Primacy of existential pain and suffering in residents in chronic pain in nursing homes: a phenomenological study.
The study's rationale: Chronic pain is a major health problem among the elderly, both in the community and within nursing homes.


OBJECTIVE
The purpose of the study was to examine the essentials of the experience of residents in chronic pain in nursing homes. METHODOLOGICAL DESIGN AND METHODS: The research approach was interpretive phenomenology. Data were collected in 23 dialogues with 12 residents, ages 74-97. Mean age was 86 years.


RESULTS
The main finding is the primacy of existential pain and suffering in residents in chronic pain in nursing homes. Indeed they recounted a culmination of existential pain and suffering, e.g. loss of loved ones, loss of former home, health and independence, as well as loss of connectedness. Many seemed to be in some kind of grief and their work towards reconciliation to their life and circumstances seemed an ongoing process with successful results while others seemed more haltering or even stuck. Living with chronic pain in a nursing home is indeed a challenge and many blocks to successful pain management were identified. The main sources of strength were loved ones who were seen as lifelines. Nurses seemed distant in their narratives of pain management.


CONCLUSIONS
Frailty of residents is a limitation as a few were starting to forget from one interview to the other and some were actually in pain at the time of our dialogue.


CONCLUSIONS
It is important to support a healthy process of grieving and reconciliation in elderly people who live with chronic pain in nursing homes. Those who suffer in silence with their pain and discomforts and do not seek help should be identified and cared for. The residents' own sources of strength should be identified and supported. Multi-professional collaboration with educational thrust is needed towards quality pain management of elderly people in nursing homes where existential pain and suffering is not excluded.
Gudmannsdottir
Gudrun Dora
GD
Geriatric Unit, Landspitali-University Hospital, Reykjavik, Iceland. gudrundg@landspitali.is
Halldorsdottir
Sigridur
S
D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D009735:Nursing Homes; D010146:Pain / Q000503:physiopathology / Q000523:psychology*; D059408:Pain Management; D010147:Pain Measurement