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
Official Date:	July 2011
Dates:	Date Event July 2011 Submitted
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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