J Clin Nurs. 2024 Apr 8. doi: 10.1111/jocn.17164. Online ahead of print.

ABSTRACT

AIM: To understand nurses’ knowledge, beliefs and experiences affect pain management practices in hospitalised persons living with dementia (PLWD).

DESIGN: Naturalistic inquiry using qualitative descriptive design.

METHODS: Semi-structured interviews were conducted with 12 registered nurses who worked in one acute care hospital in Southern California from October to November 2022. Data were analysed using content analysis to identify themes.

RESULTS: Two themes were developed: improvising pain assessment, which included how pain was documented, and administration hesitancy referring to nurse’s concerns about PLWD’s confusion. Nurses described the challenges of assessing pain in hospitalised PLWD particularly if they were non-verbal and/or demonstrating responsive behaviours. Nurse’s years of experience, dementia stigma, and their unconscious biases affected nurses’ pain management practices.

CONCLUSIONS: The study findings highlight the complex challenges of pain management in hospitalised PLWD that are exacerbated by nurses’ knowledge deficits, negative stereotypical beliefs, dementia stigma and unconscious biases towards older people that contributes to undermanaged pain in hospitalised PLWD.

IMPLICATIONS: A comprehensive strategy using an implementation framework is needed to address nurse’s knowledge gaps, unconscious bias, dementia stigma and techniques that enhance communication skills is suggested. Building a foundation in these areas would improve pain management in hospitalised PLWD.

IMPACT: Improving pain management in hospitalised PLWD would improve the quality of life, decrease hospital length of stay, prevent readmissions, and improve nurse satisfaction.

REPORTING METHOD: The study adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ).

PATIENT CONTRIBUTIONS: Improving pain management in hospitalised PLWD would prevent long term confusion, episodes of delirium and improve quality of life as they recover from their acute illness for which they required hospital care.

PMID:38590077 | DOI:10.1111/jocn.17164