Date of Award

2005

Degree Type

Thesis

Degree Name

Bachelor of Nursing Honours

Faculty

Faculty of Computing, Health and Science

Abstract

Pain, in palliative care clients, consists of more than just a physical manifestation of their condition. Pain can be experienced on a psychological or emotional level, a psychosocial level or even at a spiritual level. It is widely accepted that nurses in the palliative care setting manage well the physical issues that their clients have, but perceptions can vary on their management of the "non - physical" pain experienced by their clients. This study provided an opportunity for palliative care nurses to describe their perceptions of their management of the psychosocial and spiritual pain experienced by their clients in the home hospice setting through a qualitative, exploratory framework. Heideggerian phenomenology provided the philosophical base for the study, with the conceptual framework being established by concepts identified in a literature review of current knowledge and perceptions of psychosocial and spiritual issues, relating to palliative care nursing within the home hospice setting. The sample comprised of six Registered Nurses working in the palliative care, home hospice setting within the Perth Metropolitan area (Western Australia). First stage of recruitment for the study was by an open invitation, with the second phase being conducted within specific parameters to ensure that a purposive sample was achieved. The researcher-conducted interviews were tape recorded for later transcription and analysis. Qualitative analysis was performed on the interview transcripts, which produced four main themes. Existing perceptions of psychosocial and spiritual pain was the first theme identified in this study. In this theme, correlation was found between the concepts identified in the literature review and with the experience and perceptions of the nurses under study. The second theme described the nurses' perception of their role in the management of the psychosocial and spiritual pain experienced by their clients in the home hospice setting. This perception was found to relate to existing knowledge in that the primary role of nurses in this setting was said to consist of assessment and referral. The third theme described the factors that influenced the management of the "non- physical" pain in the clients. Factors relating to the three main stakeholders (the nurse, the client and the Silver Chain organization) were described first, followed by global factors that included all of the stakeholders. The last theme described the recommendations and advice for improvement of management of these issues. Formal assessment of psychosocial and spiritual pain, more specific training in management of these issues, and access to more spiritual resources were regarded as the main improvements to the organization, while the advice that was given related to improving holistic care, communication skills and maintenance of self care. The recommendations made by the nurses reflect those made in other studies regarding the importance of training for the nurses in dealing with these issues, as well as the accessibility of suitable resources to aid the management of these issues. The advice given by the nurses demonstrated how central the concept of holistic nursing was to palliative care, especially in the home hospice setting.

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