Nurses' experiences of pain management for people with advanced dementia approaching the end of life: a qualitative study

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      AIMS AND OBJECTIVES: To explore hospice, acute care and nursing home nurses' experiences of pain management for people with advanced dementia in the final month of life. To identify the challenges, facilitators and practice areas requiring further support.

      BACKGROUND: Pain management in end-stage dementia is a fundamental aspect of end of life care; however, it is unclear what challenges and facilitators nurses experience in practice, whether these differ across care settings, and whether training needs to be tailored to the context of care.

      DESIGN: A qualitative study using semi-structured interviews and thematic analysis to examine data.

      METHODS: 24 registered nurses caring for people dying with advanced dementia were recruited from ten nursing homes, three hospices, and two acute hospitals across a region of the United Kingdom. Interviews were conducted between June 2014 and September 2015.

      RESULTS: Three core themes were identified: challenges administering analgesia, the nurse-physician relationship, and interactive learning and practice development. Patient-related challenges to pain management were universal across care settings; nurse- and organisation-related barriers differed between settings. A need for interactive learning and practice development, particularly in pharmacology, was identified.

      CONCLUSIONS: Achieving pain management in practice was highly challenging. A number of barriers were identified; however, the manner and extent to which these impacted on nurses differed across hospice, nursing home and acute care settings. Needs-based training to support and promote practice development in pain management in end-stage dementia is required.

      RELEVANCE TO CLINICAL PRACTICE: Nurses considered pain management fundamental to end of life care provision; however, nurses working in acute care and nursing home settings may be under-supported and under-resourced to adequately manage pain in people dying with advanced dementia. Nurse-to-nurse mentoring and ongoing needs-assessed interactive case-based learning could help promote practice development in this area. Nurses require continuing professional development in pharmacology. This article is protected by copyright. All rights reserved.

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      • Nurses’ experiences of pain management for people with advanced dementia approaching the end of life: a qualitative study

        Rights statement: © 2016, Wiley This is the peer reviewed version of the following article: De Witt Jansen, B, Brazil, K, Passmore, P, Buchanan, H, Maxwell, D, Mcilfatrick, SJ, Morgan, SM, Watson, M & Parsons, C 2016, 'Nurses' experiences of pain management for people with advanced dementia approaching the end of life: a qualitative study' Journal of Clinical Nursing, which has been published in final form at http://onlinelibrary.wiley.com/doi/10.1111/jocn.13442/abstract. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.

        Accepted author manuscript, 699 KB, PDF-document

      DOI

      Original languageEnglish
      Number of pages11
      Pages (from-to)1234-1244
      JournalJournal of Clinical Nursing
      Journal publication date05 Apr 2017
      Issue number9-10
      Volume26
      Early online date21 Jun 2016
      DOIs
      StatePublished - 05 Apr 2017

      ID: 55467520