Abstract
Aim
To establish a comprehensive pre-implementation baseline of pain management for people living with dementia (PLWD) in acute hospitals by exploring behavioural, contextual, organisational and clinical practice factors to inform the implementation of the DOTS approach.
Background
Pain is common yet frequently under-recognised and inconsistently managed in PLWD in acute care. Behaviour change frameworks, such as COM-B, may help identify determinants of practice and inform implementation strategies.
Design
Multiple-methods study, underpinned by the COM-B framework and guided by the Medical Research Council framework for developing and evaluating complex interventions.
Methods
The study was conducted across five wards in two acute hospitals in the United Kingdom. Healthcare staff (n = 148) completed an adapted 6-item COM-B self-evaluation scale (0–10). Semi-structured interviews with ward managers and a pain management specialist nurse (n = 6) were analysed using deductive thematic analysis. A retrospective review of patient documentation (n = 50) assessed compliance with the National Institute for Health and Care Excellence dementia guidelines.
Results
Staff reported high perceived capability, opportunity and motivation, suggesting strong self-reported readiness to deliver effective pain management. However, qualitative findings highlighted barriers across the COM-B domains, including knowledge gaps and inconsistent use of pain assessment tools. Documentation review highlighted deficits in recording acute pain, chronic pain history and usual pain management strategies. Only five patients received analgesia within 60 min of admission, despite many presenting with fractures or serious infections.
Conclusion
A discrepancy exists between self-reported behavioural determinants and documented clinical practice, indicating inconsistent pain management for PLWD in acute care.
To establish a comprehensive pre-implementation baseline of pain management for people living with dementia (PLWD) in acute hospitals by exploring behavioural, contextual, organisational and clinical practice factors to inform the implementation of the DOTS approach.
Background
Pain is common yet frequently under-recognised and inconsistently managed in PLWD in acute care. Behaviour change frameworks, such as COM-B, may help identify determinants of practice and inform implementation strategies.
Design
Multiple-methods study, underpinned by the COM-B framework and guided by the Medical Research Council framework for developing and evaluating complex interventions.
Methods
The study was conducted across five wards in two acute hospitals in the United Kingdom. Healthcare staff (n = 148) completed an adapted 6-item COM-B self-evaluation scale (0–10). Semi-structured interviews with ward managers and a pain management specialist nurse (n = 6) were analysed using deductive thematic analysis. A retrospective review of patient documentation (n = 50) assessed compliance with the National Institute for Health and Care Excellence dementia guidelines.
Results
Staff reported high perceived capability, opportunity and motivation, suggesting strong self-reported readiness to deliver effective pain management. However, qualitative findings highlighted barriers across the COM-B domains, including knowledge gaps and inconsistent use of pain assessment tools. Documentation review highlighted deficits in recording acute pain, chronic pain history and usual pain management strategies. Only five patients received analgesia within 60 min of admission, despite many presenting with fractures or serious infections.
Conclusion
A discrepancy exists between self-reported behavioural determinants and documented clinical practice, indicating inconsistent pain management for PLWD in acute care.
| Original language | English |
|---|---|
| Pages (from-to) | 1-17 |
| Number of pages | 17 |
| Journal | Journal of Clinical Nursing |
| Early online date | 12 Aug 2026 |
| DOIs | |
| Publication status | Published online - 12 Aug 2026 |
Bibliographical note
Publisher Copyright:© 2026 The Author(s). Journal of Clinical Nursing published by John Wiley & Sons Ltd.
Rights Retention Statement
RRPSW not applied, published cc-byData Availability Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request. The data are not publicly available due to privacy or ethical restrictions. The data utilised in the submitted manuscript have been lawfully acquired in accordance with The Nagoya Protocol on Access to Genetic Resources and the Fair and Equitable Sharing of Benefits Arising from Their Utilisation to the Convention on Biological Diversity. The relevant fieldwork permission was obtained.Funding
The study was primarily funded by the Department for the Economy, Northern Ireland (https://doi.org/10.13039/100016337). The research team applied for and successfully secured additional funding from the Martha McMenamin Memorial Scholarship and the Caring for People with Complex Needs Research Centre at Ulster University. The funding source has no role in the study design, data collection and analysis, data interpretation, manuscript writing or the decision to submit the manuscript for publication.
| Funders |
|---|
| Department for the Economy |
UN SDGs
This output contributes to the following UN Sustainable Development Goals (SDGs)
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SDG 3 Good Health and Well-being
Keywords
- acute care
- COM-B framework
- dementia
- healthcare staff
- MRC framework
- multiple-methods
- pain management
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