Bakgrund Antalet äldre ökar alltmer i världen och därmed även personer med demens. Det uppskattas att hälften av alla personer med demens lever med en smärta. Demenssjukdom medför svårigheter att kommunicera och förmedla smärta. Sjuksköterskorna får hitta andra sätt att bedöma smärta hos personer med demens vilket ofta innebär observationerav icke-verbala tecken på smärta. Syfte Syftet var att studera sjuksköterskors erfarenheter av att bedöma smärta hos personer med demens. Metod Studien var en strukturerad litteraturöversikt med inslag av den metodologi som används vid systematiska översikter. Resultat Resultatet innehöll huvudkategorin; sjuksköterskors erfarenheter av vad som underlättar respektive försvårar bedömning av smärta och underkategorierna; organisation, kommunikation, samverkan samt kunskap och erfarenhet. Sjuksköterskornas erfarenheter var att kommunikationssvårigheter, personalbrist, tidsbrist, kunskapsbrist, försvårar bedömningen av smärta hos patientgruppen. Kunskap, erfarenhet, fungerande kommunikation med andra professioner i vårdteamet och anhöriga underlättar bedömning av smärta för sjuksköterskor. Slutsats Sjuksköterskorna beskrev många hinder som försvårade bedömningen av smärta hos personer med demens och fann egna strategier som underlättade bedömningen. Sjuksköterskor använder sällan bedömningsinstrument och baserar bedömning av smärta på sin intuition. / Background The number of elderly is steadily increasing in the world and with that follows a great number of persons with dementia. It is estimated that around 50% of all persons with dementia suffers from pain. Dementia causes a cognitive impairment that leads to difficulties in communicating and conveying pain. The nurses have to find other ways to assess pain in persons with dementia which often involves observations of non-verbal signs of pain. Aim The Aim was to explore nurses experience of assessing pain in persons with dementia. Method The study was a structured literature review with elements of the methodology used in systematic reviews. Results The result included the main category; nurses' experiences of what facilitates and hinders the assessment of pain and the subcategories; organization, communication, collaboration, knowledge and professional experience. The nurses' experiences were that communication difficulties, lack of staff, time and knowledge make it difficult to assess pain. Knowledge,experience, effective communication with colleagues and relatives facilitates the assessment of pain for nurses. Conclusions The nurses described many obstacles that made it difficult to assess pain in people with dementia, they found their own strategies that facilitated the assessment of pain. Nurses rarely use pain scales, they use their intuition to assess pain.

Aim: The overall aim of the thesis was to explore and describe registered nurses’ (RNs) and certified nursing assistants’ (CNAs) experiences of detection and assessment of pain in older people with cognitive impairment and dementia. A further aim was to evaluate the Abbey Pain Scale-SWE (APS-SWE) in dementia care practice. Methods: An exploratory and descriptive design was used in Study I. An exploratory and interpreting design was used in Study II and Study III. A prospective, descriptive, observational and instrumental design was used in Study IV. Focus group interviews (I) and individual interviews (II, III) were applied to explore and describe RNs’ and CNAs’ experiences of pain assessment in people living with dementia. Qualitative content analysis (I) and philosophical hermeneutics (II) were used to analyse qualitative data. Observation, instrument, and questionnaire were applied to evaluate reliability and face validity of the APS-SWE for pain assessment. Descriptive statistics and reliability analyses were used to analyse quantitative data (IV). Results: RNs in special housing accommodation settings experiences that pain assessment in people with dementia is challenging primarily due to their changed RN consultant role, which to a great extent is directed into administrative and consultative tasks rather than bedside care. This has led to decreased time in daily nursing care, preventing recognising symptoms of pain. This have also led to that RNs are dependent on information from CNAs who are the front-line staff providing daily care (I). CNAs’ perception of signs of pain in people with dementia emerges from being present in the care situation and alertness on physical and behavioural changes that could be due to pain, and from providing the care in a preventive, protective and supportive way to prevent painful situations occurring (II). RNs and CNAs working in home healthcare team use a variety of strategies to detect and assess pain. A trustful work relationship based on staff continuity and a good relation to the person in need of care facilitates pain assessment situations (III). Systematic observation of older people living in special housing accommodation during rest and mobility using the APS-SWE demonstrates that the scale has adequate internal consistency, reliability, and face validity for pain assessment (IV). Conclusions: This thesis found that the RNs’ and CNAs’ detections and assessments of pain rely on solid cooperation, staff continuity, and good knowledge of the person cared for. It was also revealed that there is a lack of using appropriate and assisting pain tools. The APS-SWE show adequate reliability and face validity and can serve as a useful pain tool to assist in detection and assessment of pain in older people who are limited in verbalising pain recognisable. Further evaluation of how the person-centred perspective is applied in pain assessment situations is needed in order to evaluate positive outcomes in people with dementia. Further psychometric evaluation of the APS-SWE in clinical dementia care practice is needed to strengthen validity and reliability.

Bakgrund: Smärta är en personligt upplevd förnimmelse som finns för att signalera att något i kroppen är fel. I de fall då smärtan inte pågått i mer än 3–6 månader klassas den som akut. Sjuksköterskor har till uppgift att identifiera smärta hos patienten och för att underlätta detta har det utvecklats smärtskattningsskalor. Syfte: Syftet med studien var att beskriva sjuksköterskors erfarenhet av faktorer som kan påverka användning av smärtskattningsskalor vid akut smärta hos patienter på sjukhus. Metod: En allmän litteraturstudie utifrån Polit och Becks niostegsprincip med nio kvalitativa och tre kvantitativa artiklar. Resultat: Sjuksköterskor anser att det råder kunskapsluckor gällande smärtskattningsskalor. De menar också att tidsbristen och andra organisatoriska aspekter hindrar dem från att smärtskatta utifrån skalor. Likaså är bristande kommunikation mellan patienter och sjuksköterskor en anledning som försvårar identifieringen av smärtan med hjälp av smärtskattningsskalor. Slutsats: Sjuksköterskors erfarenheter av smärtskattning utifrån smärtskattningsskalor utgår från utbildningsnivå, arbetsplatsens smärtskattningsrutiner och sjuksköterskors arbetsbörda. Förslag på fortsatt forskning: Det behövs utvärderas fler strategier och rutiner på hur smärtskattningsskalor kan användas, samt fler skalor anpassade till olika patientgrupper.

