Geriatric Hospital Nurses' Empathy, Attitude and Pain Management for Patients with Dementia

Mihyun Lee; Myonghwa Park

doi:10.7469/kjan.2016.28.4.388

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Lee and Park: Geriatric Hospital Nurses' Empathy, Attitude and Pain Management for Patients with Dementia

Original Article

Korean J Adult Nurs 2016;28(4):388-398.

Published online: NaN August 2016

DOI: https://doi.org/10.7469/kjan.2016.28.4.388

Geriatric Hospital Nurses' Empathy, Attitude and Pain Management for Patients with Dementia

Mihyun Lee, MSN, RN¹, Myonghwa Park, Ph.D., RN^2,

^¹Doctoral Student, College of Nursing, Chungnam National University, Daejeon

^²Professor, College of Nursing, Chungnam National University, Daejeon, Korea

Corresponding author: Park, Myonghwa College of Nursing, Chungnam National University, 266 Munhwa-ro, Jung-gu, Daejeon 35015, Korea. Tel: +82-42-580-8328, Fax: +82-42-580-8309, E-mail: mhpark@cnu.ac.kr

Received 28 April 20169 August 2016 Accepted 22 August 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purposes of this study were to identify nurses' empathy, attitude and pain management for patients with dementia and the factors associated with their performance of pain management.

Methods

The study design was a cross-sectional survey. The participants in the study were 114 nurses working at 12 geriatric hospitals. This study utilized the Interpersonal Reactivity Index (IRI), which measures four empathy factors. Nurses’ attitudes toward pain and performance of pain management, and general and pain related characteristics were measured by self-administered questionnaires.

Results

Barriers to pain management for patients with dementia were absence of guidelines, prejudice of pain in dementia, and lack of time and knowledge deficit. There was a significant positive correlation between empathic concern and attitudes, perspective-taking of empathy and pain management. There was also a correlation between empathy and pain management. Stepwise linear regression analysis indicated that the significant factors affecting the performance of pain management included perspective-taking of empathy, use of pain management in dementia guideline and attitudes toward pain. These factors explained 24.0% of variance.

Conclusion

The findings from this study suggest that empathy and positive attitude are the important provider attributes which needs to be enhanced by educational programs. It is also necessary to develop and disseminate guidelines for a dementia specific pain management.

Keywords: Dementia, Empathy, Attitude, Pain, Nurses

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Table 1.

Geriatric Hospital Nurses' General and Pain related Characteristics (N=114)

Characteristics	Categories	n (%) or M±SD
Age (year)		44.22±8.62
	＜40	39 (34.2)
	＜40 40~49	39 (34.2) 42 (36.9)
	≥50	33 (28.9)
Gender	Female	110 (96.5)
Gender	Male	4 (3.5)
Marital status	Married	100 (87.7)
	Single	13 (11.4)
	Others	1 (0.9)
Level of education	3 year	54 (47.4)
Level of education	4 year	60 (52.6)
Work position	Head	23 (20.2)
	Charge	13 (11.4)
	Staff	78 (68.4)
Years at geriatric hospital^†		5.73±3.31
	＜5	40 (37.7)
	5~9	50 (47.2)
Total years of career experience^†		13.32±7.33
	＜5	8 (7.4)
	5~9	19 (17.6)
	10~14	45 (41.7)
	≥15	36 (33.3)
Knowledge of general pain management	Yes	42 (36.8)
Knowledge of general pain management	No	72 (63.2)
Competency of general pain management	Yes	33 (28.9)
Competency of general pain management	No	81 (71.1)
Educational experience of pain management in dementia	Yes	59 (51.8)
Educational experience of pain management in dementia	No	55 (48.2)
Educational source of pain management in dementia^‡	Continuing education	34 (29.8)
	Hospital	32 (28.1)
	Professional association	9 (7.9)
	Academic society	13 (11.4)
	Graduate courses	4 (3.5)
Number of pain management education in dementia^†	1	20 (34.5)
	3	8 (13.7)
	≥4	15 (25.9)
Need for education of pain management in dementia	Yes	112 (98.2)
Need for education of pain management in dementia	No	2 (1.8)
Educational contents for pain management in dementia^‡	Medications	77 (67.5)
	Type of pain assessment	60 (52.6)
	Use of pain assessment scale	39 (34.2)
	Non-pharmacological intervention	37 (32.5)
	Pathology of pain	33 (28.9)
	Outcome of pain	36 (31.6)
	Classification of pain	29 (25.4)
	Barriers to pain management	26 (22.8)
	Effect of pain management	18 (15.8)
Use of pain management guideline	Yes	37 (32.5)
Use of pain management guideline	No	77 (67.5)
Sources of pain management guideline^‡	Hospital	11 (9.6)
	Professional association	8 (7.0)
	Academic society	15 (13.2)
	Others	5 (4.4)
Barriers to pain management in dementia^‡	Previous habit of caring for patient	s 37 (32.5)
	Lack of knowledge	32 (28.1)
	Lack of responsibility	19 (16.7)
	High-risk patient classification	11 (9.6)
	Not important	2 (1.8)
	Absence of guidelines	60 (52.6)
	Lack of time	35 (30.7)
	Lack of facilities and support	25 (21.9)
	Lack of human resource	25 (21.9)
	Not a priority	23 (20.2)
	Difficulty of procedure	21 (18.4)
	Taking a long time	7 (6.1)
	Lack of experts to referral	21 (18.4)
	Lack of other staffs' cooperation	14 (12.3)

^† Missing value was excluded;

^‡ Multiple response.

