Development of a Decision Support Computer Program for Pain Management in Institutionalized Patients with Dementia

노인요양시설에서의 치매환자 통증관리를 위한 컴퓨터 의사결정지원시스템 개발

  • Chang, Sung-Ok (College of Nursing, Korea University) ;
  • Lim, Se-Hyun (Department of Nursing, FAR EAST University) ;
  • Lee, Su-Jung (National Evidence-based Healthcare Collaborating Agency) ;
  • Kim, Mi-So (College of Nursing, Korea University)
  • Received : 2011.01.06
  • Accepted : 2011.02.19
  • Published : 2011.02.28

Abstract

Purpose: The purpose of this study was to develop a computer decision making support system that enables nurses to utilize the computer in selecting the best decision for pain management for patients with dementia institutionalized in nursing homes. Methods: To formulate the protocol for the management of patients' pain, the researcher analyzed content of interviews with 30 nurses in three nursing homes and an expert group. A decision support computer program was formalized based on existing protocols. To evaluate the effectiveness and applicability of the system, analysis of data on patient pain management and nurse satisfaction with the system were done after the formalized decision support computer program was complete. Results: The decision support computer program for pain management for institutionalized patients with dementia was finalized after adjustments following the evaluation. Nurse satisfaction with the program was moderate. It also provided opportunity to reassess thinking about pain and pain management. Conclusions: The results indicate that this program provides nurses with useful knowledge for pain management in institutionalized patients with dementia and aids in decision making in nursing practice in nursing home.

Keywords

References

  1. Abbey, J., Piller, N., De Bellis, A., Esterman, A., Parker, D., & Giles, L. (2004). The abbey pain scale: A 1-minute numerical indicator for people with end-stage dementia. International Journal of Palliative Nursing, 10(1), 6-13.
  2. Chang, S. O. (2007). Development and effect of pain management protocol for nursing home patients with dementia. Journal of Korean Academy of fundamentals of nursing, 14(1), 29-43.
  3. Chang, S. O., Oh, Y. J., Park, E. Y., Kim, G. M., & Kil, S. Y. (2010). Concept analysis of nurses' pain identification of demented patients in nursing home: Development of hybrid model. Pain Management Nursing, Manuscript submitted for publication.
  4. Cho, D. S. (1987). A perspective on the decision support system. Ewha Management Review, 5, 1-22.
  5. Epps, C. D. (2001). Recognizing pain in the institutionalized elder with dementia. Geriatric Nursing, 22(2), 71-77. https://doi.org/10.1067/mgn.2001.115199
  6. Ferrell, B. A., Ferrell, B. R., & Rivera, L. (1995). Pain in cognitively impaired nursing home residents. Journal of Pain Symptom Management, 10(8), 591-598. https://doi.org/10.1016/0885-3924(95)00121-2
  7. Gorry, G. A., & Scott-Morton, M. S. (1971). A framework for management information systems. Sloan Management Review, 13(1), 55-70.
  8. Horgas, A. L., & Elliott, A. F. (2004). Pain assessment and management in persons with dementia. Nursing Clinics of North America, 39(3), 593-606. https://doi.org/10.1016/j.cnur.2004.02.013
  9. Jang, W. S. (2002). A study on establishing strategic information system for The Office of President in Korea (The Blue House): with special reference to Decision Support System (DSS). Yonsei University, Seoul.
  10. Kim, D. J. (2003). Development of data warehouse based clinical decision support system for the diagnosis of diffusion pulmonary disease. Unpublished master's thesis, Yonsei University, Seoul.
  11. Kim, K. M. J., Kim, K. J., Cha, Y. N., Jang, H. S., Han, H. S., Jung, S. S., et al. (NANDA). (2006). NANDA Nursing Diagnoses, Goals and Interventions. Seoul: Hunmoonsa.
  12. Kovach, C. R., Noonan, P. E., Griffie, J., Sandy, M., & Weissman, D. E. (2001). Use of the assessment of discomfort in dementia protocol. Application Nursing Research, 14(4), 193-200. https://doi.org/10.1053/apnr.2001.26784
  13. Lee, S. J., & Chang, S. O. (2010). A study on the types of pain identification by nurses for nursing home patients with dementia. Journal of Korean Academy of Fundamentals of Nursing, 17, 508-519.
  14. Long Term Care Insurance. (2010). Current status of long-term care institute. Retrieved November 19, 2010, from http:// www.longtermcare.or.kr
  15. Manfredi, P. L., Breuer, B., & Meier, D. E. (2003). Pain assessment in elderly patients with severe dementia. Journal of Pain Symptom Management, 25(1), 48-52. https://doi.org/10.1016/S0885-3924(02)00530-4
  16. McCaffery, M., & Pasero, C. (1999). Pain: Clinical manual (2nd ed.). St Louis: Mosby.
  17. Molony, S. L., Kobayashi, M., Holleran, N., & Mezey, M. (2005). Assessing pain as a fifth vital sign in long-term care facilities: Recommendations from the field. Journal of Gerontological Nursing, 31, 16-24.
  18. Morrison, R. S., & Siu, A. (2000). A comparison of pain and its treatment in advanced dementia and cognitively intact patients with hip fractures. Journal of Pain Symptom Management, 19, 240-248. https://doi.org/10.1016/S0885-3924(00)00113-5
  19. National Health Insurance Corporation. (2007). Elderly Health and Welfare Policies. Retrieved February 19, 2011, from http://www.nhic.or.kr
  20. Scherder, E. J., Slaets, J., Deijen, J. B., Gorter, Y., Ooms, M. E., & Ribbe, M. (2003). Pain assessment in patients with possible vascular dementia. Psychiatry, 66(2), 133-145.
  21. World Health Organization. (1992). Mental Health: Dementia. Retrieved November 19, 2010, from http://www.who.int/en/