To Örebro University

Background: Pain assessment in people living with dementia is a challenge due to the complexity of pain and dementia and the difficulties in self-reporting. In home healthcare, nurses are frequently involved in pain assessment situations and there is a need to explore how home healthcare teams' manage pain assessment in this setting.

Aim: The study aimed to explore home healthcare teams' experiences of pain assessment among care recipients with dementia.

Design: An exploratory qualitative design was used.

Methods: Open-ended individual interviews were conducted with thirteen registered nurses and ten nursing assistants, working in three different home healthcare teams in one municipality in western Sweden. Philosophical hermeneutics was utilised to interpret the home healthcare teams' experiences.

Results: Four interpretations emerged: the need for trusting collaboration, the use of multiple assessment strategies, maintenance of staff continuity in care and assessment situations, and the need for extended time to assess pain.

Conclusions: The home healthcare teams recognise pain assessment in people with dementia as involving a complex interaction of sensory, cognitive, emotional and behavioural components in which efforts to acquire understanding of behavioural changes mainly guides their assessments. The solid team coherence between registered nurses and nursing assistants aided the assessment procedure. To assess pain, the teams used multiple methods that complemented one another. However, no systematic routines or appropriate evidence-based pain tools were used.

Implications for Practice: The team members'concern for care recipients when assessing pain is evident and needs to be acknowledged by the organisation which is responsible for the quality of care. Future studies should focus on further exploration of nurses' experiences with pain and dementia in home healthcare settings and address what nurses identify and how they deal with their findings. It is imperative to investigate how organisations and nurses can ensure best practices and how the implementation of evidence-based routines for assessing pain may aid in pain assessment situations.