Evaluating and Ranking the Factors Affecting the Acute Pain Management in Older Adults with Dementia after Hip Fracture Surgery: Second Order Confirmatory Factor Analysis

Farzaneh Didvar, Fatemeh Ghaffari, Abbas Shamsalinia

Abstract


Background: Even though nurses take various measures to decrease acute pain after surgery in older adults with dementia, it is unclear why most of them suffer from severe pain. This study aimed to evaluate the factors affecting acute pain management in older adults with dementia after hip fracture surgery.

Materials and Methods: This cross‑sectional study used single‑stage cluster and convenience sampling to select 330 nurses working in hospitals located in Western Mazandaran, Iran, in 2020. The demographic characteristic questionnaire and the Obstacles to Postoperative Pain Management in Dementia Scale (OPOPMDS) were used to collect data.

Results: The study results confirmed the modified model. The second‑order Confirmatory Factor Analysis (CFA) indicated that the Critical Ratio (CR) for all three factors was more than 1.96, and the significance level was considered 0.05. Based on the values of standard coefficients, older people‑related (β = 0.86, p < 0.001), system‑related (β = 0.70, p < 0.001), and healthcare provider‑related (β = 0.61, p < 0.001) factors had the highest impacts on the OPOPMD.

Conclusions: The study results suggested that older adult‑related factors had the most significant impact on the OPOPMD.

 


Keywords


: Acute pain, aged, critical care nursing, dementia, disease management, hip fracture nurse, pain, perspective, postoperative

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References


Ioannidis I, Ismail AM, Forssten MP, Ahl R, Cao Y, Borg T, et al. The mortality burden in patients with hip fractures and dementia. Eur J Trauma Emerg Surg 2021;27:1 7.

Jeon JH, Park JH, Oh C, Chung JK, Song JY, Kim S, et al. Dementia is associated with an increased risk of hip fractures: A nationwide analysis in Korea. J Clin Neurol 2019;15:243 9.

Scurrah A, Shiner CT, Stevens JA, Faux SG. Regional nerve blockade for early analgesic management of elderly patients with hip fracture–A narrative review. Anaesthesia 2018;73:769 83.

Abou Setta AM, Beaupre LA, Rashiq S, Dryden DM, Hamm MP, Sadowski CA, et al. Comparative effectiveness of pain management interventions for hip fracture: A systematic review. Ann Intern Med 2011;155:234 45.

Pourabbas B, Emami MJ, Vosoughi AR, Mahdaviazad H, Kargarshouroki Z. Mortality and function after surgically treated hip fracture in adults younger than age 60. Acta Ortop Bras

;25:129 31.

Kheiri S, Akbari Aghdam H, Motififard M, Gharib Gashteh Shahi N, Saleki Mehrjardi M, Rezaei T. The effect of skin traction on pain relief in patients with isolated intertrochanteric fractures, a randomized clinical trial. BMC Musculoskelet Disord 2023;24:1 3.

Yoo JI, Lee YK, Koo KH, Park YJ, Ha YC. Concerns for older adult patients with acute hip fracture. Yonsei Med J 2018;59:1240 4.

Wylde V, Hewlett S, Learmonth ID, Dieppe P. Persistent pain after joint replacement: Prevalence, sensory qualities, and postoperative determinants. Pain 2011;152:566 72.

Ruel M, Boussat B, Boudissa M, Garnier V, Bioteau C, Tonetti J, et al. Management of preoperative pain in elderly patients with moderate to severe cognitive deficits and hip fracture: A retrospective, monocentric study in an orthogeriatric unit. BMC Geriatr 2021;21:1 9.

Graff V, Grosh T. Multimodal analgesia and alternatives to opioids for postoperative analgesia. ApsfNewsletter 2018;33:46 7.

Cohen M, Quintner J, van Rysewyk S. Reconsidering the International Association for the study of pain definition of pain. Pain Rep 2018;3:e634.

Gan TJ. Poorly controlled postoperative pain: Prevalence, consequences, and prevention. J Pain Res 2017;10:2287-98.

Erlenwein J, Müller M, Falla D, Przemeck M, Pfingsten M, Budde S, et al. Clinical relevance of persistent postoperative pain after total hip replacement–A prospective observational cohort study. J Pain Res 2017;10:2183 93.

