Abstract
Significant contact between nursing staff and nursing home residents with dementia occurs during assistance with activities of daily living during morning care; however, the content and process of morning care have received little attention in the scientific literature. To better understand the morning care process and its role in generation of pain symptoms, 51 videotaped episodes of morning care involving 17 nursing home residents from 3 long-term care facilities were coded and analyzed; each resident had a diagnosis of dementia and concern about possible pain during assistance with activities of daily living. The typical morning care episode involved performance of multiple activities of daily living during a short period of time, during which pain stimulation and expression occurred frequently. Much could be done to make morning care more an activity to be enjoyed rather than a task to be completed.
Keywords: pain, activities of daily living, morning care
Full Text
The Full Text of this article is available as a PDF (67.3 KB).
Contributor Information
Philip D. Sloane, Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina, psloane@med.unc.edu, Department of Family Medicine, University of North Carolina, Chapel Hill, psloane@med.unc.edu .
Lois L. Miller, School of Nursing, Oregon Health & Science University, Portland, Oregon.
C. Madeline Mitchell, Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina.
Joanne Rader, School of Nursing, Oregon Health & Science University, Portland, Oregon.
Kristen Swafford, School of Nursing, Oregon Health & Science University, Portland, Oregon.
Shirin O. Hiatt, School of Nursing, Oregon Health & Science University, Portland, Oregon.
References
- Talerico KA, Evans LK Making sense of aggressive/ protective behaviors in persons with dementia . Alzheimer's Care Quarterly. 2000;1:77-88. [Google Scholar]
- Liukkonen A. The content of nurses' oral shift reports in homes for elderly people. J Adv Nurs. 1993. ;18:1095-1100. [DOI] [PubMed] [Google Scholar]
- Rogers JC, Holm MB, Burgio LD, et al. Improving morning care routines of nursing home residents with dementia. J Am Geriatr Soc. 1999;47:1049-1057. [DOI] [PubMed] [Google Scholar]
- Wells DL, Dawson P., Sidani S., Craig D., Pringle D. Effects of an abilities-focused program of morning care on residents who have dementia and on caregivers. J Am Geriatr Soc. 2000;48:442-449. [DOI] [PubMed] [Google Scholar]
- Kihlgren M., Kuremyr D., Norberg A., et al. Nurse-patient interaction after training in integrity promoting care at a long-term ward: analysis of video-recorded morning care sessions . Int J Nurs Stud. 1993;30:1-13. [DOI] [PubMed] [Google Scholar]
- Feldt KS The Checklist of Nonverbal Pain Indicators (CNPI). Pain Manag Nurs. 2000;1:13-21. [DOI] [PubMed] [Google Scholar]
- Mentes JC, Teer J., Cadogan MP The pain experience of cognitively impaired nursing home residents: perceptions of family members and certified nursing assistants. Pain Manag Nurs. 2004;5:118-125. [DOI] [PubMed] [Google Scholar]
- Miller LL, Talerico KA, Rader J., et al. Development of an intervention to reduce pain in older adults with dementia: challenges and lessons learned. Alzheimer's Care Quarterly. 2005;6:154-167. [Google Scholar]
- Morris JN, Hawes C., Fries BE, et al. Designing the national resident assessment instrument for nursing homes. Gerontologist. 1990;30:293-307. [DOI] [PubMed] [Google Scholar]
- Sloane PD, Hoeffer B., Mitchell CM, et al. Effect of person-centered showering and the towel bath on bathing-associated aggression, agitation and discomfort in patients with dementia: a randomized clinical trial. J Am Geriatr Soc. 2004;52:1795-1804. [DOI] [PubMed] [Google Scholar]
- Albert M., Cohen C. The Test for Severe Impairment: an instrument for the assessment of patients with severe cognitive dysfunction. J Am Geriatr Soc. 1992;40:449-453. [DOI] [PubMed] [Google Scholar]
- Morris JN, Fries BE, Morris SA Scaling ADLs within the MDS. J Gerontol A Biol Sci Med Sci. 1999;54:M546-M553. [DOI] [PubMed] [Google Scholar]
- Talerico KA, Miller LL Development of the Pain and Caregiving Tool (PACT): An Observational Measure of Care Recipients and Their Caregivers. Portland, OR: Oregon Health & Science University, School of Nursing; 2003. [Google Scholar]
- The Observer System for Collection and Analysis of Observational Data [computer program]. Version 5.0. Wageningen, Netherlands: Noldus Inc; 2003. [Google Scholar]
- Sherder E., Oosterman J., Swaab D., et al. Recent developments in pain in dementia. BMJ. 2005;330:461-464. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Huffman JC, Kunik ME Assessment and understanding of pain in patients with dementia. Gerontologist. 2000;40: 574-581. [DOI] [PubMed] [Google Scholar]
- Herr K., Bjoro K., Decker S. Tools for assessment of pain in nonverbal older adults with dementia: a state-of-the-science review. J Pain Symptom Manage. 2006;31:170-192. [DOI] [PubMed] [Google Scholar]
- Talerico K. , Miller L., Swafford K., Rader J., Sloane P., Hiatt S. Psychosocial approaches to prevent and minimize pain in people with dementia during morning care. Alzheimer's Care Quarterly. 2006; 7:163-174. [Google Scholar]
- Rader J, Tornquist EM, eds. Individualized Dementia Care: Creative, Compassionate Approaches. New York, NY: Springer; 1995. [Google Scholar]
- Barton EM, Baltes MM, Orzech MJ Etiology of dependence in older nursing home residents during morning care: the role of staff behavior. J Pers Soc Psychol. 1980;38:423-431. [DOI] [PubMed] [Google Scholar]
- Rogers JC, Holm MB, Burgio LD, Hsu C., Hardin JM, McDowell BJ Excess disability during morning care in nursing home residents with dementia . Int Psychogeriatr. 2000;12:267-282. [DOI] [PubMed] [Google Scholar]
- Bliwise DL, Bevier WC, Bliwise NG, Edgar DM, Dement WC Systematic 24-hr behavioral observations of sleep and wakefulness in a skilled-care nursing facility. Psychol Aging. 1990;5:16-24. [DOI] [PubMed] [Google Scholar]