Table 2.

Empathy, Attitudes, and Performance of Pain Management (N=114)

Variables	Categories	Range	M±SD
Empathy	Fantasy	1.71~4.86	3.25±0.64
	Empathic concern	1.29~4.86	3.59±0.58
	Perspective-taking	2.43~4.86	3.50±0.53
	Personal distress	1.29~4.29	2.69±0.54
Attitudes toward pain in dementia		2.08~3.50	2.76±0.26
Performance of pain management in dementia	Assessment	2.83~5.00	4.13±0.56
	Intervention	2.57~5.00	3.92±0.57
	Total	2.66~4.97	3.99±0.51

Table 3.

Differences in Empathy, Attitude, Performance of Pain Management according to the Geriatric Hospital Nurses' Characteristics (N=114)

Characteristics	Categories	n	Empathy: fantasy		Empathy: empathic concern		Empathy: perspective -taking		Empathy: personal distress		Attitudes		Pain management: assessment		Pain management: intervention		Pain management: total
Characteristics	Categories	n	M±SD	t or F (p)	M±SD	t or F (p)	M±SD	t or F (p)	M±SD	t or F (p)	M±SD	t or F (p)	M±SD	t or F (p)	M±SD	t or F (p)	M±SD	t or F (p)
Age (year)	＜40	39	3.29±0.68	0.12	3.54±0.62	4.91	3.41±0.57	2.62	2.75±0.47	2.08	2.75±0.29	0.44	4.12±0.54	0.49	3.81±0.57	1.09	3.92±0.50	0.59
	40~49^a	42	3.23±0.64	(.881)	3.43±0.58	(.009)	3.44±0.49	(.077)	2.56±0.57	(.130)	2.74±0.24	(.642)	4.19±0.55	(.609)	3.95±0.53	(.337)	4.03±0.49	(.556)
	≥50^b	33	3.23±0.61		3.84±0.46	a＜b	3.68±0.52		2.80±0.55		2.80±0.26		4.06±0.61		4.00±0.61		3.99±0.51
Marital status	Married	100	3.28±0.64	-1.51	3.62±0.58	-1.40	3.52±0.53	-1.01	2.71±0.55	-0.71	2.77±0.26	-0.59	4.13±0.57	-0.18	3.96±0.55	-2.05	4.02±0.51	-1.55
Marital status	Others	14	3.01±0.64	(.133)	3.38±0.59	(.164)	3.36±0.57	(.313)	2.60±0.46	(.479)	2.72±0.27	(.556)	4.10±0.55	(.855)	3.63±0.59	(.043)	3.79±0.51	(.527)
Level of education	3 year	54	3.23±0.62	-0.25	3.54±0.55	-0.86	3.41±0.49	-1.59	2.72±0.54	0.57	2.71±0.23	-1.75	4.03±0.55	-1.77	3.89±0.61	-1.30	3.91±0.52	-1.62
Level of education	4 year	60	3.26±0.67	(.803)	3.63±0.61	(.388)	3.57±0.56	(.113)	2.67±0.54	(.568)	2.80±0.29	(.082)	4.22±0.56	(.078)	3.98±0.52	(.193)	4.06±0.49	(.107)
Job position	Head/charg	e 36	3.24±0.63	-0.14	3.61±0.50	0.27	3.63±0.58	1.75	2.71±0.49	0.20	2.86±0.28	2.80	4.10±0.62	-0.41	3.92±0.52	0.01	3.98±0.51	-0.14
Job position	Staff	78	3.26±0.65	(.886)	3.58±0.62	(.788)	3.44±0.51	(.082)	2.69±0.56	(.842)	2.71±0.24	(.006)	4.14±0.54	(.678)	3.92±0.59	(.985)	4.00±0.52	(.886)
Years at geriatric hospital	＜5^a	40	3.28±0.72	0.31	3.54±0.71	0.17	3.40±0.50	0.80	2.80±0.59	1.74	2.68±0.23	10.41	4.18±0.55	1.88	3.94±0.55	1.47	4.02±0.49	1.94
	5~9^b	50	3.26±0.57	(.730)	3.60±0.49	(.842)	3.53±0.57	(.452)	2.74±0.51	(.180)	2.75±0.23	(＜.001)	4.01±0.57	(.157)	3.83±0.59	(.234)	3.89±0.52	(.148)
	10~14^c	16	3.13±0.64		3.52±0.57		3.53±0.41		2.50±0.41		3.01±0.30	a＜c b＜c	4.29±0.60		4.10±0.53		4.17±0.51
Total years of career experience	＜5	8	3.14±0.85	0.29	3.62±0.82	0.45	3.64±0.58	1.44	2.76±0.57	1.83	2.68±0.32	4.98	3.87±0.53	1.22	3.77±0.65	0.35	3.81±0.53	0.65
	5~9^a	19	3.18±0.62	(.831)	3.48±0.48	(.715)	3.36±0.39	(.234)	2.77±0.38	(.145)	2.59±0.22	(.003)	4.21±0.51	(.305)	4.00±0.58	(.788)	4.07±0.49	(.579)
	10~14	45	3.31±0.65		3.54±0.65		3.42±0.55		2.80±0.59		2.76±0.24	a＜b	4.18±0.56		3.90±0.53		4.00±0.48
	≥15^b	36	3.25±0.63		3.66±0.50		3.63±0.54		2.53±0.52		2.86±0.27		4.01±0.59		3.87±0.60		3.92±0.56
Knowledge of general pain management	Yes	42	3.24±0.62	0.12	3.62±0.60	-0.50	3.65±0.49	-2.32	2.49±0.55	3.22	2.78±0.29	-0.66	4.28±0.56	-2.25	4.10±0.50	-2.72	4.17±0.46	-2.85
Knowledge of general pain management	No	72	3.25±0.66	(.901)	3.57±0.58	(.613)	3.41±0.54	(.022)	2.81±0.49	(.002)	2.75±0.25	(.510)	4.04±0.55	(.026)	3.81±0.58	(.007)	3.89±0.51	(.005)
Competency of general pain management	Yes	33	3.26±0.64	-0.10	3.65±0.67	-0.65	3.57±0.56	-0.88	2.54±0.69	1.89	2.74±0.30	0.21	4.30±0.63	1.96	4.16±0.51	3.12	4.21±0.51	2.95
Competency of general pain management	No	81	3.25±0.65	(.917)	3.56±0.55	(.512)	3.47±0.52	(.380)	2.75±0.45	(.060)	2.77±0.25	(.641)	4.06±0.52	(.055)	3.82±0.56	(.003)	3.90±0.49	(.004)
Educational experience of pain management in dementia	Yes	59	3.21±0.57	0.61	3.60±0.53	-0.19	3.58±0.52	-1.70	2.56±0.54	2.88	2.75±0.27	0.27	4.17±0.57	-0.74	4.03±0.53	-2.11	4.07±0.49	-1.81
Educational experience of pain management in dementia	No	55	3.29±0.72	(.539)	3.58±0.63	(.844)	3.41±0.54	(.092)	2.84±0.50	(.005)	2.77±0.26	(.783)	4.09±0.55	(.458)	3.80±0.59	(.037)	3.90±0.52	(.072)
Use of pain management guideline	Yes	37	3.20±0.67	0.56	3.61±0.51	-0.32	3.54±0.40	-0.69	2.57±0.50	1.75	2.67±0.24	2.47	4.34±0.60	-2.90	4.11±0.63	-2.47	4.19±0.58	-2.91
Use of pain management guideline	No	77	3.27±0.67	(.574)	3.58±0.62	(.747)	3.48±0.59	(.489)	2.76±0.55	(.081)	2.80±0.26	(.015)	4.02±0.52	(.004)	3.88±0.52	(.015)	3.90±0.58	(.004)

