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Barriers to chronic pain management in community-dwelling low-income older adults: Home-visiting nurses’ perspectives

      Summary

      This study identified barriers to effective chronic pain management for low-income community-dwelling older adults from home-visiting nurses’ perspectives. Four focus group discussions investigated 23 nurses (five to six participants in each focus group) at local home-visiting nursing care centres in Suwon, Korea for data collection. Data were analyzed with inductive thematic analysis. Patient-related, nurse-related, and organizational barriers were identified. Patient-related barriers included limited understanding, lack of success in achieving compliance, continued use of traditional medicines, and financial hardship. Nurse-related barriers were limitations of managing chronic pain, inadequate knowledge and experience, lack of confidence, and uniform interventions. Organizational barriers included inadequate staffing and time constraints, few national support policies, unclear guidance, and limited access to available resources. The nurses’ experiences in caring for older adults with chronic pain provided insights into how nurses perceived barriers to adequate pain management in community-based settings; this may be different from acute care settings. This understanding precedes development of innovative practice strategies for chronic pain management in primary healthcare services.

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      References

        • American Geriatrics Society Panel on the Pharmacological Management of Persistent Pain in Older Persons
        Pharmacological management of persistent pain in older persons.
        Journal of the American Geriatrics Society. 2009; 57: 1331-1346
        • Austrian J.S.
        • Kerns R.D.
        • Reid M.C.
        Perceived barriers to trying self-management approaches for chronic pain in older persons.
        Journal of the American Geriatrics Society. 2005; 53: 856-861
        • Bair M.J.
        • Matthias M.S.
        • Nyland K.A.
        • Huffman M.A.
        • Stubbs D.L.
        • Kroenke K.
        • et al.
        Barriers and facilitators to chronic pain self-management: A qualitative study of primary care patients with comorbid musculoskeletal pain and depression.
        Pain Medicine. 2009; 10: 1280-1290
        • Barbour R.
        • Kitzinger J.
        The challenge and promise of focus groups.
        in: Barbour R. Kitzinger J. Developing focus group research: Politics, theory and practice. Sage, London1999: 1-20
        • Bernhofer E.I.
        • Sorrell J.M.
        Chronic pain in older adults.
        Journal of Psychosocial Nursing and Mental Health Services. 2012; 50: 19-23
        • Braun V.
        • Clarke C.
        Using thematic analysis in psychology.
        Qualitative Research in Psychology. 2006; 3: 77-101
        • Cornally N.
        • McCarthy G.
        Chronic pain: The help-seeking behavior, attitudes, and beliefs of older adults living in the community.
        Pain Management Nursing. 2011; 12: 206-217
        • Davis G.C.
        • Hiemenz M.L.
        • White T.L.
        Barriers to managing chronic pain of older adults with arthritis.
        Journal of Nursing Scholarship. 2002; 34: 121-126
        • Dewar A.
        Assessment and management of chronic pain in the older person living in the community.
        Australian Journal of Advanced Nursing. 2006; 24: 33-38
        • Dima A.
        • Lewith G.T.
        • Little P.
        • Moss-Morris R.
        • Foster N.E.
        • Bishop F.L.
        Identifying patients’ beliefs about treatments for chronic low back pain in primary care: A focus group study.
        The British Journal of General Practice. 2013; 63: e490-e498
        • Doody O.
        • Slevin E.
        • Taggart L.
        Focus group interviews part 3: Analysis.
        British Journal of Nursing. 2013; 22: 266-269
        • Egan M.
        • Cornally N.
        Identifying barriers to pain management in long-term care.
        Nursing Older People. 2013; 25: 25-31
        • Fisher R.
        • Ewing J.
        • Garrett A.
        • Harrison E.K.
        • Lwin K.K.
        • Wheeler D.W.
        The nature and prevalence of chronic pain in homeless persons: An observational study.
        1000 Research. 2013; 2: 164
        • Gaskin D.J.
        • Richard P.
        The economic costs of pain in the United States.
        The Journal of Pain. 2012; 13: 715-724
        • Gudmannsdottir G.D.
        • Halldorsdottir S.
