Home care nurses\u27 decisions about pain management with older clients

Unrelieved pain is a pervasive problem affecting a large percentage of older adults. To increase understanding of this problem, a qualitative study was done to describe the decision-making processes used by homecare nurses in selecting pain management interventions for older clients. The following research questions guided the investigation: How do experienced homecare nurses define situations and make decisions about pain management interventions for older clients? What factors do homecare nurses consider in defining the situation and making decisions about pain management interventions for older clients? What is the stream of nurses\u27 actions following decisions about pain management interventions for older clients? To answer these questions, data were collected from observations, interviews, and record reviews associated with 30 home visits by 12 nurses to older clients with pain. Patterns were identified in how nurses defined situations related to pain management. First, nurses defined that pain was no longer a problem when the pain was at the lowest level expected for the situation and acceptable to the client. Second, nurses thought that pain needed further assessment when clients were unable to provide adequate information about their pain. Third, nurses identified intermittent pain as needing better management when interventions were needed to improve pain relief. The fourth, fifth, and sixth ways that nurses defined pain related to poor management by caregivers, clients, or physicians. Following their definitions of situations, nurses decided to communicate with other health team members about pain management, arrange for additional services, and to instruct clients and caregivers about pain medications, non-pharmacological approaches, and safety measures. There were multiple factors that influenced how nurses defined their clients\u27 situations related to pain management. Examples of factors related to clients and caregivers were their description of pain, rating of pain level, and current pain treatment. In addition, physician and nurse knowledge, experience, beliefs, and communication factored into nurses\u27 definitions. Nursing actions observed following decisions about pain management included communication with other members of the health care team; instruction about pain medications, non-pharmacological approaches to pain, and safety; provision of nursing care and psychosocial support; and the arrangement of additional services