Daibes, Mayada (2011) "A pain that ruins mountains" : a case study of factors influencing postoperative pain management in two Jordanian hospitals. PhD thesis, University of Warwick.

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Abstract

Postoperative pain is still poorly managed among surgical patients despite evidence-based approaches to its treatment being well established. Prompted by the persistence of this problem, many researchers have studied factors influencing postoperative pain management. Empirical clinical research has dominated this area and has presented a set of factors which, albeit important, have not taken into account the influence of contextual factors on the individual’s practices in pain management. This study is designed to examine the role of context on the practices and interactions of professionals and patients during postoperative pain management. Informed by the insights of post-structuralism, it uses nonparticipant observation, informal and semi-structured interviews with participants of both genders (29 staff nurses, 13 surgeons, 38 patients, and 20 patients’ family members), and a document review to construct a case study of four surgical patients’ wards in two Jordanian hospitals. Also included is a descriptive analysis of pain and distress scores, and a thematic analysis of the raw data The findings reveal both a significant problem with pain among Jordanian surgical patients, and limited engagement by nurses in postoperative pain management. It is found that a series of socio-cultural and organizational factors limit participants’ practices in respect of pain management. Influential socio-cultural factors include: sexual surveillance, an inferior public view of nurses, patriarchal ideas, and use of personal influence (wasta). Organisational factors include: hierarchical observations, fear of punishment, the subordination of nursing staff, perceptions of low staffing and high workload, and social hierarchies, such as rank. In combination these contextual factors operate as a set of disciplinary and power mechanisms that limit the ability of nurses to become involved in patients’ pain management; impede nursing professionalism by restricting autonomy and self-regulation; reduce some of the patients’ willingness to communicate pain and lead to a reluctance to be cared for by professionals of a different gender. It is concluded that in this area organisational policies are subservient to nurses’ culturally constructed approaches to pain management. As such, socio-cultural factors appeared to have a greater effect than organizational factors. Recommendations are made to address the situation and provide for appropriate pain relief after surgery.

Item Type:	Thesis or Dissertation (PhD)
Subjects:	R Medicine > RD Surgery R Medicine > RT Nursing
Library of Congress Subject Headings (LCSH):	Postoperative pain -- Jordan, Pain -- Treatment -- Jordan, Nursing -- Jordan
Date:	July 2011
Institution:	University of Warwick
Theses Department:	School of Health and Social Studies
Thesis Type:	PhD
Publication Status:	Unpublished
Supervisor(s)/Advisor:	Seers, Kate ; Blaxter, Loraine, 1945-
Extent:	xv, 399 leaves : ill., charts
Language:	eng
URI:	http://wrap.warwick.ac.uk/id/eprint/47360

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