Bakgrund: Smärta är ett vanligt symtom hos palliativa patienter medcancersjukdom. En del patienter är inte fullt smärtlindrande och detta kan skapa ettonödigt lidande för patienterna som försämrar deras livskvalité.Syfte: Syftet är att belysa kunskapsläget om hur sjuksköterskor utvärderarsmärtsymtom hos palliativa patienter med cancersjukdomMetod: En litteraturstudie med 16 artiklar av både kvalitativ och kvantitativmetod valdes ut från databaserna Cinahl och Pubmed.Resultat: Sammanställningen av artiklarna resulterade i fyra stycken olika teman.Dessa är bedömningsinstrument, att utvärdera med eller utanbedömningsinstrument, sjuksköterskans utvärderande arbete, utvärdering medolika instrument.Slutsats: Genom att använda smärtbedömningsinstrument kan sjuksköterskansarbete att utvärdera smärtsymtom underlättas och smärtsymtom för patientenminskas. Genom en planerad implementering av dessa bedömningsinstrument meden kompletterande utbildning kan sjuksköterskan få bättre kunskap ombedömningsinstrument vilket kan leda till bättre förståelse och förutsättningar förpalliativa patienternas behov av smärtutvärdering. Detta kan leda till förbättradupplevd livskvalité hos de palliativa patienterna med cancersjukdom. / Background: Pain is a common symptom in palliative cancer patients. Somepatients are not fully relieved of pain which can create unnecessary suffering forthe patients.Aim: The purpose is to describe how nurses evaluate pain symptoms in palliativepatients with cancer.Methods: A literature study with 16 articles consisting of both qualitative andquantitative methods from two databases, Cinahl and Pubmed.Results: The compilation of the articles resulted in four different themes. Theseare pain assessment instruements, to evaluate with or without pain assessmentinstruments, the nurse's evaluation work, and comparison of different instruments.Conclusions: By using pain assessment tools, the nurse's work to evaluate painsymptoms can be facilitated and pain symptoms for the patient reduced. Through aplanned implementation of these assessment instruments with a supplementaryeducation, the nurse can gain better knowledge of the assessment instrument canlead to a better understanding and conditions for palliative patients' needs for painevaluation. This can lead to improved perceived quality of life in the palliativepatients with cancer.

Aim: The overall aim of the thesis was to explore and describe registered nurses’ (RNs) and certified nursing assistants’ (CNAs) experiences of detection and assessment of pain in older people with cognitive impairment and dementia. A further aim was to evaluate the Abbey Pain Scale-SWE (APS-SWE) in dementia care practice. Methods: An exploratory and descriptive design was used in Study I. An exploratory and interpreting design was used in Study II and Study III. A prospective, descriptive, observational and instrumental design was used in Study IV. Focus group interviews (I) and individual interviews (II, III) were applied to explore and describe RNs’ and CNAs’ experiences of pain assessment in people living with dementia. Qualitative content analysis (I) and philosophical hermeneutics (II) were used to analyse qualitative data. Observation, instrument, and questionnaire were applied to evaluate reliability and face validity of the APS-SWE for pain assessment. Descriptive statistics and reliability analyses were used to analyse quantitative data (IV). Results: RNs in special housing accommodation settings experiences that pain assessment in people with dementia is challenging primarily due to their changed RN consultant role, which to a great extent is directed into administrative and consultative tasks rather than bedside care. This has led to decreased time in daily nursing care, preventing recognising symptoms of pain. This have also led to that RNs are dependent on information from CNAs who are the front-line staff providing daily care (I). CNAs’ perception of signs of pain in people with dementia emerges from being present in the care situation and alertness on physical and behavioural changes that could be due to pain, and from providing the care in a preventive, protective and supportive way to prevent painful situations occurring (II). RNs and CNAs working in home healthcare team use a variety of strategies to detect and assess pain. A trustful work relationship based on staff continuity and a good relation to the person in need of care facilitates pain assessment situations (III). Systematic observation of older people living in special housing accommodation during rest and mobility using the APS-SWE demonstrates that the scale has adequate internal consistency, reliability, and face validity for pain assessment (IV). Conclusions: This thesis found that the RNs’ and CNAs’ detections and assessments of pain rely on solid cooperation, staff continuity, and good knowledge of the person cared for. It was also revealed that there is a lack of using appropriate and assisting pain tools. The APS-SWE show adequate reliability and face validity and can serve as a useful pain tool to assist in detection and assessment of pain in older people who are limited in verbalising pain recognisable. Further evaluation of how the person-centred perspective is applied in pain assessment situations is needed in order to evaluate positive outcomes in people with dementia. Further psychometric evaluation of the APS-SWE in clinical dementia care practice is needed to strengthen validity and reliability. / <p>Study IV</p><p>Karlsson C, Ernsth Bravell M, Ek K, Johansson L &amp; Bergh I (2014): Reliability and face validity of the Abbey Pain Scale-SWE in Swedish dementia care practice. Submitted June, 2015.</p>