Assessment and management of acute pain in older people: barriers and facilitators to nursing practice

Abstract

Objective: The aim of this review was to examine the pain management practices of nurses, and identify barriers and facilitators to the assessment and management of pain for older people, within the acute hospital setting.

Design:  Integrative literature review.

Setting: Acute care for inpatients in a tertiary hospital.

Subjects: Older people defined as 65 years of age or over.

Primary argument: A nurse’s individual practice was found to significantly influence how pain is managed in the older patient; this encompassed nurses attitudes, communication, documentation, and the use of pharmacological and nonpharmacological strategies. Nurses’ ability to provide optimal care was found to be influenced by organisational factors such as workforce planning and the workplace environment. Provision of knowledge and skills to both nurses and older patients through education was found to facilitate better pain management; whilst a model of care whereby the nurse has authority and the patient is perceived as a passive recipient was found to be a hindrance to optimal pain management outcomes.

Conclusion: Findings indicate that nurses need to improve communication with older patients, increase their knowledge of pain assessment and management principles in regards to this population, and have a greater awareness of human and social influences. Whilst organisational factors can impact upon nursing care, pain management needs to be highly prioritised and promoted as  essential. Targeted education is required to overcome many of the identified barriers, and is a key recommendation from this review.