title: Effective pain management as part of palliative care for persons living with HIV/AIDS in a developing country: a qualitative study.
abstract: OBJECTIVE
  The aim of this research was to explore and understand nurses' experiences of managing pain for persons living with human immune virus/ acquired immune deficiency syndrome receiving palliative care at home in Botswana.
  
  
  BACKGROUND
  Community palliative and hospice care in Africa and Botswana were developed for persons with end-stage acquired immune deficiency syndrome and other terminal illnesses being cared for at home. As antiretro viral therapies extend the lives of persons living with human immune virus/acquired immune deficiency syndromes, there is an increase in the chronic conditions associated with human immune virus/acquired immune deficiency syndrome. Despite a strong demand for care of persons living with human immune virus/acquired immune deficiency syndromes and other chronic illnesses, little is known about Botswanan community nurses' capacity to manage community-based end-of-life care for persons living with human immune virus/acquired immune deficiency syndromes.
  
  
  METHODS
  A qualitative study approach guided by van Manen's interpretive analysis was undertaken.
  
  
  METHODS
  Data were collected using semi-structured interviews that were audio-recorded, transcribed and analysed using qualitative interpretive analysis. Thirteen nurses from 12 health districts in Botswana were recruited to the study using purposeful sampling.
  
  
  RESULTS
  Participants identified that pain management was a significant issue. A lack of nurses' ability to advocate effectively for patients because of a lack of relevant skills and knowledge and poor availability of appropriate analgesics was a limiting factor along with doctors' reluctance to prescribe opioids to effectively manage pain.
  
  
  CONCLUSIONS
  Lack of resources coupled with lack of training for nurses has a negative impact on palliative care and the delivery of care services to persons living with human immune virus/acquired immune deficiency syndromes in Botswana.
  
  
  CONCLUSIONS
  Being attentive and listening to the nurses' voices in the provision of palliative care at home is an essential element in identifying the challenges they encounter. Lack of adequate palliative care training and a chronic shortage of resources have serious implications for the delivery of home-based palliative care in Botswana.
authors.affiliation: University of New England, Armidale, NSW, Australia.
authors.forename: Tshepiso Daisy
authors.initials: TD
authors.lastname: Mojapelo
authors.affiliation: University of New England, Armidale, NSW, Australia.
authors.forename: Kim
authors.initials: K
authors.lastname: Usher
authors.affiliation: Centre for Nursing and Midwifery Research, James Cook University, Cairns, Qld, USA.
authors.forename: Jane
authors.initials: J
authors.lastname: Mills
mesh_terms: D000328:Adult; D000700:Analgesics / Q000627:therapeutic use; D001902:Botswana; D003906:Developing Countries; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D059408:Pain Management; D010166:Palliative Care; D000070659:Patient Comfort; D036301:Qualitative Research; D013727:Terminal Care
chemical_list: D000700:Analgesics
keywords: HIV/AIDS; PLWHAs; nurses’ advocacy; opioid availability; pain assessment; pain management