Elderly patients' experiences of pain and distress from the patients' and nurses' point of view

Abstract

The aims of these studies were to investigate some aspects of elderly patientsí pain and distress, related to their sense of coherence (SOC), need for social support, functional ability, and background variables and to compare patientsí reported experiences of pain and distress with nursesí assessments. The first study investigated pain and distress from elderly patientsí perspective using a grounded theory approach in intensive care. Interviews and observations were conducted with 18 patients. A model, developed from the analysis of data, describes elderly patientsí experiences of pain and distress as four interrelated aspects: a sensory, an intellectual, an emotional, and an existential dimension. Sixteen categories form the four dimensions. Questionnaires derived from this model were used in studies II-V. Study II compared elderly patientsí (n = 51) reported experiences of pain and distress with nursesí (n = 44) and enrolled nursesí (n = 37) assessments in intensive care. The patientsí self-reported experiences of pain and distress did not agree completely with the nursesí and enrolled nursesí assessments. Nurses overestimated some of the patientsí experiences; whereas enrolled nurses tended to underestimate the patientsí pain and distress and assessed the interventions as more sufficient than did their patients. The third study explored postoperative experiences of pain and distress in elderly patients. One-hundred patients who had undergone elective surgery in two orthopaedic and two surgical units were interviewed, using a structured interview format on three occasions. Logistic regression analyses showed that pain and distress were significantly related above all to type of surgery and SOC. Three different clusters of patients, who showed variations in their experiences of pain and distress, were identified. Study IV compared experiences of pain and distress among older chronic pain patients in the community with enrolled nursesí assessments and related potential differences to patient and enrolled nurse characteristics. Data were collected through personal interviews with 38 patients and questionnaires completed by 38 enrolled nurses. Enrolled nurses underestimated patientsí experiences of physical pain and discomfort, breathing problems, resignation, and dependency. Personality as a nurse characteristic seemed to influence the enrolled nursesí assessment of patientsí pain and distress. The fifth study identified various profiles of experiences of pain and distress experiences among older chronic pain patients and compared if background variables, SOC, functional ability, and experiences of interventions aimed at reducing pain and distress varied between the profiles of patients. Interviews were carried out with 42 elderly patients. A cluster analysis yielded three clusters, each representing a different profile of patients. One profile, with subjects of advanced age, showed a decreased functional ability, and favourable scores in most of the categories of pain and distress. Another profile of patients showed favourable mean scores in all categories. The third cluster of patients showed unfavourable scores in most categories of pain and distress. In conclusion, the assessment of patientsí pain and distress could be more systematic in acute health care as well as in the community. Nurses need to become aware of possible biases related to pain and distress assessment as a result of personality factors and other variables. Patients in postoperative care, as well as in the community, with less favourable scores of pain and distress had a weaker SOC compared with patients with more favourable pain and distress scores. The differences suggest that there is a need to treat the patients in different ways in the caring situation.