title: Barriers to postoperative pain management in hip fracture patients with dementia as evaluated by nursing staff.
abstract: This paper reports a study of the perceptions of nursing staff regarding barriers to postoperative pain management in hip fracture patients with dementia, their expectations, and facilitators offered by their employers to overcome these barriers. Patients with dementia are at high risk for insufficient postoperative pain treatment, mainly owing to inability to articulate or convey their pain experience. Nursing staff have an essential role in the treatment and care of patients who are vulnerable, and therefore unable to advocate for their own pain treatment. Questionnaires with both structured and open-ended questions were used to collect data from nursing staff members in seven university hospitals and ten city-center hospitals from March to May 2011. The response rate was 52% (n = 331). According to nursing staff, the biggest barrier in pain management was the difficulty in assessing pain owing to a patient's cognitive impairment (86%). Resisting care and restlessness among patients with dementia can lead to use of restraints, although these kinds of behavioral changes can point to the occurrence of pain. There were statistically significant differences between the sufficiency of pain management and barriers. Those who expected pain management to be insufficient identified more barriers than those who expected pain management to be sufficient (p < .001). Further updating education for nursing staff in pain detection and management is needed so that nursing staff are also able to recognize behavioral symptoms as potential signs of pain and provide appropriate pain management.
authors.affiliation: Department of Nursing Science, University of Eastern Finland, Kuopio, Finland. Electronic address: momaatta@student.uef.fi.
authors.forename: Maija
authors.initials: M
authors.lastname: Rantala
authors.affiliation: Department of Nursing Science, University of Eastern Finland, Kuopio, Finland.
authors.forename: Päivi
authors.initials: P
authors.lastname: Kankkunen
authors.affiliation: Department of Nursing Science, University of Eastern Finland, Kuopio, Finland.
authors.forename: Tarja
authors.initials: T
authors.lastname: Kvist
authors.affiliation: Department of Nursing Science, University of Eastern Finland, Kuopio, Finland.
authors.forename: Sirpa
authors.initials: S
authors.lastname: Hartikainen
mesh_terms: D000328:Adult; D000368:Aged; D000700:Analgesics / Q000008:administration & dosage; D003144:Communication Barriers; D003430:Cross-Sectional Studies; D003704:Dementia / Q000451:nursing* / Q000523:psychology; D005260:Female; D016330:Frail Elderly; D006620:Hip Fractures / Q000451:nursing* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009741:Nursing Staff, Hospital; D059408:Pain Management / Q000379:methods / Q000451:nursing*; D010147:Pain Measurement / Q000451:nursing; D010149:Postoperative Pain / Q000188:drug therapy / Q000451:nursing* / Q000523:psychology; D013527:Perioperative Nursing / Q000379:methods; D012149:Restraint, Physical; D011795:Surveys and Questionnaires
chemical_list: D000700:Analgesics