Registered Nurses´ View of Performing Pain Assessment among Persons with Dementia as Consultant Advisors

BACKGROUND: Pain assessment in persons with dementia is well known as a challenging issue to professional caregivers, because of these patients´ difficulties in verbalising pain problems. Within municipal dementia care in Sweden, pain assessment has become problematic for registered nurses, as they have entered a new role in their nursing profession, from being clinical practitioners to becoming consultant advisers to other health care staff. AIM: To present municipal registered nurses´ view of pain assessment in persons with dementia in relation to their nursing profession as consultant advisers. METHODS: Purposive sampling was undertaken with 11 nurses invited to participate. Data were collected by focus groups. Qualitative content analysis was used to analyse the data. FINDINGS: Four categories were identified to describe registered nurses´ view of pain assessment: estrangement from practical nursing care, time consuming and unsafe pain documentation, unfulfilled needs of reflection possibilities, and collaboration and coordination. CONCLUSIONS: The performance of pain assessment through a consultant advising function is experienced as frustrating and as an uncomfortable nursing situation. The nurses feel resistance to providing nursing in this way. They view nursing as a clinical task demanding daily presence among patients to enable them to make accurate and safe assessments. However, due to the consultative model, setting aside enough time for the presence seems difficult to accomplish. It is necessary to promote the quality of systematic routines in pain assessment and reflection, as well as developing professional knowledge of how pain can be expressed by dementia patients, especially those with communication difficulties.