title: Emergency nurses perceptions of the role of family/carers in caring for cognitively impaired older persons in pain: a descriptive qualitative study.
abstract: BACKGROUND
  On arrival to the emergency department many older persons are accompanied by family/carers. Yet the role of family/carers in the emergency department is unclear. We know very little about how emergency department nurses balance care practices to accommodate family/carers while specifically meeting the needs of cognitively impaired older persons experiencing pain.
  
  
  OBJECTIVE
  The aim of this paper was to understand emergency nurses' perceptions of the role of family/carers in caring for the older cognitively impaired person experiencing pain.
  
  
  METHODS
  Emergency nurses were invited to participate in focus group interviews. A semi-structured interview tool was developed from the literature and comprised open-ended questions and three Likert scale items which assisted to focus nurses' thoughts on their perceived role of family/carers in the emergency department.
  
  
  METHODS
  The study was undertaken across four emergency departments in Sydney, Australia and included two district hospitals and two tertiary referral hospitals.
  
  
  METHODS
  Emergency nurses were invited to participate in one face to face, focus group interview. Purposive sampling was used and inclusion criteria included at least one year emergency department experience.
  
  
  METHODS
  Interview data were analysed and organised thematically. Two expert qualitative researchers independently reviewed transcripts and emerging coding and interpretation.
  
  
  RESULTS
  Eighty nurses participated in 16 focus group interviews across four hospitals. Participating nurses included 67 (84%) females and 13 (16%) males with 8.6 years (mean; SD ±8.64) experience in the emergency department. Three key themes relating to family/carers emerged from the analysis. The themes included (i) the role of families and carers in building a clinical picture; (ii) family and carers as a hidden workforce; and (iii) family and carer roles in pain management decision making.
  
  
  CONCLUSIONS
  The study has provided insight into the role of family/carers as perceived by emergency nurses. There were many benefits in partnering with family/carers when information gathering on the older cognitively impaired person in pain. Family/carers are sensitive to health behaviour changes of older cognitively impaired people, which can assist nurses to optimise pain management.
authors.affiliation: Northern Sydney Local Health District, Faculty of Health University of Sydney, Australia. Electronic address: margaret.fry@uts.edu.au.
authors.forename: Margaret
authors.initials: M
authors.lastname: Fry
authors.affiliation: Centre for Healthy Brain Ageing, University of New South Wales, Australia; University of Technology Sydney, Sydney, Australia. Electronic address: lynnette.chenoweth@uts.edu.au.
authors.forename: Lynn
authors.initials: L
authors.lastname: Chenoweth
authors.affiliation: School of Social Science, Monash University, Research and Practice Development, Northern Sydney Local Health District, Australia. Electronic address: casimir.macgregor@monash.edu.au.
authors.forename: Casimir
authors.initials: C
authors.lastname: MacGregor
authors.affiliation: School of Primary, Aboriginal and Rural Health Care, University of Western Australia, Australia. Electronic address: glenn.arendts@uwa.edu.au.
authors.forename: Glenn
authors.initials: G
authors.lastname: Arendts
mesh_terms: D017028:Caregivers; D003072:Cognition Disorders / Q000503:physiopathology*; D004636:Emergency Service, Hospital; D006801:Humans; D009723:Nurse-Patient Relations; D010147:Pain Measurement; D011368:Professional-Family Relations; D000078329:Workforce
keywords: Carer; Cognitive impairment; Emergency Department; Family; Older person; Pain management