van Raders, Petronella (2012) Pain is what the patient says it is, but… : an ethnographic study of the factors which influence nurses when they make pain management decisions in a clinical setting. PhD thesis, University of Warwick.

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Abstract

Barriers to effective postoperative pain management mean many patients
suffer needless pain. Few studies have observed nurses as they manage
postoperative pain in a clinical setting; those who used observation have
demonstrated the importance of context to pain management practice.
This ethnographic study aimed to examine what factors influenced nurses
when they made pain management decisions, and how the culture of the
clinical environment impacted on pain management practice. One hundred
and fifty seven hours of participant and non-participant observation, semistructured
interviews with thirty-six members of staff, contemporaneous field
notes, and document analysis were used to investigate the culture of pain
management in one postoperative ward.
Analysis identified three themes with sub themes. First, the revealing of a
pain management culture, which incorporated the ward environment and
processes, and a new finding of the silence of routine pain management
communication. Second, nurses’ decision-making responses to pain
management opportunities including a new finding of a single pain
management action. The final theme is nurses’ expectations of patient
behaviours and knowledge, including how patients should look, what they
should say and know, and nurses’ responses to patients who do not conform
to expectations.
The findings suggest culturally mediated pain management behaviours,
linked to a ward culture where pain was not a priority, leading to inattention
to pain management. Using Social identity theory these behaviours are
presented as in-group pain management social norms; part of the culture of
‘how pain management is done around here’.
These pain management in-group behaviours are presented as the critical
factors influencing nurses’ pain management decision-making in a clinical
setting. They are not targeted through traditional education and their
explication may indicate pain management education should be directed
more towards cultural change.

Item Type:	Thesis or Dissertation (PhD)
Subjects:	R Medicine > RT Nursing
Library of Congress Subject Headings (LCSH):	Pain -- Treatment -- Decision making, Nursing -- Decision making
Official Date:	July 2012
Dates:	Date Event July 2012 Submitted
Institution:	University of Warwick
Theses Department:	School of Health and Social Studies
Thesis Type:	PhD
Publication Status:	Unpublished
Supervisor(s)/Advisor:	Seers, Kate; Rycroft-Malone, Jo
Sponsors:	League of St. Bartholomew’s Nurses
Extent:	364 leaves.
Language:	eng

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