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nurses, pain, rural, terminally ill



  1. Jablonski, Kevin MSN, RN
  2. Duke, Gloria PhD, RN


The multifaceted burden of facing a terminal illness is compounded further by unrelieved pain. This descriptive qualitative study explores nurse perceptions of barriers to and facilitators for effective pain management for persons who are terminally ill and are in an acute care rural setting. Major barriers included themes of judgmentalism, lack of knowledge and skills, conflicts, lack of time, authoritative boundaries, and fears. Themes reflecting facilitators included education, use of specialty services, and individualized care. Implications for practice include the important need for eliminating myths and misperceptions of healthcare providers through innovative education and mentored practice; elimination of myths and misconceptions of family/patient; attainment of a more balanced physician-nurse authoritative structure; effective communication among all healthcare providers, patient, and family; facilitating support by nurse administrators to those who are advocating for patients in pain; and recognizing the dire need to overcome barriers to facilitate effective pain management in all populations. Future research should focus on longitudinal, interventional studies to improve pain management in this particularly vulnerable population in nonhospice, non-palliative care settings with measurable patient and family outcomes.