Publication Date

Spring 2015

Degree Type

Doctoral Project

Degree Name

Doctor of Nursing Practice (DNP)



First Advisor

Susan McNiesh

Second Advisor

Virginia Kane

Third Advisor

Canyon Steinzig


End of life, Substance Use Disorder, Qualitative metasynthesis, Knowing the patient, Subjectivity of pain


Pain management, end of life (EOL) care, and substance use disorder (SUD) are individually identified as National healthcare challenges and priorities. Despite 50 years of advances in the understanding of pain management, pain is still inconsistently assessed and undertreated in all populations, including those with life limiting illness. When a patient with a life limiting illness and history of SUD is encountered, pain management becomes further complicated. Effective pain management for all patients, regardless of coexisting complications, is an ethical obligation of health care providers. Given the lack of research into EOL pain management of patients with SUD, it is not surprising that such individuals have been identified as a vulnerable population at high risk for undertreatment of pain. Additionally, the physical, psychosocial/spiritual care of this population can be challenging and frustrating, and there are few studies to guide health professionals in any of these areas. In this qualitative metasynthesis, the findings were derived from collecting, analyzing, interpreting and synthesizing the qualitative literature from 2010 – 2015 on the phenomena. The findings of this project reaffirm that pain can only be a subjective experience, and there is no more reliable gauge of pain than the individual’s subjective report. The findings demonstrate also that clinicians continue to struggle with this subjectivity. The overarching finding of this project is that the concept of “knowing the patient” becomes even more significant as the foundation of effective care in the EOL/ SUD patient population. The combination of the key findings of this project, recommendations concerning pain management in EOL SUD patients, along with expert clinical knowledge and experience of end of life interdisciplinary team members, can provide a roadmap for the care of this challenging patient population.

Included in

Other Nursing Commons


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