (37%) fått tillräckligt med hjälp mot smärtan. Inga signifikanta skillnader kunde ses utifrån ålder. Slutsats: Studiens resultat visar att NRS användes i hög utsträckning samt att barnen generellt var nöjda med hur ofta de blivit tillfrågade om sin smärta och med hjälpen de fått mot smärtan. Resultatet visar också områden där förbättringar kan göras såsom den preoperativa informationen. Studien belyser det viktiga ämnet barns smärta ur barns perspektiv och kan fungera som ett underlag för att förbättra bedömning och behandling av barns smärta. / Background: Studies show that in pediatric care, nurses underestimate children's pain and perform pain assessments too seldom.Aim: To investigate how pain measurements were performed in a postoperative pediatric care unit, how pain assessment scales were employed, and how children experienced the pain relief. Furthermore the study aimed to investigate how children's age influenced the above mentioned factors. Method: A quantitative cross-sectional study based on a survey and a consecutive sample. 30 children, undergoing surgery, aged 5-17 answered questionnaires postoperatively. The children answered the questionnaires themselves or with support from their caretakers. Results: The pain assessment scales Visual Analoge Scale (VAS) and Faces Pain Scale-revised (FPS-r) were rarely used (3% each), while Numeric Rate Scale (NRS) was frequently used (78%). Only 20% of the children received preoperative information about pain assessment scales. In general the children were pleased with how often they were asked about their pain (73%) and the majority (80%) thought they always (43%) or often (37%) received enough help with their pain. No significant difference was found regarding age. Conclusion: The study shows that NRS was frequently used, and that the children felt content with how often personnel asked about their pain and the help they received. Preoperative information about pain assessment scales was an area for improvement. The study highlights the important subject of children’s pain from a child's perspective and could be used to make improvements in children's pain measurement and treatment.

Bakgrund: Alzheimers är en långsam progressiv sjukdom och är den vanligaste demenssjukdomen. Sjukdomen innebär försämrat närminne och begränsar kommunikationsförmågan. Hur smärta uttrycks i jämförelse med friska personer i samma ålder är oklart. Syfte: Syftet var att belysa hur personer med Alzheimers sjukdom uttrycker sin smärta. Metod: Arbetet var en litteraturöversikt med systematiska sökningar som gjordes i tre databaser. Resultat: Denna litteraturstudie belyste tre olika kategorier: Variation av uttalad smärtintensitet, manifestation av smärta och skattning av smärta. Slutsats: Det som framträdde var att hur personer med Alzheimers sjukdom uttryckte sin smärta inte gick att generalisera, smärta upplevdes olika för varje individ. Observerande skalor var att föredra framför självskattningsskalor vid bedömning av smärta hos personer med Alzheimers sjukdom. / Alzheimer disease is a slow progressive disease that is the most common type of dementia. The disease cause deterioration of cache and limit the ability to communicate. How pain is expressed in comparison to healthy people of the same age is unclear. Aim: The purpose was to highlight how people with Alzheimer's disease expressed their pain. Result: This literature study has highlighted three different categories: The variation of pain intensity, manifestation of pain and estimation of pain. Conclusion: What emerged was how people with Alzheimer's disease expressed their pain could not be generalized, pain was different for each individual. Observing scales was preferable to self-assessment scales for pain assessment in people with Alzheimer's disease.

