Learning disability nurses' experiences of being with clients who may be in pain.

Abstract

This study aims to describe the experiences of Learning Disability Nurses (RNLDs) when they are with clients who may be in pain but who cannot communicate their feelings verbally. Research indicates that general nurses often find it difficult to perceive their patients' pain accurately, but no studies refer to the experiences of RNLDs. For people with severe learning disabilities this could lead not only to unnecessary suffering, but also to long-term tissue damage and may even prove fatal. A phenomenological approach was adopted, as unrecognized pain is a subject about which little is known and the lived experiences of nurses and the meanings that they attach to them were being explored. Data were collected by unstructured interviews with a snowball sample of eight RNLDs. The participants were asked to describe a situation in which they thought a client was in pain. Analysis was based on Hycner's guidelines for the phenomenological analysis of interviews. Five central themes emerged: the importance of a caring relationship with the client, recognizing changes in verbal and nonverbal behaviour, searching for a meaning in the client's behaviour, negotiating with other health professionals and sharing in the client's feelings. Nurses valued highly their relationship with a client, which can, in itself, be therapeutic. Clients apparently used a wide range of both conventional and nonconventional forms of nonverbal communication, including aggressive and self-harming behaviours, as the primary way of expressing pain. Functional speech cannot be taken as an indicator that the clients can self-care with regard to pain. RNLDs play an important role in negotiating between their clients and other health professionals, but must be careful not to make assumptions about the causes of pain and pass these assumptions on to the General Practitioner as a professional opinion. The use of diagnostic tests should be supported. RNLDs appeared to be sympathetic, rather than empathetic, towards their client's painful experiences.