Ambulance staff assessment of pain in people living with dementia

An exciting opportunity to apply for a fully funded PhD position in the College of Health, Science and Society, UWE Bristol.

Ref: 2324-OCT-HSS06

The expected start date of these studentships is 1 October 2023.

The closing date for applications is 30 June 2023.

Assessment of pain by ambulance staff in an emergency for someone living with dementia is currently inadequate. Assessment is crucial to ensure pain is treated and reduce the chances of complications; if pain is not accurately assessed then injuries, such as hip fractures, could be missed by ambulance staff. Lack of timely treatment leads to a high risk of a need for further healthcare, longer hospital stays and death. In previous research, we found pain is less often recorded in ambulance care records for older people living with dementia compared to older people without dementia. It is likely that this is because it is difficult for ambulance staff to assess pain using the usual methods, particularly if the patient is confused or distressed and finds it difficult to communicate.

Pain assessments for people with dementia who are in hospital or a care home often rely on reports from carers or on repeated observations over a period of time. This is difficult for ambulance staff because they are not with the patient for very long, often don’t have access to medical records and need to make decisions quickly. There are 30-40 pain assessment tools for use with people with dementia that have been published in the literature. However, only two of these are potentially suitable for ambulance patients; the others are more suitable to use with people living in care homes or patients staying in hospital. There are no pain assessment tools specifically designed for the ambulance service.

The aim of this project is to investigate how ambulance staff assess and document pain in people living with dementia, explore barriers and facilitators to pain assessment tools and develop a new tool for the ambulance service.

There are six objectives for the project:

• Systematic literature review to identify and evaluate pain assessment tools.
• Review of ambulance electronic patient data to determine how, and how often, pain is assessed and treated for people with dementia.
• Investigation of the feasibility of linking ambulance data to hospital data and determine if it is possible to collect additional outcomes to enable planning for further post-doctoral research.
• Qualitative interviews with staff, patients and carers to investigate their experiences of pain assessment during an ambulance call.
• Consensus exercise with stakeholders to prioritise components of pain tools identified in the review, synthesise with data from interviews and develop a new assessment tool for ambulance staff.
• Test the acceptability of the tool with ambulance staff.

There are 8 million emergency ambulance calls in the UK every year; these are increasingly for older adults.  Approximately 15% of calls to people aged 65 years and over are for with someone living with dementia. This PhD project is the first step in a pathway of research to improve emergency care for people with dementia who are experiencing pain. At the end of this PhD, it is anticipated we will have a new method of assessing pain in people living with dementia that can be used by ambulance staff. Better pain assessment will lead to shorter hospital stays, fewer complications and reduced mortality for people with dementia who need an emergency ambulance.

For an informal discussion about the studentship, please email Professor Sarah Voss at sarah.voss@uwe.ac.uk

The studentship is available from 1 October 2023 for a period of three and half years, subject to satisfactory progress and includes a tax exempt stipend, which is currently £18,622 per annum.

In addition, full-time tuition fees will be covered for up to three years.

Applicants must have a minimum upper second class undergraduate honours degree (or equivalent) in a relevant health sciences discipline and ideally will have relevant masters degree or other evidence of post-graduate research experience.

A recognised English language qualification is required.

Please submit your application online. When prompted use the reference number 2324-OCT-HSS06.

Supporting documentation

You will need to upload your research proposal, all your degree certificates and transcripts and your proof of English language proficiency as attachments to your application, so please have these available when you complete the application form.

References

You will need to provide details of two referees as part of your application. At least one referee must be an academic referee from the institution that conferred your highest degree. Your referee will be asked for a reference at the time you submit your application, so please ensure that your nominated referees are willing and able to provide references within 14 days of your application being submitted.

The closing date for applications is 30 June 2023.

It is expected that interviews will take place during August. If you have not heard from us by 31 July 2023, we thank you for your application but on this occasion you have not been successful.