Aim The thesis set out to examine validations of three observational pain assessment tools and establish nurses’ expectations of them and the factors that might influence them within intensive care unit (ICU) settings. Background The guidelines to pain assessment specific to ICU patients have been of great interest to health professionals over the last 20 years. Pain assessment remains a challenge for most ICU patients due to the difficulty of assessing pain with any precision. Evidence suggests that the Behavioural Pain Scale (BPS) and Critical- Care Pain Observation Tool (CPOT) have demonstrated sound psychometric properties. A review of the relevant literature highlighted the fact that no such studies have yet been conducted with a similar homogenous group in Asia. The Wong-Baker Face Pain Rating Scale (FPRS) is currently widely used for nonverbally communicating patients (NVCPs) with pain in ICU settings, and is even recommended for use with children. Valid assessment tools are required for effective pain assessment in ICU settings, particularly in patients who are experiencing communication difficulties. Design An embedded mixed methods design was employed to: 1) translate Chinese versions of BPS and CPOT, 2) test their validity and reliability of in comparison with FPRS, and 3) establish the nurses’ expectations about the three study scales when undertaking pain assessment by using semi-structured focus group interviews. Methods This thesis initially reviews the literature available to select the most appropriate scales for assessing pain in critically-ill NVCPs. The selected scales were then translated into a Traditional-Chinese version using established procedures for the Taiwanese context. Evaluations of the three pain scales were gathered using quantitative measures of pain scores in NVCPs experiencing painless/painful interventions. These were further compared with a few focus groups to establish the feasibility and utility of the three pain scales. The psychometric properties of the pain scales were assessed for reliability by using internal consistency and inter-rater agreement) and for validity by using content validity, concurrent validity, discriminant validity, and responsiveness. The validity was evaluated using ANOVA to compare the changes between the different procedures. The significance level was set at 0.05. As for the analysis of the qualitative data, this study typically follows the path of aggregating the words into themes of information and presenting the diversity of ideas gathered during the data collection. Results For the 2068 observations in 237 patients, there were no statistical differences between the characteristics of the BPS, CPOT, and FPRS groups. Validity was demonstrated by changes from baseline in the scores of the three groups, which were significantly higher during suction (p < 0.001). In regard to the result for the criterion validity, both BPS and CPOT had moderate positive correlations with FPRS. The internal consistency was excellent; the Cronbach’s α was 0.700 for BPS and 0.821 for CPOT when all items were included. The majority of nurses preferred to use BPS to assess pain in their clinical practice. When the nurses were asked how long they needed and how easy they found it to complete the assessments using these tools, they all agreed that each patient assessments were easier and took the least time when they used FRPS. However, the nurses considered that the most effective pain reaction during nociceptive procedures had been assessed by using BPS. Even though all of the participant nurses stated that CPOT provides a detailed item-description about pain behaviour, it also provided the biggest obstacle to use because of its ambiguous indicators. Conclusions BPS, CPOT and FRPS provide potentially useful measurement scales for assessing pain in ICU NVCPs. However, judging from the inconsistencies between the nurses’ replies, the results could reflect a conflict between the need to use a validated measure of pain for NVCPs on the one hand and managing a heavy workload in the ICU on the other. This study opens up an avenue for investigating further the link between the underlying conceptions of pain behaviour and the effectiveness of pain assessments in NVCPs when using an objective pain measurement.

Bakgrund: Postoperativ smärta uppkommer efter operation. En obehandlad akut smärta kan utvecklas till långvarig smärta och detta är den vanligaste orsaken till att patienter söker läkarvård. Sjuksköterskans ansvar är att lindra, bedöma och skatta smärta hos patienter. Ett ömsesidigt förtroende kan underlätta arbetet, emellertid blir enbart hälften av patienterna på en avdelning delaktiga i sin smärtbehandling. Patientens egna uppfattningar, tidigare erfarenheter och beskrivning av smärta bör tas på allvar. Studiens teoretiska referensram är Joyce Travelbees teori där huvudkomponenten innefattar förståelse för vad som händer i interaktionen mellan patienten och sjuksköterskan. Vårdlidande kan uppstå om patienten förlorar kontroll, vilket är vanligt förekommande inom vården. Smärta är ett exempel på en situation när patienten tappar kontroll över situationen. Syfte: Syftet var att beskriva patienters upplevelse av postoperativ smärta.  Metod: Litteraturstudie av kvalitativa artiklar genomförd i databaserna Pubmed, CINAHL, PsycINFO. Totalt inkluderades 10 stycken vetenskapliga artiklar.  