Experiences of the older hospitalised person on nursing pain care: An ethnographic insight

Aims and objectives To present an ethnographic insight into the older hospitalised person (those aged over 65 years) perceptions and experiences of pain care provision by nurses in acute care. Background Pain care provision by nurses remains less than optimal for the older hospitalised person despite numerous evidence-based guidelines. There is a paucity of research providing input from the experiences of the older hospitalised person in relation to their perspectives of pain care provision by nurses in acute care. Pain care research needs more involvement from those older persons with documented diagnoses of dementia, delirium or cognitive impairment, and intellectual disabilities and those in their end stage of palliation. Design A focused ethnographic study. The consolidated criteria for reporting qualitative research (COREQ) were used to report the findings of this study. Methods A focused ethnographic study was conducted in 8 acute care units within 2 large tertiary referral hospitals on the east coast of Australia. Consisting of semi-structured interviews (n = 12) of cognitively intact older persons (11 hr). Twenty-three (23) semi-structured interviews with nine (9) RN participants (12 hr and 38 min). Participant observation period totalled 1,041 hr. Results The older persons' experiences of receiving pain care were based on a formulaic assessment process focusing on intensity of pain and pain management options provided often lacked their input. The older persons often did not perceive their pain care provision as being of benefit to themselves. The nurses lacked insight and understanding on the nature of pain for the older person. Conclusion Understanding was gained into how the older persons' pain care was hampered due to the lack of appropriate, and meaningful pain care provision and provides insight into why the older hospitalised person continues to experience a less than optimal experience. Relevance to clinical practice Older hospitalised persons can gain continuity of pain care when nurses negotiate with them to repattern or restructure their nursing routines for pain care provision. Older people need inclusion into pain care decisions. All vulnerable older persons require nurses to use an evidence-based pain assessment tool.