Nurses' experiences with pain management in long term care settings: a grounded theory study

The purpose of this grounded theory study was to investigate nurses' experiences with pain management in long term care settings where the majority of the residents are elderly persons. A non-probability, purposive sample of sixteen registered nurses was obtained from three nursing homes in St. John's, Newfoundland. Semistructured interviews, averaging approximately one hour, were audiotaped and conducted in a private place. Open-ended questions explored nurses' perceptions of assessment protocols, intervention strategies, knowledge requirements, and barriers to and facilitators of effective pain management. Interviews were transcribed verbatim within 48-hours, checked for accuracy, and subjected to the constant comparative method of analysis. Credibility and accuracy of the themes and emerging conceptual categories were confirmed by an independent rater and follow up telephone calls to participants. -- Three theoretical categories have emerged to define nurses' experiences with managing pain: knowing the resident; assuming the helping role; and striving to achieve positive outcomes. The emerging theory suggests that the constructs of knowing the resident, assuming the helping role and striving to achieve positive outcomes exert independent and interactive effects on nurses' abilities to manage residents' pain in long term care settings. Based on theoretical insights gleaned from the data it is postulated that "overcoming barriers" is the common thread intersecting and joining the constructs. -- Nurses are experiencing both success and frustrations in managing patients' pain. The current study's findings suggest that unless nurses have adequate understanding of the total person and insight into the barriers to and facilitators of pain management efforts, decisions about appropriate strategies and effective monitoring of intervention outcomes will be compromised in long term care settings