        Primacy of existential pain and suffering in residents in chronic pain in nursing homes: A phenomenological study.
        Scandinavian Journal of Caring Sciences. 2009; 23: 317-327
        • Henry S.G.
        • Eggly S.
        How much time do low-income patients and primary care physicians actually spend discussing pain? A direct observation study.
        Journal of General Internal Medicine. 2012; 27: 787-793
        • Horsburgh D.
        Evaluation of qualitative research.
        Journal of Clinical Nursing. 2003; 12: 307-312
        • Jablonski A.
        • Ersek M.
        Nursing home staff adherence to evidence-based pain management practices.
        Journal of Gerontological Nursing. 2009; 35: 28-37
        • Kaasalainen S.
        • Brazil K.
        • Coker E.
        • Ploeg J.
        • Martin-Misener R.
        • Donald F.
        • et al.
        An action-based approach to improving pain management in long-term care.
        Canadian Journal on Aging. 2010; 29: 503-517
        • Kaasalainen S.
        • Coker E.
        • Dolovich L.
        • Papaioannou A.
        • Hadjistavropoulos T.
        • Emili A.
        • et al.
        Pain management decision making among long-term care physicians and nurses.
        Western Journal of Nursing Research. 2007; 29: 561-580
        • Karttunen N.M.
        • Turunen J.
        • Ahonen R.
        • Hartikainen S.
        More attention to pain management in community-dwelling older persons with chronic musculoskeletal pain.
        Age and Ageing. 2014; 43: 845-850
        • Kitzinger J.
        Qualitative research: Introducing focus groups.
        British Medical Journal. 1995; 311: 299-302
        • Lansbury G.
        Chronic pain management: A qualitative study of elderly people's preferred coping strategies and barriers to management.
        Disability and Rehabilitation. 2000; 22: 2-14
        • Matthias M.S.
        • Parpart A.L.
        • Nyland K.A.
        • Huffman M.A.
        • Stubbs D.L.
        • Sargent C.
        • et al.
        The patient-provider relationship in chronic pain care: Providers’ perspectives.
        Pain Medicine. 2010; 11: 1688-1697
        • Ministry of Health & Welfare
        2008 living profiles and welfare services needs of older persons in Korea.
        Author, Seoul, Korea2009
        • Ock M.
        • Kim J.E.
        • Jo M.W.
        • Lee H.J.
        • Kim H.J.
        • Lee J.Y.
        Perceptions of primary care in Korea: A comparison of patient and physician focus group discussions.
        BMC Family Practice. 2014; 15: 178
        • Park J.
        • Hirz C.E.
        • Manotas K.
        • Hooyman N.
        Nonpharmacological pain management by ethnically diverse older adults with chronic pain: Barriers and facilitators.
        Journal of Gerontological Social Work. 2013; 56: 487-508
        • Park J.
        • Hughes A.K.
        Nonpharmacological approaches to the management of chronic pain in community-dwelling older adults: A review of empirical evidence.
        Journal of the American Geriatrics Society. 2012; 60: 555-568
        • Smith B.H.
        • Torrance N.
        Management of chronic pain in primary care.
        Current Opinion in Supportive and Palliative Care. 2011; 5: 137-142
        • Teh C.F.
        • Karp J.F.
        • Kleinman A.
        • Reynolds Iii C.F.
        • Weiner D.K.
        • Cleary P.D.
        Older people's experiences of patient-centered treatment for chronic pain: A qualitative study.
        Pain Medicine. 2009; 10: 521-530
        • van Hecke O.
        • Torrance N.
        • Smith B.H.
        Chronic pain epidemiology and its clinical relevance.
        British Journal of Anaesthesia. 2013; 111: 13-18
        • Weiner D.K.
        • Rudy T.E.
        Attitudinal barriers to effective treatment of persistent pain in nursing home residents.
        Journal of American Geriatric Society. 2002; 50: 2035-2040
        • Wilsey B.L.
        • Fishman S.M.
        • Crandall M.
        • Casamalhuapa C.
        • Bertakis K.D.
        A qualitative study of the barriers to chronic pain management in the ED.
        American Journal of Emergency Medicine. 2008; 26: 255-263
        • Xu B.
        • Descalzi G.
        • Ye H.
        • Zhuo M.
        • Wang Y.
        Translational investigation and treatment of neuropathic pain.
        Molecular Pain. 2012; 8: 1-8
        • Yang S.O.
        • Lee S.H.
        A Survey on the customized visiting nurse's assessment and management of chronic musculoskeletal pain in older adults.
        Journal of Korean Academy Community Health Nursing. 2010; 21: 311-320