Nurses' experiences of pain management for people with advanced dementia approaching the end of life: a qualitative study.
OBJECTIVE
To explore hospice, acute care and nursing home nurses' experiences of pain management for people with advanced dementia in the final month of life. To identify the challenges, facilitators and practice areas requiring further support.


BACKGROUND
Pain management in end-stage dementia is a fundamental aspect of end-of-life care; however, it is unclear what challenges and facilitators nurses experience in practice, whether these differ across care settings, and whether training needs to be tailored to the context of care.


METHODS
A qualitative study using semi-structured interviews and thematic analysis to examine data.


METHODS
Twenty-four registered nurses caring for people dying with advanced dementia were recruited from 10 nursing homes, three hospices and two acute hospitals across a region of the UK. Interviews were conducted between June 2014-September 2015.


RESULTS
Three core themes were identified: challenges administering analgesia, the nurse-physician relationship, and interactive learning and practice development. Patient-related challenges to pain management were universal across care settings; nurse- and organisation-related barriers differed between settings. A need for interactive learning and practice development, particularly in pharmacology, was identified.


CONCLUSIONS
Achieving pain management in practice was highly challenging. A number of barriers were identified; however, the manner and extent to which these impacted on nurses differed across hospice, nursing home and acute care settings. Needs-based training to support and promote practice development in pain management in end-stage dementia is required.


CONCLUSIONS
Nurses considered pain management fundamental to end-of-life care provision; however, nurses working in acute care and nursing home settings may be undersupported and under-resourced to adequately manage pain in people dying with advanced dementia. Nurse-to-nurse mentoring and ongoing needs-assessed interactive case-based learning could help promote practice development in this area. Nurses require continuing professional development in pharmacology.
School of Pharmacy, Queen's University Belfast, Belfast, UK.
Bannin
B
De Witt Jansen
School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK.
Kevin
K
Brazil
Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK.
Peter
P
Passmore
Alzheimer's Society.
Hilary
H
Buchanan
Kerrsland Surgery, Belfast, UK.
Doreen
D
Maxwell
Institute of Nursing and Health Research, Ulster University, Ulster, UK.|All Ireland Institute of Hospice and Palliative Care, Dublin, Ireland.
Sonja J
SJ
McIlfactrick
Marie Curie Hospice, Belfast, UK.
Sharon M
SM
Morgan
Northern Ireland Hospice, Belfast, UK.
Max
M
Watson
School of Pharmacy, Queen's University Belfast, Belfast, UK.
Carole
C
Parsons
D000368:Aged; D000369:Aged, 80 and over; D003704:Dementia / Q000451:nursing*; D005260:Female; D006801:Humans; D008297:Male; D009723:Nurse-Patient Relations; D009735:Nursing Homes; D059408:Pain Management / Q000451:nursing*; D010147:Pain Measurement / Q000451:nursing*; D010166:Palliative Care / Q000379:methods*; D019555:Physician-Nurse Relations; D036301:Qualitative Research; D013727:Terminal Care
dementia; nurse; nurse education; pain; palliative care