Nurses’ experiences of pain management for people with advanced dementia approaching the end of life: a qualitative study

banin de witt jensen, Kevin Brazil, peter passmore, hilary buchanan, doreen maxwell, Sonja McIlfatrick, Sharon morgan, Max watson, Carole Parsons

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Aims and objectives. 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.Design. A qualitative study using semi-structured interviews and thematic analysis to examine data. Methods. 24 registered nurses caring for people dying with advanced dementia were recruited from ten nursing homes, three hospices, and two acute hospitals across a region of the United Kingdom. Interviews were conducted between June 2014 and 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.
Original languageEnglish
Pages (from-to)1234-1244
JournalJournal of Clinical Nursing
Issue number9-10
Early online date11 Jun 2016
Publication statusPublished - May 2017



  • pain
  • palliative care
  • dementia
  • nurse
  • nurse education

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