Effective pain management as part of palliative care for persons living with HIV/AIDS in a developing country: a qualitative study

Abstract

Aim and objectives. The aim of this research was to explore and understand nurses' experiences of managing pain for persons living with human immune virus/ acquired immune deficiency syndrome receiving palliative care at home in Botswana. Background. Community palliative and hospice care in Africa and Botswana were developed for persons with end-stage acquired immune deficiency syndrome and other terminal illnesses being cared for at home. As antiretro viral therapies extend the lives of persons living with human immune virus/acquired immune deficiency syndromes, there is an increase in the chronic conditions associated with human immune virus/acquired immune deficiency syndrome. Despite a strong demand for care of persons living with human immune virus/acquired immune deficiency syndromes and other chronic illnesses, little is known about Botswanan community nurses' capacity to manage community-based end-of-life care for persons living with human immune virus/acquired immune deficiency syndromes. Design. A qualitative study approach guided by van Manen's interpretive analysis was undertaken. Methods. Data were collected using semi-structured interviews that were audiorecorded, transcribed and analysed using qualitative interpretive analysis. Thirteen nurses from 12 health districts in Botswana were recruited to the study using purposeful sampling. Results. Participants identified that pain management was a significant issue. A lack of nurses' ability to advocate effectively for patients because of a lack of relevant skills and knowledge and poor availability of appropriate analgesics was a limiting factor along with doctors' reluctance to prescribe opioids to effectively manage pain. Conclusion. Lack of resources coupled with lack of training for nurses has a negative impact on palliative care and the delivery of care services to persons living with human immune virus/acquired immune deficiency syndromes in Botswana. Relevance to clinical practice. Being attentive and listening to the nurses' voices in the provision of palliative care at home is an essential element in identifying the challenges they encounter. Lack of adequate palliative care training and a chronic shortage of resources have serious implications for the delivery of home-based palliative care in Botswana.