Barriers to adequate pain and symptom relief at the end of life: A qualitative study capturing nurses’ perspectives

Gerber, K; Willmott, L; White, B; Yates, P; Mitchell, G; Currow, DC; Piper, D

Barriers to adequate pain and symptom relief at the end of life: A qualitative study capturing nurses’ perspectives

Gerber, K Willmott, L White, B Yates, P Mitchell, G Currow, DC Piper, D

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Publisher:: Elsevier BV
Publication Type:: Journal Article
Citation:: Collegian, 2021
Issue Date:: 2021-01-01

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Field	Value	Language
dc.contributor.author	Gerber, K
dc.contributor.author	Willmott, L
dc.contributor.author	White, B
dc.contributor.author	Yates, P
dc.contributor.author	Mitchell, G
dc.contributor.author	Currow, DC
dc.contributor.author	Piper, D
dc.date.accessioned	2021-09-10T03:39:55Z
dc.date.available	2021-09-10T03:39:55Z
dc.date.issued	2021-01-01
dc.identifier.citation	Collegian, 2021
dc.identifier.issn	1322-7696
dc.identifier.uri	http://hdl.handle.net/10453/150445
dc.description.abstract	Background: Symptom management remains a critical challenge at the end of life. Barriers to symptom relief predominantly focus on perspectives of physicians, patients or care systems but rarely acknowledge the views of nurses. Aim: Examine nurses’ perceptions of barriers to adequate end-of-life symptom relief. Methods: Semi-structured interviews with 25 nurses across different settings who routinely prescribed and/or administered symptom relief to patients near the end of life in Queensland and New South Wales, Australia. Data were analysed using a six-stage hybrid thematic analysis technique. Findings: Nurses identified five barriers to adequate symptom management. Firstly, fears concerning symptom relief such as hastening death, causing addiction, loss of consciousness, and legal/professional repercussions affected clinical practice. Secondly, lack of knowledge, experience and training hindered symptom management. Nurses discussed knowledge gaps regarding medication and palliative care, symptom assessments, recognition of dying and relevant laws. Thirdly, personal, cultural and religious beliefs influenced staff's willingness to offer pain relief, and patients’ and families’ willingness to accept it. Lack of communication between medical teams, patients and families further challenged symptom management. Lastly, institutional barriers played a considerable role as time constraints, insufficient staff support and difficulties accessing resources prevented end-of-life symptom management. Discussion: The identified barriers highlight a substantial need for targeted interventions. Setting-specific challenges such as limited access to medication, staff and palliative care services must be addressed. Conclusions: To provide better end-of-life care, services should acknowledge nurses’ unique insights. Particular attention should be on supporting nurses in aged care facilities, community settings and remote areas.
dc.language	en
dc.publisher	Elsevier BV
dc.relation	http://purl.org/au-research/grants/nhmrc/1060254
dc.relation.ispartof	Collegian
dc.relation.isbasedon	10.1016/j.colegn.2021.02.008
dc.rights	info:eu-repo/semantics/closedAccess
dc.subject	1110 Nursing
dc.subject.classification	Nursing
dc.title	Barriers to adequate pain and symptom relief at the end of life: A qualitative study capturing nurses’ perspectives
dc.type	Journal Article
utslib.for	1110 Nursing
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/IMPACCT
utslib.copyright.status	closed_access	*
dc.date.updated	2021-09-10T03:39:54Z
pubs.publication-status	Published

Abstract:

Background: Symptom management remains a critical challenge at the end of life. Barriers to symptom relief predominantly focus on perspectives of physicians, patients or care systems but rarely acknowledge the views of nurses. Aim: Examine nurses’ perceptions of barriers to adequate end-of-life symptom relief. Methods: Semi-structured interviews with 25 nurses across different settings who routinely prescribed and/or administered symptom relief to patients near the end of life in Queensland and New South Wales, Australia. Data were analysed using a six-stage hybrid thematic analysis technique. Findings: Nurses identified five barriers to adequate symptom management. Firstly, fears concerning symptom relief such as hastening death, causing addiction, loss of consciousness, and legal/professional repercussions affected clinical practice. Secondly, lack of knowledge, experience and training hindered symptom management. Nurses discussed knowledge gaps regarding medication and palliative care, symptom assessments, recognition of dying and relevant laws. Thirdly, personal, cultural and religious beliefs influenced staff's willingness to offer pain relief, and patients’ and families’ willingness to accept it. Lack of communication between medical teams, patients and families further challenged symptom management. Lastly, institutional barriers played a considerable role as time constraints, insufficient staff support and difficulties accessing resources prevented end-of-life symptom management. Discussion: The identified barriers highlight a substantial need for targeted interventions. Setting-specific challenges such as limited access to medication, staff and palliative care services must be addressed. Conclusions: To provide better end-of-life care, services should acknowledge nurses’ unique insights. Particular attention should be on supporting nurses in aged care facilities, community settings and remote areas.

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http://hdl.handle.net/10453/150445