District nurses' involvement in pain care: a theoretical model.
OBJECTIVE
To explore district nurses care of chronic pain sufferers and to create a theoretical model that can explain the variation in district nurses experiences when caring for these patients.


BACKGROUND
Many people suffer from chronic pain, which greatly affects their wellbeing and causes physical suffering and psychosocial limitations. District nurses frequently meet patients who suffer from chronic pain and consequent problems. District nurses often feel powerless and ill-equipped, and they experience difficulties during interactions with these patients.


METHODS
This is a qualitative study with a theory-generating approach. Data were collected from interviews with 20 district nurses in five focus groups. Interviews were taped, transcribed and then analysed as per the grounded theory method.


RESULTS
The result is a theoretical model of district nurses' involvement in pain care. The model: (1) illustrates three main conditions in the care situation that influence district nurses' involvement in pain care and (2) explains the connection between how district nurses actively or passively detect and actively or passively respond to patients with pain problems.


CONCLUSIONS
The model explains why district nurses sometimes feel powerless or ill-equipped in dealing with chronic pain problems. Insufficient conditions make it difficult for district nurses to become involved with pain problems and thus result in passive detection of and passive response to pain problems. Supporting patients to communicate their pain, collaboration with and involvement from other professionals regarding pain care, the organisation's guidelines and support for pain care and training in pain care are interventions that will contribute to district nurses' involvement in pain care.


CONCLUSIONS
Through the model, chronic pain care can be better explained and understood; consequently chronic pain care can be improved. The model can be used in each, unique, case-study analysis. Nursing staff and students can also use the model as a basis for discussions about chronic pain sufferers.
Blomberg
Anne-Marie
AM
Center for Family and Community Medicine Stockholm, Karolinska Institutet, Huddinge, Sweden. anne.blomberg@sll.se
Hylander
Ingrid
I
Törnkvist
Lena
L
D001291:Attitude of Health Personnel; D002908:Chronic Disease; D002983:Clinical Competence; D003142:Communication; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006694:Holistic Health; D006801:Humans; D016294:Models, Nursing; D024802:Nurse's Role / Q000523:psychology*; D009723:Nurse-Patient Relations; D009730:Nursing Assessment; D015404:Nursing Methodology Research; D009736:Nursing Process; D010146:Pain / Q000175:diagnosis / Q000451:nursing* / Q000523:psychology; D010147:Pain Measurement / Q000451:nursing; D017410:Practice Guidelines as Topic; D011320:Primary Health Care; D011637:Public Health Nursing / Q000193:education / Q000458:organization & administration*; D036301:Qualitative Research; D020377:Self Efficacy; D012944:Social Support; D011795:Surveys and Questionnaires; D013548:Sweden