{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T04:30:51Z","timestamp":1786595451987,"version":"build-2736575974"},"reference-count":46,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:00:00Z","timestamp":1786492800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:00:00Z","timestamp":1786492800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100016337","name":"Department for the Economy","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100016337","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Clinical Nursing"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To establish a comprehensive pre\u2010implementation 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Pain is common yet frequently under\u2010recognised and inconsistently managed in PLWD in acute care. Behaviour change frameworks, such as COM\u2010B, may help identify determinants of practice and inform implementation strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Multiple\u2010methods study, underpinned by the COM\u2010B framework and guided by the Medical Research Council framework for developing and evaluating complex interventions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      The study was conducted across five wards in two acute hospitals in the United Kingdom. Healthcare staff (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009148) completed an adapted 6\u2010item COM\u2010B self\u2010evaluation scale (0\u201310). Semi\u2010structured interviews with ward managers and a pain management specialist nurse (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20096) were analysed using deductive thematic analysis. A retrospective review of patient documentation (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200950) assessed compliance with the National Institute for Health and Care Excellence dementia guidelines.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Staff reported high perceived capability, opportunity and motivation, suggesting strong self\u2010reported readiness to deliver effective pain management. However, qualitative findings highlighted barriers across the COM\u2010B 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\u2009min of admission, despite many presenting with fractures or serious infections.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>A discrepancy exists between self\u2010reported behavioural determinants and documented clinical practice, indicating inconsistent pain management for PLWD in acute care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Implications for Clinical Practice<\/jats:title>\n                    <jats:p>Interventions should prioritise strengthening healthcare staff's capability and embedding structured, system\u2010level processes to support timely person\u2010centred pain management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Reporting Methods<\/jats:title>\n                    <jats:p>STROBE guidelines were followed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patient or Public Contribution<\/jats:title>\n                    <jats:p>A multidisciplinary steering group, including clinical leaders and dementia representatives, contributed to the study.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jocn.70508","type":"journal-article","created":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T04:26:11Z","timestamp":1786595171000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Exploring Pain Management for People Living With Dementia in Acute Care Settings Using the\n                    <scp>COM<\/scp>\n                    \u2010B Framework to Guide Baseline Data Gathering"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7828-3907","authenticated-orcid":false,"given":"Faisal","family":"Mahama","sequence":"first","affiliation":[{"name":"School of Nursing and Paramedic Science, Institute of Nursing and Health Research Ulster University  Derry\/Londonderry UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4627-3189","authenticated-orcid":false,"given":"Deirdre","family":"Harkin","sequence":"additional","affiliation":[{"name":"School of Nursing and Paramedic Science, Institute of Nursing and Health Research Ulster University  Derry\/Londonderry UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"Hayes","sequence":"additional","affiliation":[{"name":"The Western Health and Social Care Trust, MDEC Building, Altnagelvin Area Hospital Site  Derry\/Londonderry UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-1185-9601","authenticated-orcid":false,"given":"Mandy","family":"Doherty","sequence":"additional","affiliation":[{"name":"The Western Health and Social Care Trust, MDEC Building, Altnagelvin Area Hospital Site  Derry\/Londonderry UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8069-2961","authenticated-orcid":false,"given":"Vivien","family":"Coates","sequence":"additional","affiliation":[{"name":"School of Nursing and Paramedic Science, Institute of Nursing and Health Research Ulster University  Derry\/Londonderry UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,12]]},"reference":[{"key":"e_1_2_16_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/PR9.0000000000000803"},{"key":"e_1_2_16_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/11.3.187"},{"key":"e_1_2_16_4_1","doi-asserted-by":"publisher","DOI":"10.1038\/s44159\u2010024\u201000305\u20100"},{"key":"e_1_2_16_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/ALZ.13809"},{"key":"e_1_2_16_6_1","doi-asserted-by":"publisher","DOI":"10.1186\/S13012\u2010017\u20100605\u20109"},{"key":"e_1_2_16_7_1","unstructured":"Besley S. 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