Resultat: Generellt upplevde patienter postoperativ smärta fysiskt. Kroppsliga förnimmelser var kopplade till smärtans karaktär, intensitet och varaktighet. Patienterna upplevde att smärtan begränsade vardagliga livet genom svårigheter att utföra aktivitet och sämre sömn. Patientens psykiska upplevelse präglades av rädsla och oro. Patienter upplevde att vårdpersonalens bemötande hade en inverkan på förtroendet. Tidigare erfarenhet och kunskap av smärta påverkade hur patienter hanterade smärta. Den farmakologiska och icke- farmakologiska smärtlindringen upplevdes positivt och negativt. Slutsats:Patienter upplever smärtans karaktär, varaktighet, intensitet och lokalisation individuellt. Förtroendet för vårdpersonal, deras bemötande och attityd har en betydelsefull inverkan på patienternas postoperativa smärtupplevelse. Tidigare erfarenheter av smärtlindring och relationen till vårdpersonal påverkar patienters inställning gentemot analgetika.  Nyckelord: lidande, postoperativ smärta, smärtbedömning, smärtlindring, upplevelse. / Background: Postoperative pain emerge after surgery. Untreated acute pain can develop into chronic pain. It’s the most common cause for patients to seek medical treatment. It’s the nurse's responsibility to ease and evaluate pain among patients. Mutual trust can help make these responsibilities easier, though only half of the patient in a caring unit gets to be involved in their pain-treatment. Patients opinions, earlier experiences and descriptions of pain must be taken seriously. The theoretical reference frame of this study is Joyce Travelbee’s theory, where the main component includes the understanding of the interaction between patients and nurses. Suffering in healthcare can develop if the patient loses control, which is common in health care. Pain is an example of a situation when a patient loses control over of the situation. Aim: To describe patients experiences of postoperative pain. Method: A literature study of 10 qualitative articles, found in Pubmed, CINAHL and PsycINFO. Results: Patients generally experienced their postoperative pain physically. The experience related to the pains character, intensity and durability. The pain was often perceived to restrict everyday-life by bringing difficulties performing exercises and resulted in deficient sleep. The physical experience where tinged by fear and anxiety. The healthcare professional’s treatment towards patients had an impact on the relationships trust-status. Earlier experiences and knowledge about pain affected how patients handled their pain. Pharmacological and nonpharmacological pain treatment were experienced as both positive and negative.  Conclusion: Patients experiences the character of the pain, as well as the intensity and durability, individually varying. Trust towards healthcare staff, their treatment and attitude, had an impact on the postoperative pain experience. Earlier experiences of pharmacological treatments and the relationship with staff impacted patients attitude towards analgesics.  Keywords: Experience, painassessment, pain relief, postoperative pain, suffering.

The diploma thesis entitled "Experience of children in assessment and treatment of pain in hospitalization at children's departments" deals with the topic of children's pain and its treatment. The issue is the main topic of the theoretical and practical part of the thesis and both of them focus on children at their pre-school and school age. The theoretical part of the thesis describes the current state of the issue, the psychology of a child at the pre-school and school age and also pain as such and its specifics in children. It is obvious that pain of a child is different not only in diagnostics and treatment. A child reacts differently also in experiencing pain, and also fables are often among people regarding pain that persist even these days. It is important to realize that a child is not a smaller adult, and that is why care for a child must be different. At the same time a child has to be taken as an integral human being who experiences pain and it always has to be assessed objectively according to scales and other objective methods selected according to the child's age. In this area, a big problem can be fables about children's pain that persist even in the current population. The research part of the thesis is aimed at interviews with children hospitalized at children's departments regarding their pain and also interviews with nurses. It compares information obtained from both groups of respondents and it looks for answers to questions of experiencing pain by a child, assessment by a nurse and treatment. It is apparent from the results of the research that children perceived differences in assessment and treatment of pain at home and in hospital, particularly in the change of the person that have to approach, and also in using non-pharmacological methods that are used more by mothers at home. This regards frequency and the way of pain assessment; children are not aware of regularity of assessment, they do not know the scales that the nurses mentioned as those that are used most often. Treatment of pain in hospitals is mostly pharmacological. But children do not always get the information about effect of a drug when it is administered to them. At the same time this part of the thesis looks for the possibilities and the need to create a standard for assessment and treatment of pain in children as well as the most important parts that the standards should contain. In this connection, a draft of the standard for nursing care of a child in pain was created within the thesis which makes up an appendix hereof.

