This paper presents a systematic review of the paper documented by Karlsson et al (2012), Jansen et al. (2016), Lichtner et al. (2016) Gilmore -Bykovskyi et al. (2013) and on pain assessment and management for patients with dementia. The paper gives a critique of the methodological approach adopted in each paper and a discussion of the identified themes pointing out the similarities and differences observed based on the CASP tool.

A clear statement of the study aim and the objectives is one of the major principles of a good research. According to Padgett (2016) a clear research aim does not just define the research questions but also guide the study in ensuring that the findings collected actually addresses the overall goal. Three out of the four papers chosen for critical analysis had a clear statement of the study aim. Jansen et al. (2016), Karlsson et al (2012) and Lichtner et al. (2016) all had a clear statement of the objective at the introductory part of the paper. For instance, Lichtner et al. (2016) paper focused on investigating the role of health care professionals in the assessment of pain amongst the patients with dementia. The identified study aim informed the research questions that followed as well as guided the direction of the research through to the end.

From another perspective, Yin (2011) has reported that statement of the research aim has no significant value if it is irrelevant to the topic under investigation. However, from the review conducted, all the research aims stated by the scholars of the three papers were relevant to the study under investigation. Jansen et al. (2016), Karlsson et al.(2012) and Lichtner et al. (2016) all had research aims that were relevant to the topic under investigation. As much as the research topic of Gilmore -Bykovskyi et al. (2013) guided the action of the researcher in obtaining the study findings, the authors ought to have listed the main aim of the study to make it easier for the readers and potential users of the paper understand the focus of the paper. Moreover, stating the research aim would have ensured that the actual purpose of the study is achieved thus enhancing its overall quality.

Gilmore -Bykovskyi et al.(2013), Jansen et al. (2016), Lichtner et al. (2016) and Karlsson et al.(2012) adopted a qualitative research approach  in their study. According to Padgett (2016) qualitative research design entails the use of the subjective views of the study participants to respond to the research aim and research questions under investigation. The fact that all the authors of the four papers focused on understanding and interpreting the subjective actions of the study participants made the approach effective. Holloway and Galvin (2016) have pointed out, that qualitative research approach is most suitable in cases where a researcher seeks to gather comprehensive information on the actions of the study participants. The qualitative research approach was therefore most suitable for the four studies.

The scholars of the four papers adopted a case study research design where the research was conducted in organizational settings. Karlsson et al.(2012) took a case of consulting firms of a certain municipality in Sweden, Jansen et al. (2016), involved nursing homes, hospice and acute care hospitals, Gilmore -Bykovskyi et al.(2013) involved four skilled nursing homes in Wisconsin while Lichtner et al. (2016) engaged four hospitals from Scotland and England in the study. According to Ellinger and McWhorter (2016) case study approach is effective in case where an in-depth understanding of a phenomenon in real life is desired. Since all the studies have an overall goal of exploring the knowledge of nurses in pain assessment and management for persons with dementia, better results could only be attained by carrying out the context in a real setting. This justifies the effectiveness and suitability of adopting the case study research design. Nevertheless, all the studies apart from that of Lichtner et al. (2016) gave a justification for the use of the case study research design as opposed to other research approaches such as survey design. This justification is vital in the selection of a research design to adopt and ought to be included in the methodological approach to enhance the credibility of the study.

Devotta et al (2016) have pointed out that the robust nature of the data collection methods will have significant influence on the quality of data collected and whether it actually answer the research questions developed. Different data collection methods have been used in the four papers, Karlsson et al. (2012) made use of focus groups, Lichtner et al. (2016) used semi-structured interviews, observation and critical review of patient records while Jansen et al. (2016) and Gilmore -Bykovskyi et al (2013) adopted semi-structured interviews as their data collection methods. As much as the approaches used in each paper enabled the researchers to obtain comprehensive information needed, the use of a single data collection method as reported by Ellinger and McWhorter (2016) is not appropriate in any case study. The fact that the study is limited to a few cases and is subjective in nature requires the researcher to incorporate the data triangulation method in enhancing the validity of the findings. In this case, the paper by Lichtner et al. (2016) is likely to have yielded better results in terms of validity and reliability in comparison with the findings obtained in the other papers.

The data analysis methods adopted in each of the study was also effective in enhancing the quality of the findings. Karlsson et al. (2012) used content analysis, Lichtner et al. (2016) and Jansen et al. (2016) used thematic analysis while Gilmore-Bykovskyi et al. (2013) used grounded dimensional method to analyze the raw data collected. Regardless of the data analysis method employed in each paper, the rigorous nature through which the analysis process was done ensured that the final findings were credible and consistent (Fain, 2017). All the papers that adopted thematic analysis also used the Nvivo10 software to facilitate the analysis as well as the management of data that further enhanced the quality of the final findings. Gilmore -Bykovskyi et al (2013) carried out the data analysis after every interview to ensure that the quality of the final findings is not affected by the perceived workload in case that the analysis was done after conducting all the interviews. The comparison of the themes identified and the raw data collected was also done by the lead researcher in all the studies to ensure consistency of the findings. Holloway and Galvin (2016) reported that the type of data analysis used in analyzing qualitative data has minimal effects on the quality of the final findings; rather, the way through which the analysis is done is likely to have significant implications on the data quality. As such, the rigorous nature of the data analysis process as observed in all the papers ensured that the data collected were of maximum quality.

Valuable results were obtained in all the four papers reviewed. The common theme identified in all the papers is the relationship between the clinician and the nurses. The authors reported that a positive relationship between the two practitioners would enhance the quality of the pain assessment and management process, though in most cases difficult relationships were observed thus acting as a barrier for proper management of pain in the patients with dementia. Overlying on the patients for pain assessment has also been identified in the papers as a major drawback in the proper management of pain. Themes such as uncertainty on likelihood of pain, training and development and unfulfilled need for reflection are specific to Gilmore -Bykovskyi et al (2013), Jansen et al. (2016) and Karlsson et al. (2012) respectively. As much as some of the themes identified differ across the four papers, they have given a clear understanding of the nurses’ experience in relation to pain assessment and management.

Ethical issues including confidentiality, voluntary participation, and respect for persons must be taken into consideration while engaging directly with the study participants. All the papers apart from Gilmore -Bykovskyi et al (2013) adhered to the ethical standards presented by their respective ethics committee. On the contrary, Gilmore -Bykovskyi et al (2013) did not received approval from the ethical committee, however, the researchers conducted the interviews at a convenient time for all the nurses and ensured that they willingly take part in the study. Moreover, the researchers offered steep ends for the study participants to further encourage them to take part in the study to enhance the ethical nature of their study. Nevertheless, Gilmore -Bykovskyi et al (2013) should have included informed consent forms that assure the confidentiality of the information presented by the study participants.

Regardless of having attained their goals, the four papers could not go without certain limitations. The use of limited number of focus group was the major limitation observed in the study by Karlsson et al.(2012). The credibility of the findings obtained was questionable since the chosen group did not give a clear representation of the case. Lichtner et al. (2016) also failed to give recommendations on the approaches needed to improve the effectiveness of the patient assessment process for persons with dementia. Apart from ascertaining that the patient assessment process was poorly done, the researchers ought to have given suggestions on what needs to be done to ensure that the study problem is addressed. The use of a single data collection method by Gilmore -Bykovskyi et al.(2013) and Jansen et al. (2016) was also their major weakness since it is likely to affect the quality of the information collected. Future studies seeking to explore the experience of nurses in pain assessment and management for patients with dementia should take into consideration the identified limitations avail more accurate and credible findings.