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Nurses' experiences of pain management for people with advanced dementia approaching the end of life: a qualitative study.
J Clin Nurs. 2017 May; 26(9-10):1234-1244.JC

Abstract

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

Twenty-four registered nurses caring for people dying with advanced dementia were recruited from 10 nursing homes, three hospices and two acute hospitals across a region of the UK. Interviews were conducted between June 2014-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 undersupported 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.

Authors+Show Affiliations

School of Pharmacy, Queen's University Belfast, Belfast, UK.School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK.Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK.Alzheimer's Society.Kerrsland Surgery, Belfast, UK.Institute of Nursing and Health Research, Ulster University, Ulster, UK. All Ireland Institute of Hospice and Palliative Care, Dublin, Ireland.Marie Curie Hospice, Belfast, UK.Northern Ireland Hospice, Belfast, UK.School of Pharmacy, Queen's University Belfast, Belfast, UK.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27324751

Citation

De Witt Jansen, Bannin, et al. "Nurses' Experiences of Pain Management for People With Advanced Dementia Approaching the End of Life: a Qualitative Study." Journal of Clinical Nursing, vol. 26, no. 9-10, 2017, pp. 1234-1244.
De Witt Jansen B, Brazil K, Passmore P, et al. Nurses' experiences of pain management for people with advanced dementia approaching the end of life: a qualitative study. J Clin Nurs. 2017;26(9-10):1234-1244.
De Witt Jansen, B., Brazil, K., Passmore, P., Buchanan, H., Maxwell, D., McIlfactrick, S. J., Morgan, S. M., Watson, M., & Parsons, C. (2017). Nurses' experiences of pain management for people with advanced dementia approaching the end of life: a qualitative study. Journal of Clinical Nursing, 26(9-10), 1234-1244. https://doi.org/10.1111/jocn.13442
De Witt Jansen B, et al. Nurses' Experiences of Pain Management for People With Advanced Dementia Approaching the End of Life: a Qualitative Study. J Clin Nurs. 2017;26(9-10):1234-1244. PubMed PMID: 27324751.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Nurses' experiences of pain management for people with advanced dementia approaching the end of life: a qualitative study. AU - De Witt Jansen,Bannin, AU - Brazil,Kevin, AU - Passmore,Peter, AU - Buchanan,Hilary, AU - Maxwell,Doreen, AU - McIlfactrick,Sonja J, AU - Morgan,Sharon M, AU - Watson,Max, AU - Parsons,Carole, Y1 - 2017/02/07/ PY - 2016/06/11/accepted PY - 2016/6/22/pubmed PY - 2017/5/30/medline PY - 2016/6/22/entrez KW - dementia KW - nurse KW - nurse education KW - pain KW - palliative care SP - 1234 EP - 1244 JF - Journal of clinical nursing JO - J Clin Nurs VL - 26 IS - 9-10 N2 - 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: Twenty-four registered nurses caring for people dying with advanced dementia were recruited from 10 nursing homes, three hospices and two acute hospitals across a region of the UK. Interviews were conducted between June 2014-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 undersupported 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. SN - 1365-2702 UR - https://www.unboundmedicine.com/medline/citation/27324751/Nurses'_experiences_of_pain_management_for_people_with_advanced_dementia_approaching_the_end_of_life:_a_qualitative_study_ L2 - https://doi.org/10.1111/jocn.13442 DB - PRIME DP - Unbound Medicine ER -