title: Certified nursing assistants' perception of pain in people with dementia: a hermeneutic enquiry in dementia care practice.
abstract: OBJECTIVE
  To interpret certified nursing assistants' perception of pain in people with dementia in nursing care practice.
  
  
  BACKGROUND
  Detection and understanding of pain in people with dementia remains a challenge due to their difficulty in verbalising their pain. Nursing assistants provide daily nursing care and therefore play a vital role in pain detection. Nevertheless, pain research from the nursing assistants' perspective is sparse.
  
  
  METHODS
  A qualitative approach within the interpretive tradition was adopted.
  
  
  METHODS
  Individual interviews with twelve certified nursing assistants, all working in dementia care, were conducted and interpreted using philosophical hermeneutics.
  
  
  RESULTS
  Nursing assistants' perception of pain is on three levels. Each level consists of a theme. The first theme 'Being in the facing phase' refers to the initial perception of the person's expressions. The second theme 'Being in the reflecting phase' means ability to reflect more deeply on one's perception, together with other colleagues and next of kins. The third theme 'Being in the acting phase' means perception arising from preventive and protective care focusing on contributing to well-being. The themes served as a basis for comprehensive understanding, where perception of pain arises from closeness, compassion and dialogue based on personhood, accompanied by professional knowledge of pain and dementia.
  
  
  CONCLUSIONS
  Nursing assistants' perception of pain is based on ethical concerns and on their own subjective pain experiences rather than on medical skills. Their perception derives from fundamental values that are important aspects of nursing care. Interdisciplinary solidarity may strengthen cooperation amongst CNAs and RNs to achieve best pain management practice.
  
  
  CONCLUSIONS
  Attention to nursing assistants' perception of pain needs to be highlighted when they are front-line staff and have developed important pain detection skills. Their skills are essential complements and must be used in the development of pain management in dementia care practice.
authors.affiliation: Department of Nursing, School of Health Sciences, Jönköping University, Jönköping, Sweden. christina.karlsson@his.se
authors.forename: Christina
authors.initials: C
authors.lastname: Karlsson
authors.forename: Birgitta
authors.initials: B
authors.lastname: Sidenvall
authors.forename: Ingrid
authors.initials: I
authors.lastname: Bergh
authors.forename: Marie
authors.initials: M
authors.lastname: Ernsth-Bravell
mesh_terms: D000328:Adult; D002568:Certification; D003704:Dementia / Q000150:complications* / Q000451:nursing / Q000503:physiopathology; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009728:Nursing Assistants / Q000523:psychology*; D010147:Pain Measurement