a, b, c: Scheffé test.

Table 4.

Correlation among Empathy, Attitude, and Performance of Pain Management (N=114)

Variables	Categories	Empathy				Attitude
		FS	EC	PT	PD	Attitude
		r (p)	r (p)	r (p)	r (p)	r (p)
Empathy	EC	.46 (＜.001)
	PT	.37 (＜.001)	.59 (＜.001)
	PD	.22 (.017)	-.04 (.646)	-.10 (.250)
Attitude		.09 (.322)	.22 (.015)	.13 (.141)	-.09 (.293)
Pain management in dementia	Total	.02 (.814)	.15 (.102)	.27 (.003)	-.12 (.188)	.12 (.170)
	Assessment	.06 (.519)	.11 (.238)	.19 (.041)	-.07 (.408)	.18 (.045)
	Intervention	-.01 (.992)	.15 (.102)	.28 (.002)	-.13 (.168)	.08 (.394)

FS=fantasy; EC=empathic concern; PT=perspective-taking; PD=personal distress.

Table 5.

Associated Factors with Performance of Pain Management by Stepwise Multiple Regression (N=114)

Variables	B	SE	β	t	R²	p
(Constant)	72.02	24.11		2.98		.004
Empathy: Perspective-taking	1.42	0.56	0.29	2.51	.08	.013
Use of pain management guideline	7.61	4.07	0.25	2.39	.19	.019
Attitude toward pain in dementia	1.28	0.58	0.22	2.20	.22	.030
Competency of general pain management	-0.32	0.58	0.19	1.86	.25	.065
R²=.25, Adjusted R²=.24, F=2.48, p=.006

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