O objetivo geral desse estudo foi avaliar a dor crônica isquêmica percebida e a qualidade de vida do cliente relacionada a essa dor. Os objetivos específicos foram: descrever o perfil sócio-demográfico e econômico dos clientes com dor crônica isquêmica, mensurar a intensidade da dor crônica isquêmica percebida, identificar os descritores de maior e menor atribuição para a dor crônica isquêmica, escalonar os principais descritores de dor crônica isquêmica e avaliar a qualidade de vida dos clientes que queixam de dor crônica isquêmica. Para tal, foram realizados 4 Experimentos, nos quais utilizamos métodos psicofísicos diferentes. Cem clientes portadores de Doença Arterial Obstrutiva Periférica destes participaram dos Experimentos 1, 2 e 4 e trinta do Experimento 3. Os resultados para análise descritiva foram: média de idade de 64,83 ± 12,14 anos, 67 pertencem ao gênero masculino, 54 casados, 63 aposentados, 79 católicos, 58 frequentaram o ensino fundamental incompleto, sendo que 89 queixavam-se de dor há mais de seis meses. A maioria dos participantes atribuiu o valor 10 para a intensidade da dor, sendo média aritmética de 5,59 ± 3,16 pontos. Os cinco descritores de maior atribuição (estimação de categorias) que caracterizam a dor crônica foram: desagradável, perturbadora, forte, preocupante e cansativa e os de menor atribuição foram: punitiva, deprimente, persistente, angustiante e desastrosa. Os descritores de maior atribuição (estimação de magnitude) foram: terrível, dolorosa, incômoda, preocupante e cansativa e os de menor atribuição foram: enjoada, forte perturbadora, chata e desagradável. Os domínios da qualidade de vida mais afetados foram: o domínio físico, seguido pelos domínios ambiental, psicológico e social. Existe correlação entre todos os domínios de QV e a qualidade de vida global do instrumento WHOQOL-bref e entre todos os domínios de QV e de dor crônica. / The general aim of this study was to assess the perceived chronic ischemic pain and the pain-related quality of life (QOL), regarding this specific pain. The specific aims were: to describe the socio-demographic and economic profiles of the clients with chronic ischemic pain, to measure the intensity of the perceived chronic ischemic pain, to identify the least and most frequent descriptors for chronic ischemic pain, to rank the main descriptors of chronic ischemic pain and to evaluate the quality of life of the clients who complain of chronic ischemic pain. Four experiments were carried out, using different psychophysical methods. One hundred carriers of peripheral obstructive arterial disease participated in Experiments 1, 2 and 4, and 30 took part in Experiment 3. Results for descriptive analysis were: average 64.83 ± 12.14 years of age, 67 were male, 54 were married, 63 pensioners, 79 catholic, 58 had incomplete primary education and 89 complained of pain for more than six months. Most participants rated their pain intensity as 10, the arithmetic average was 5.59 ± 3.16 points. The five most frequent descriptors (category estimation) that characterized chronic pain were: unpleasant, disturbing, strong, preoccupying and tiring. The least frequent were: punishing, depressing, persistent, distressing and disastrous. The most frequent descriptors (magnitude estimation) were: terrible, painful, disagreeable, preoccupying and tiring. The least frequent were: sickening, strong, perturbing, boring and unpleasant. The most affected quality of life domains were: the physical domain, followed by the environmental, psychological and social domains. There is correlation between all the QOL domains and the overall quality of life in the WHOQOL-bref instrument, and between all the domains of QOL and chronic pain.

A vacinação ocupa um papel de destaque na prevenção de doenças e proteção da saúde, tanto no âmbito individual quanto coletivo. Contudo sua realização impõe uma série de condições desagradáveis, principalmente às crianças pequenas. Dentre os vários aspectos críticos que compõem os momentos de vacinação, destaca-se a dor provocada pela aplicação da vacina, por suas implicações para as crianças e seus familiares. Dado que o foco do atendimento nas Salas de Vacina está colocado, principalmente, sobre a vacina (preparação, aplicação, conservação, entre outros), outros aspectos críticos da vacinação das crianças não estão contemplados durante os atendimentos. Visando contribuir para a qualidade da assistência nas Salas de Vacina, este estudo busca levantar na literatura científica elementos que facilitem aos profissionais envolvidos no atendimento e na organização das Salas de Vacina, o reconhecimento da dor pela qual passam as crianças durante sua vacinação, através de instrumentos de avaliação. Para tal foi feita uma revisão da literatura, buscando instrumentos de avaliação de dor em crianças menores de dois anos. A busca foi estruturada a partir do acrônimo PICO em dez diferentes bases. Os descritores foram adaptados para atender às especificidades das mesmas e foi utilizado o Endnoteweb® para sistematização e compartilhamento das informações. Foram identificados 295 estudos entre 1993 e 2010 cujos resumos foram analisados e, aplicando-se os critérios de exclusão chegou-se a um conjunto de 24 artigos que foram lidos na íntegra. Tendo em vista a finalidade chegou-se a uma amostra final de 12 artigos que apresentavam 8 escalas. Constatou-se que as escalas mais adequadas para avaliação das crianças durante a vacinação são: MBPS, CHIPPS, NIPS e ABC. Estas escalas utilizam os parâmetros consagrados na literatura, em composições e especificações diferentes. / Vaccination has an important role to prevent diseases and protect health, both for individuals and for collectives. However its implementation requires a series of unpleasant conditions, especially to small children. Among several critical aspects that are present at the time of vaccination, there is the pain caused by the adistration of vaccine, because of its implications for children and their families. Since the focus of attention in the rooms vaccine is placed primarily on the vaccine (preparation, implementation, maintenance, etc.), other critical aspects of vaccination of children are not covered during the sessions. To contribute to the quality of care in rooms vaccine, this study raises some elements in the scientific literature to facilitate the professionals involved in care and organization of rooms vaccine, the recognition of pain that children may have during their vaccination, through assessment instruments. It was developed a review of the literature, searching for tools to evaluate pain in children under two years. The search was structured from the acronym PICO in ten different bases. The descriptors were adapted to meet the specific needs of these and Endnoteweb© was used to systematize and share information. Were identified 295 studies between 1993 and 2010 whose abstracts were reviewed and, applying the exclusion criteria was reached at a sample of 24 articles that were read in full. Given the goal was reached a final sample of 12 articles that presented eight scales. It was found that the most appropriate scale for assessing children for vaccination are: MBPS, CHIPPS, NIPS and ABC using the parameters established in the literature with compositions and different specifications.

