Challenging behavior and pain in dementia. Experiences of nursing staff in an acute care hospital

BackgroundPeople with dementia are receiving treatment in acute care hospitals at increasing rates. Most prominently, patients exhibiting behavioral and psychological symptoms of dementia (BPSD) are perceived as significant burdens for staff members. Non-detected pain is seen as one substantial reason for behavior that is seemingly unexplainable. In order to gather information about dealing with BPSD asurvey was performed. The objective of this study was to enable a more cause-oriented treatment.MethodsThe procedure consisted of an anonymous survey of nurses, by semi-structured interviews with open and closed questions about BPSD: type, frequency, perceived burden, therapeutic countermeasures including pain recognition.ResultsA total of 46 nurses from 3 wards (internal, geriatric, surgery) were interviewed. 1.Nurses reported being heavily burdened by patients with BPSD. 2.A structured identification of possible causes as part of an established treatment process was not observed. 3.Offering to talk with the patient in order to identify possible causes for BPSD was seen as the first step in the right direction but is inhibited by the limitations of people with severe dementia. 4.Pain as one important cause for BPSD was known by the staff but was often measured by inadequate instruments. 5.Positioning and mobilization were the most commonly used attempts at treatment.ConclusionNurses are especially affected in their daily work by patients with BPSD. Clarifying the cause may play acrucial role in treating BPSD.