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You will now choose a guiding conceptual framework for your research paper. Provide details about the theorist and framework including its history. Add this to your “working manuscript” and submit the entire document in Canvas. Include appropriate APA formatted references.
This portion of the paper needs to be 1-2 pages in length.
Additional Resource for finding a theory or framework: http://nursing-theory.org/theories-and-models/Links to an external site.
Example (this example was prepared for another research course; however, I think it may provide some clarity on the expectations of developing a conceptual framework and will also help you to understand what is meant by conceptual and operational definitions. Please be sure you adhere to the rubric for THIS assignment (see below) when writing your paper.) Assignment 3 Exemplar.docxDownload Assignment 3 Exemplar.docx
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Assignment Rubric:
Includes appropriate conceptual and operational definitions of variables.20%Identifies a theory or framework congruent with the research purpose.10%Identifies the relationships among variables.20%Includes a diagram or visual representation of the model (may be obtained from outside sources or original; must place in the paper and cite according to APA formatting).20%Explains how the theory will guide the research project.20%APA Formatting10%Total100%
Improving Pain Management Among Elderly Patients with Dementia
According to the World Health Organization (2019), approximately 50 million people have dementia and there are around 10 million new cases diagnosed each year. Of patients with dementia, the majority are elderly. A study on the prevalence of pain by Duncan et al. (2011) found that pain disproportionately affects the elderly population. A number of studies have been performed to evaluate pain management among elderly patients with dementia. According to Gilmore-Bykovskyi and Bowers (2013), there is a high rate of uncertainty among nurses treating elderly patients with dementia for pain. They determined that education and utilization of evidence-based pain assessments, nursing education, and the use of non-pharmacologic strategies must be improved. Gilmore-Bykovskyi and Bowers introduced their Response to Certainty of Pain (RCP) model as a method of conceptualizing nurses’ decision making and pain assessment and level . Rababa (2018) notes that this RCP model is the only model to consider both nursing perspective and decision-making and pain assessment. Although research has been conducted to determine appropriate ways to both assess and treat pain in elderly patients with dementia, there is a gap in the literature for evidence-based methods that integrate healthcare decision making, subjective assessments, and objectified pain assessments. In order to improve pain control and quality of life among patients with dementia, further research into existing models and perhaps modification, if needed, should be done. The purpose of this study is to determine if implementation of the RCP model within a nursing home will increase nurses’ expressed certainty in pain management decision-making.
Literature Review
(In this section you should discuss the focus/purpose of the review, describe how you will organize your sources and why you will organize them that way)
A literature review was conducted in order to determine the existing literature and identify potential gaps in the literature on pain management for elderly patients with dementia. A comprehensive list of studies from the review was compiled using PubMed, Google Scholar, and CINAHL. Publication dates for the search were limited to the past 5 years with a focus on peer-reviewed journals. Key search terms included pain management AND dementia, pain management AND elderly, and pain management AND nursing home. “Pain management AND dementia” yielded 8,678 results in PubMed, 35,900 results in Google Scholar, and 54 results in CINAHL. “Pain management AND elderly” yielded 77,117 results in PubMed, 97,400 results in Google Scholar, and 160 results in CINAHL. “Pain management AND nursing home” yielded 11,147 results in PubMed, 78,600 results in Google Scholar, and 123 results in CINAHL. Relevant studies were thoroughly read and critically appraised. The retained studies were grouped based on the search terminology used to locate them. Critical findings from the articles are included in an evidence table (Appendix).
Pain Management AND Dementia
Pain management and dementia were the two primary concepts under consideration for this project. The majority of reviewed studies sought to gain insight from nurses or define relationships related to the management of pain for patients with dementia. Very few articles actually applied any type of tool, scale, or intervention to assess pain in this vulnerable population. Studies like those of Lichtner et al. (2016) and Husebo, Achterberg, and Flo (2016) determined the need for improved strategies to assess pain among patients with dementia. Some of the concepts central to the need for improved pain management included uncertainty of pain, difficulty performing assessments in patients with limited communication ability, and fear among nurses related to over-medication or addiction associated with the use of analgesics. Of those studies that did offer strategies to improve pain management among those with dementia was a qualitative article by Rababa (2018) on the tools currently available to assess pain among patients with dementia. Rababa (2018) noted that the only tool to take into account uncertainty on the part of the nurse and assessment type was the Response to Certainty of Pain model. This model, initially introduced by Gilmore-Bykovskyi and Bowers (2014), offers a trajectory to manage pain when the assessment leads to either certainty on the part of the nurse, or uncertainty.
Pain Management AND Elderly
In this section I would discuss the articles I found with these search terms.
Pain Management AND Nursing Home
In this section I would discuss the articles I found with these search terms.
Summary of Findings
(In this section you should include a concise summary of your findings, a judgement stating whether there is adequate knowledge about the topic, and a brief statement of proposed change based on your findings)
Conceptual and Operational Definitions
In order to clarify the meaning of specific terminology used in this manuscript, conceptual and operational definitions of variables will be provided. The first variable pertinent to this study is the Response to Certainty of Pain (RCP) model. The conceptual definition of this model is that there are two possible trajectories associated with pain assessments completed by nurses, certain and uncertain (Gilmore-Bykovskyi & Bowers, 2013). While certainty of pain typically leads to prompt treatment, uncertainty of pain can lead to delays in or inadequate treatment of pain.
In order to assess certainty of pain in this project, conceptual definitions introduced by Gilmore-Bykovskyi and Bowers (2013) will be used. The authors define certainty and uncertainty of pain as the degree to which a nurse is able to assess that pain is present. Building on that concept is the concept of pain indicators, which may include visual and auditory indications of pain such as grimacing, moaning, jaw clinching, verbal complaints, and changes in behavior. Pain management decision-making is operationally defined as the nurses’ decision, based on assessment of the patient, whether or not to treat the patient with pharmacologic and/or non-pharmacologic treatments. In order to complete this project, nurses will be provided education about the RCP and provided a decision-making algorithm based on the RCP model. This algorithm will be introduced and described and operationally defined in the methods section of the manuscript.
Conceptual Framework
The conceptual framework chosen for this project is Kolcaba’s Theory of Comfort. Kolcaba’s Theory of Comfort is a middle-range nursing theory that classifies comfort according to three overarching themes, which include relief, ease, and transcendence (Kolcaba, 2003). These themes are central to the purpose of this research, which is to assess nurses’ decision-making in regard to pain management. Kolcaba defines relief as, “the experience of a patient who has a specific comfort need met” (2003, p. 9). Relief of discomfort and pain are overarching goals of this project. The additional themes, ease and transcendence, are defined respectively by Kolcaba (2003, p. 9) as, “a state of calm or contentment” and “the state in which one rises above problems or pain.” These themes are explored in the context of domain, of which, Kolcaba makes 4 distinctions including physical, psychospiritual, environmental, and sociocultural. Kolcaba developed a taxonomic grid in order to visualize the connection between the comfort state variables and context of experience variables, see Figure 1.
Kolcaba’s Theory of Comfort will provide the framework and foundation for this research in that the themes of comfort state and context of experience are central to the education, implementation, and evaluation of the RCP model and decision-making algorithm. Kolcaba’s variables will be interwoven into the decision-making algorithm and education that nurses receive as part of the intervention for this research. In addition, the variables will be applied to evaluation of results in determining whether improvements were made in meeting comfort needs of patients.