Det är känt att ambulanspersonalens omhändertagande av barns smärta kan bli bättre. Akut smärta hos barn är en vanlig orsak till att barn söker ambulanssjukvård. Barn i för- skoleålder utgör en utmaning på grund av bristerna i den språkliga och kognitiva ut- vecklingen, som gör det svårt för dem att kommunicera kring sin egen smärta. Att ge- nomföra en adekvat smärtskattning hos barn är ett sätt att mäta deras smärta och därige- nom utföra en lämplig behandling, samt kunna utvärdera effekten av genomförd be- handling. Idag är VAS det vanligaste smärtskattningsinstrument som används i ambu- lansen, det är endast validerat från barn &gt; 8 år. Syfte: Att undersöka hur smärtskattning av barn i åldrarna tre till sex år inom prehospital akutsjukvård genomförs och vilka för- utsättningar som finns för att genomföra smärtskattning. Studien är en integrativ littera- turstudie. Tio artiklar ingår i studien, åtta kvantitativa och två kvalitativa. Sökning efter vetenskapliga artiklar skedde i databaserna Pubmed, Cinahl och Embase. Artiklarna granskades med SBU:s granskningsmall. Resultatet visar på olika sätt hur ambulansper- sonal försöker förstå barns smärta, men att det i dagsläget finns mer att önska. Smärt- skattning kan utföras oftare men kunskap och erfarenhet saknas om hur och varför man ska smärtskatta. Behandlingsriktlinjer räcker inte för att öka frekvensen samt förbättra utförandet av smärtskattning. I ambulansmiljö saknas det validerade instrument till barn i  förskoleåldern. Förutsättningar för att använda validerade smärtskattningsinstrument visade sig vara kunskap och erfarenhet. Både personalen och verksamheten har ett an- svar för att skapa förutsättningar till smärtskattnings. Det för att öka chansen till en hållbar vårdrelation.

Ett ansvarsområde för sjuksköterskor är att identifiera smärta och smärtlindra för att minska lidande. Sjuksköterskor har en viktig roll i att bemöta personer med demenssjukdom och deras behov. Detta görs genom lyhördhet, öppenhet och genom att försöka förstå även det som inte sägs. Personer med demenssjukdom upplever smärta på samma sätt som innan sjukdomens debut. Däremot har de svårt att verbalt beskriva och förmedla sig samt att lokalisera smärtan vilket innebär en större risk att bli underbehandlade. Därför har sjuksköterskor ett stort ansvar att vara extra uppmärksam på känsloyttringar runt personer med demenssjukdom. Syftet med litteraturstudien var att beskriva vårdpersonalens erfarenheter av att smärtbedöma personer med demenssjukdom. Studien genomfördes som en allmän litteraturstudie. Tio resultatartiklar valdes ut då de svarade till studiens syfte. Efter gemensam granskning skapades kategorin Samverkan i team med subkategorierna Hierarkiska glapp och Tillit och gemenskap. Den andra kategorin var Detektivarbete med subkategorierna Tolka patientens ledtrådar och Tidskrävande. Mest centralt i resultatet var att smärtbedömning av personer med demenssjukdom behövde baseras på personens icke verbala ledtrådar samt att det var ett tidskrävande moment för vårdpersonalen. / Nurses have a responsibility to identify and relieve pain in order to reduce suffering. They play an important role in facing the needs of a person with dementia. This is accomplished through sensibility, openness and by trying to understand non-verbal clues. Persons with dementia still experience pain to the same extent as they did before the disease. They find it hard to verbally express themselves and to locate their pain, therefore they are at risk of being undertreated. Nurses therefore have a major responsibility to notice persons with dementia’s emotions and expressions. The aim of the study was to describe the nursing staff´s experiences of pain assessment for persons with dementia. The study was conducted as a general literature study. The search resulted in ten articles. They were reviewed and two categories were identified. The first category was Collaboration in a team with subcategories Trust and solidarity and Hierarchical flaws. The second category was Detective work with subcategories Interpret the patient’s clues and Time-consuming. The key findings were that pain assessment of persons with dementia needed to be based on non-verbal cues and it required a lot of time from the nursing staff.

