Abstract

People with cancer are increasingly supported by home care services. Pain is a relevant symptom of these diseases and nurses of home care services are involved in the treatment. The German National Expert Standard "Pain management in nursing" includes evidence-based recommendations for the implementation of adequate pain management. Considering the given structural conditions of home care services, nurses describe both barriers and challenges with the implementation.By means of five guideline-based discussion groups, nurses of 14 home care services were questioned about the challenges they had experienced in pain management. The questioning focuses on the level of implementation of the recommendation for each aspect: pain assessment, pharmacological pain therapy, non-pharmacological pain therapy, pain-related side effects, information, training, and counseling in the care of people with cancer. A qualitative content analysis was conducted.On the one hand, the results illustrate a need for further knowledge and possibilities, e.g., for the assessment of pain as a multidimensional phenomenon and, on the other hand, that the conditions for continuous pain monitoring of cancer patients in home care services are limited. The need for short-term reconciliation with the treatment team and the practitioners proved to be more difficult than the cooperation with the palliative care network. Involvement of family members is important to ensure uninterrupted treatment.Beside knowledge and competencies regarding nursing care, structures and processes for interprofessional pain management need further development and research.

Highlights

  • People with cancer are increasingly supported by home care services

  • Pain is a relevant symptom of these diseases and nurses of home care services are involved in the treatment

  • nurses of 14 home care services were questioned about the challenges

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Summary

Hintergrund und Fragestellung

Schmerz ist ein häufig auftretendes Symptom bei Tumorpatienten [5]. Obwohl bei 90 % der Tumorpatienten eine zufriedenstellende Schmerztherapie möglich wäre [17], berichten 50,7 % unabhängig vom Krankheitsstadium und 66,4 % in einem fortgeschrittenen oder terminalen Stadium über Schmerzen. Inhaltlich beschrieben und festgelegt sind die Aufgaben Pflegender in der multiprofessionellen Schmerzversorgung in den Nationalen Expertenstandards „Schmerzmanagement in der Pflege“ [10, 12]. Mit Inkrafttreten des PflegeWeiterentwicklungsgesetzes (SGB XI) im Jahr 2008 sind ambulante Pflegedienste zur Umsetzung der Nationalen Expertenstandards „Schmerzmanagement in der Pflege“ verpflichtet. Als Herausforderung in der Umsetzung des Schmerzmanagements in der ambulanten pflegerischen Versorgung bei Tumorpatienten werden in der Literatur Barrieren genannt, die mit einem fehlenden Wissen der Pflegenden zum Schmerzmanagement begründet werden [13, 28, 33]. Zur Überwindung dieser Barrieren und für eine Verbesserung der multiprofessionellen Schmerzversorgung bei Tumorpatienten im häuslich ambulanten Bereich ist es wichtig, in der Evaluation des Schmerzmanagements neben der Sichtweise der Betroffenen auch die der professionellen Akteure einzubeziehen.

Medikamentöse Schmerztherapie
Nichtmedikamentöse Therapiemaßnahmen
Einhaltung ethischer Richtlinien
Literatur
Full Text
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