Nurses' culturally mediated practices influencing pain care provision for older people in acute care: Ethnographic study

Registered nurses (RN) have a pivotal role (Gorawara-Bhat, Wong, Dale, & Hogan, 2017) when undertaking pain care provision for their hospitalised patients. Pain care provision is person-centred and involves a comprehensive history, assessment, management and provision of education about pain for a patient, as well as provision of relief they find acceptable and deem safe. Numerous instances within research have identified known discrepancies between nursing assessment of pain and the pain experiences of patients (Dihle, Bjalseth, & Helseth, 2006; Gunningberg & Idvall, 2007; Schafheutle, Cantrill, & Noyce, 2001; van Dijk, Schuurmans, Alblas, Kalkman, & van Wijck, 2017; Watt-Watson, Stevens, Garfinkel, Streiner, & Gallop, 2001). Understanding and insight is lacking into why discrepancies and differences between nurses' and older persons' (those aged 65 years and over) perceptions of pain care provision are occurring. Presented here is an ethnographic insight from a nursing doctoral ethnographic study designed to explore practices of RN pain care provision for the older hospitalised person. This study provides understanding on how nursing culture can act as a barrier for effective pain care provision. The findings offer insight into why pain care provision can be less than ideal for the older person, despite the availability of evidence-based practice (EBP) guidelines. Furthermore, these findings are relevant for insight into the organisational context and how targeted measures in relation to education and managerial support are required for pain care.