Benditz A, Drescher J, Greimel F, Zeman F, Grifka J, Meißner W, et al. Implementing a benchmarking and feedback concept decreases postoperative pain after total knee arthroplasty: A prospective study including 256 patients. Sci Rep 2016;6:38218.

Zhang J, Yang M, Zhang X, He J, Wen L, Wang X, et al. The effectiveness of a co management care model on older hip fracture patients in China–A multicentre non randomised controlled study. Lancet Reg Health West Pac 2022;19:100348.

Denness KJ, Carr EC, Seneviratne C, Rae JM. Factors influencing orthopedic nurses’ pain management: A focused ethnography. Can J Pain 2017;1:226 36.

Pierre D, Mustafa G, Ngoc L. Nurses’ Responsibilities in Postoperative Pain Management Following Total Hip Arthroplasty, Bachelor’s thesis, JAMK University of Applied Sciences, Jyväskylä, Finland, 2017. Available from: https:// www.theseus.fi/bitstream/handle/10024/131818/Dumolard_Pierre. PDF?sequence=1 and isAllowed=y. [Last accessed 2023 Apr 01].

Rantala M, Kankkunen P, Kvist T, Hartikainen S. Barriers to postoperative pain management in hip fracture patients with dementia as evaluated by nursing staff. Pain Manag Nurs 2014;15:208 19.

Didvar F, Ghaffari F, Shamsalinia A. Development and psychometric assessment of barriers to postoperative pain management in dementia scale: A mixed methods exploratory study. Nurs Midwifery Stud 2022;11:253 60.

Rantala M. Nurses’ evaluations of postoperative pain management in patients with dementia. Publications of the University of Eastern Finland. Diss Health Sci 2014;30:48-62. Available from: http://urn.fi/URN: ISBN:978-952-61-14484. [Last accessed on 2023 Apr 10].

Xiao P, Zhou Y. Factors associated with the burden of family caregivers of elderly patients with femoral neck fracture: A cross sectional study. J Orthop Surg Res 2020;15:1 7.

Brennan F, Lohman D, Gwyther L. Access to pain management as a human right. Ajph 2019;109:61 5.

Moschinski K, Kuske S, Andrich S, Stephan A, Gnass I, Sirsch E, et al. Drug based pain management for people with dementia after hip or pelvic fractures: A systematic review. BMC Geriatr 2017;17:1 15.

Rantala M, Kankkunen P, Kvist T, Hartikainen S. Post operative pain management practices in patients with dementia the current situation in Finland. Open Nurs J 2012;6:71 81.

Lichtner V, Dowding D, Allcock N, Keady J, Sampson EL, Briggs M, et al. The assessment and management of pain in patients with dementia in hospital settings: A multi case exploratory study from a decision making perspective. BMC Health Serv Res 2016;16:427.

Hosseini MA, Mehri S, Fallahi Khoshknab M, Mohammadi Shahbelaghi F, Akbari Zardkhaneh S. The status of ageism in caring for elderly patients from nurses’ perspective. JCCNC 2020;6:289 96.

Ayaz NP, Sherman DW. Understanding attitudes, social norms, and behaviors of a cohort of post operative nurses related to pain and pain management. InHealthcare 2022;10:1 12.

Meissner W, Coluzzi F, Fletcher D, Huygen F, Morlion B, Neugebauer E, et al. Improving the management of post operative acute pain: Priorities for change. Curr Med Res Opin 2015;31:2131 43.

Dehnoalian A, Mohammadpour A. Barriers to pain management: Comparing the viewpoints between physicians and nurses. Anesth Pain 2014;4:49 56.

Fitzgerald S, Tripp H, Halksworth Smith G. Assessment and management of acute pain in older people: Barriers and facilitators to nursing practice. AJAN 2017;35:48 57.

Mędrzycka Dąbrowska WA, Dąbrowski S, Basiński A, Pilch D. Perception of barriers to postoperative pain management in elderly patients in Polish hospitals with and without a “Hospital Without Pain” Certificate–A multi center study. Arch Med Sci 2016;12:808 18


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