Pain Management in People With Dementia Living in Nursing Homes: A Focused Ethnographic Study

The literature on pain management for people with dementia in nursing homes places significant emphasis on the limitations dementia imposes on their ability to describe and express their pain. Little is known about how healthcare personnel can support and use the individual resources people with dementia have in pain management. Thus, this study aimed to explore pain management in people with dementia in nursing homes, focusing on the resources people with dementia have and how healthcare personnel can support and integrate these resources into their clinical practice. We applied an exploratory design with a focused ethnographic approach and collected data through participatory observations and field conversations, as well as notes from residents' medical charts. The study setting was a nursing home unit specializing in dementia care in a larger city in Norway. The study included residents with moderate- to severe stage dementia (n = 18) and nurses caring for them (n = 12). The data were analysed in line with qualitative content analysis. The analysis identified two categories: (a) Residents' pain narratives and (b) Nurses' interpretation and support. Within each category, several subcategories were identified. The categories are linked together in one overarching, latent theme describing how people with dementia express themselves in the moment and nurses integrate these moments into a coherent whole. Findings also indicate that people with dementia have individual resources and strengths that are important for pain management. With support from healthcare personnel, they can be active participants in pain management processes, in accordance with their individual abilities.