Date of Conferral



Doctor of Nursing Practice (DNP)




Deborah Lewis


Assessment of pain in patients with a diagnosis of dementia or cognitive impairment continues to be underdiagnosed as there are no objective ways of assessing their pain. Available evidence also indicates that these patients are not receiving satisfactory pain management. Due to a lack of self-reporting of pain, accurate assessments of pain are challenging. This systemic review aimed to find a pain assessment strategy effective in identifying pain in patients with a diagnosis of dementia. Kolcaba's theory of comfort was used as the theoretical framework for the study. The databases of Medline, Cochrane Database of Systematic Reviews, Embase, and Cumulative Index to Nursing and Allied Health Literature (CINHAL) Plus for data concerning pain assessment strategies for cognitively impaired patients published in the last 7 years were searched. Each article was assessed accurately, and data were obtained and analyzed. Four hundred twenty-two reviews were retrieved, of which 8 met the criteria for inclusion. SQUIRE 2.0 was used for the appraisal of the included literature. The literature qualified for the inclusion criteria was then analyzed for the level of hierarchy and grading of evidence according to the Fineout-Overholt, Melnyk Stillwell, and Williamson system. Based on the available evidence, no one pain assessment tool can be recommended. Instead, involving the interdisciplinary healthcare team, family, and caregiver/s along with the observational pain assessment tool can be effective in assessing pain for a patient with cognitive impairment. This project impacts social change by providing a pain assessment strategy for patients with a cognitive impairment.

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