Introduction The population of Sweden is getting older and therefore the estimated population of patients with dementia is likely to increase. This group of patients is particularly vulnerable in relation to pain assessment in palliative care because of the nature of dementia, which makes it harder for the patient to communicate verbally. Previous studies have shown that pain assessment of patients with dementia occurs with both observational pain assessment tools and observation but both of these approaches are associated with challenges. Palliative care of patients with dementia should be based on a person centered approach which enables healthcare professionals to see the patient and not the diagnosis. The aim The aim of this study was to describe approaches to pain assessment of patients with dementia in palliative care.   Method To answer the aim a general literature review was conducted where ten qualitative studies were included. These were reviewed qualitatively using a template for qualitative studies. The content was then analyzed with latent content analysis and Katie Eriksson’s nursing theory.  Results The results revealed that healthcare professionals used pain   assessment tools and getting to know the patient as a foundation for pain assessment. Furthermore, the healthcare professionals experienced difficulties using the pain assessment tools and tended on focus more on a person centered approach by observing the patients’ expressions, talking to family members and reading in the patients’ medical records to find information to interpret and identify pain signals Conclusion The healthcare professionals described that they used all resources available to get to know the patient focusing on person centered and holistic care. Obtaining a rich knowledge of the patient builds on continuity in care, healthcare professionals involving family members and using all of these resources together to create a good foundation for pain assessment. / Introduktion Sveriges befolkning blir allt äldre och därmed förväntas antalet patienter med demenssjukdom öka. Denna patientgrupp är särskilt utsatt i palliativ omvårdnad då demenssjukdom försvårar kommunikationen kring smärtbedömning. Tidigare forskning har visat att smärtbedömning hos patienter med demenssjukdom sker med observationsbaserade smärtskattningsinstrument och observation av patientens beteenden men att bedömningar av båda slag innebär utmaningar. Palliativ omvårdnad av patienter med demenssjukdom ska bygga på ett personcentrerat förhållningssätt vilket möjliggör för hälso- och sjukvårdspersonal att se människan och inte bara sjukdomen. Syfte Syftet var att beskriva tillvägagångssätt i smärtbedömningen av patienter som har demenssjukdom i palliativ omvårdnad.   Metod För att besvara syftet användes en litteraturöversikt där tio studier med kvalitativ design granskades. Kvalitetsgranskningen utgick från en kvalitetsgranskningsmall för bedömning av studier med kvalitativ metod. Innehållet analyserades med latent innehållsanalys och utifrån Katie Erikssons omvårdnadsteori. HuvudresultatResultaten visade att hälso- och sjukvårdspersonalen använde sig av smärtskattningsinstrument och att lära känna patienten som grund för smärtbedömning. Hälso- och sjukvårdspersonalen upplevde svårigheter att använda smärtskattningsinstrument och fokuserade därför på att arbeta personcentrerat genom att observera patientens beteenden, lyssna på anhöriga och läsa i journalen för att identifiera och tolka smärtsignaler.  Slutsats Hälso- och sjukvårdspersonalen beskrev att de använde många olika resurser för att göra en patientsäker smärtbedömning vilket gjorde att de arbetar personcentrerat och att de såg hela människan. En rik bild av patienten bygger på kontinuitet i vården, att hälso- och sjukvårdspersonalen involverar anhöriga och använder alla dessa resurser för att skapa en god grund för smärtbedömning.