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Nursing is a medical field that puts individuals in charge of patients in a medical setting. Through ethics of health care and ethics of justice, relation between the nursing personnel and patients is governed by policies and ethical personal choices. As technology grows in the medical settings, the equipment that can measure, weigh or efficiently predict patients’ emotions has not been discovered yet (Hølen, 2010). This factor introduces the nursing fraternity to the challenge of tense relations when the levels of emotional drifts cannot be directly measured or precisely predicted. Since dementia affects the functionality of the brain, nurses use the Mini Mental Status Examination (MMSE) to predict the proficiency and ability of a patient to respond to the issues related to memory.

The number of adult people suffering from dementia in the USA and across the world has been increasing over the last 2 decades at a rate of 2.1% for every half a decade (Folstein, 2008). People suffering from dementia can be related or classified in the same category as patients suffering from mental disorders. Within the care setting, patients suffering from dementia are likely to develop chronic brain inflammatory conditions (Zwakhalen, 2007). This develops into pain that requires measuring in order to give nurses ideas of how a patient is responding to treatment and interventions. However, with the fact that dementia in adults can develop from the age of 30, acute conditions develop and are diagnosed at ages higher than 50, and they require reporting. For patients who can understand their environs and can document their levels of pain, self-reporting method is used by nurses to document the level of pain in patients. However, in extreme cases where patients cannot self-report, tools for assessing pain are adapted. In this essay, the pain assessment tools are adapted to document how contemporary nursing can adapt and merge them in an elderly care setting.

With regards to pain assessment tools and the skills required to relate and maintain ethics of care and health care justice within the care setting, Abbey Tool of Pain Assessment and Doloplus-2 Tool of Pain Assessment are used in an elaborative manner to document nursing practice. The Abbey pain assessment scale identifies physical as well as emotional deviations of a patient. The scale provides spaces for marking where nurses can indicate the level of pain depending on the effects and witnessed behaviors (Abbey, 2007). Cognitively impaired patients cannot express their levels of pain by self-reporting. Therefore, there is the need to use the Dololpus-2 assessment tool. The tool is used as an indicator of pain in terms of somatic, psychomotor and psychosocial characteristics as indicators of pain. The application of the pain assessment tools in this essay have is an effort to incorporate ethics of health care and health care justice in the practical elderly setting. The purpose of picking dementia in an acute setting is as a base condition for this essay to display the responsibility and expertise required for a nurse to handle cases in a logical, ethical and justified manner.

Pain Assessment in Acute Dementia Cases

Pain assessment takes a rather longer period to establish in acute cases than in moderate ones. This is true, because nurses have to use personal experience to assess the body language of a patient in order to estimate his/her levels of pain. Manual assessment of pain through the judgment of facial expressions is an applicable stage of identifying pain in a patient. However, this method proves unreliable for cases with arthritis, because a nurse cannot distinguish pain caused by dementia and that caused by the inflammatory effects of arthritis. Recording of a patient’s behavior through their physical screens does very little, especially where verbalizations and vocalizations are assumed reliable. A patient minding his business will make noises that may resemble sounds caused by pain while, at the same time, another case might involve different sounds that do not resemble pain though the patient might be in deep pain. Regarding these inconsistencies, nurses use main pain assessment tools, namely Abbey tool and Doloplus-2.

Abbey Tool of Pain Assessment

“Self-reporting of pain cannot be relied on when it comes to dementia patients diagnosed with arthritis in an acute setting as their level of recognition, processing, remembering, and determination of their wellbeing fails to register in their minds therefore the need for Abbey tool of pain assessment”. The Abbey pain assessment scale identifies physical as well as emotional deviations of a patient. The scale provides spaces for marking where nurses can indicate the level of pain depending on the effects and witnessed behaviors. Vocalization is taken into account for this tool in cases where a nurse is supposed to identify whether a patient is whimpering, groaning or crying. The three vocalization entries are indicated with numerical values where whimpering is considered mild pain and crying as the severe level of pain. Facial expressions are the second assessment considerations that nurses apply when using the Abbey tool. Assessment of facial expression assesses how tense the patient looks, whether he/she is frowning or appears frightened. Body language is an entry that nurses have to assess in accordance to the patient’s movement in terms of fidgeting, guarding some parts of the body or looking withdrawn. Each case has three assessment entries that are supposed to be marked on the Abbey scale. This helps the nurse to distinguish different aspects of the patient, especially body language and behavioral changes that may be inconsistent and opposing each other. Physiological changes are like temperature, blood pressure or pulse outside normal limits, and perspiring and flashing of the skin are assessed and marked accordingly with their respective indication numerical. Scores of the 6 entry levels of the Abbey scale are added where zero to two, three to seven, eight to thirteen, and above fourteen indicate no pain, mild pain, moderate pain and severe pain respectively.

Doloplus-2 Tool of Pain Assessment

Cognitively impaired patients cannot express their levels of pain by self-reporting. Therefore there is the need to use the Dololpus-2 assessment tool (Perneczky, 2007). The tool is used as an indicator of pain in terms of somatic, psychomotor and psychosocial characteristics as indicators of pain. The division of human behavior into three parts helps nurses to indicate specific areas targeted by pain and the effect they cause to a patient. Somatic reactions are divided into five distinct parts of somatic complains, protective body postures, protection of sore areas, expressions and sleep patterns. These divisions of somatic reaction are subdivided into levels that require numerical indication where normal, unusual, difficult and acute levels are marked for a tally to assess the margin of pain.

Psychomotor reactions are divided into washing and/or dressing, and the ability to move along. Mobility of a patient is assessed through how easy, difficult, or impossible for one it is to walk, move or change sleeping positions. Patients who cannot wash or even dress by themselves are classified as acute cases, while those who can move with some difficulty are classified as moderate to mild cases (Nicholson, 2008). Dressing and washing portrays mixed results, especially where a patient is able to wash but cannot put on his/her clothes properly as compared to cases where a patient is unable to do either - a nurse in this care setting is required to be very observant and well-informed on what every type of movement indicates.

Psychosocial reactions involve the manner in which patients relate with their nurses, family members and care providers in either clinical setting or specialized domestic setting. The psychosocial reactions are divided into communication, social life and problem of behavior on the Doloplus-2 scale (Leong, Chong & Gibson, 2009). With communication, nurses have unchanged, heightened, lessened, and refused to communicate with a patient. Social life encompasses normal daily activities of eating, entertainment and therapy workshops in the clinical setting. Partial, full or no participation at all is the indicator nurses use to assess pain in cases of dementia. The Doloplus-2 assessment tool requires further testing of a patient regarding the psychosocial aspects that differ with time from patient to patient.

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