Originally posted by Grampy Bobby
Surely you jest. The scope and depth, narrative and graphic formula representations of this study presents an esoteric
challenge far exceeding the opening link. Mike, I need a few paragraphs of paraphrase in your own words. Thanks.
The interplay of perceiving and managing pain among nurses at a surgical ward
- a focus group study.
Aim: To describe surgical ward nurses’ perceptions of pain, and pain management.
Background: After abdominal surgery pain, as a cause of suffering, there are vital signs of physical illnesses and tissue injuries that bring people to hospital. A nurse is the person who plays a key role in the patient’s post-operative care, and therefore the one who usually has to intervene, manage, and relieve the pain that caused the patients to present themselves.
Design: This was a focused group design. This study reports on topics that are important to nurses’ perceptions of pain, and pain management, on a surgical ward.
Methods: This was a focused group design consisting of three focused group interviews, with 6 registered nurses (RNs) in each group. The interviews were conducted with a normal distribution sample of RNs at Nopparatrajathanee Hospital, Thailand.
Results: The result shows that nurses’ perceptions of pain operate in two categories. The first is as two perceptions of pain, which include unpleasant feelings of discomfort and suffering for the patient that are harmful as undesirable. These include the disability and change of personality for the patient. The second category is the nurses’ perception of pain management in three themes comprising; managing patients’ pain by being assertive; using belief and expectations. These results are reflections based upon nurses’ perceived and experienced roles, being some of the primary and important roles of the nurse. In order that the improvements regarding pain management practice, as knowledge of pain management, which have been found to be fragmentarily related to each other, represent only one perspective. The themes described form understandings, or ways of thinking about, perceptions of pain and pain management which, in relation to perceptions of pain and pain management as a whole, are either atomistic or holistic in character.
Conclusion: Findings point to the suggestion that nurses should demonstrate a holistic approach is usually applied on an individual basis; that can change, depending upon the patient, the situation, and the possibilities of approach; and also that how that approach might affect other patients, nurses, doctors, pharmacists, physiotherapists, and their relatives.
Keywords: Nurses’ perceptions of pain, pain-management, post-abdominal surgery.
It has been demonstrated that post-operative high levels of pain are experienced by 68% of patients, within the first 24 hours. Those levels of pain gradually decrease within 72 hours post-surgery (Vallano, et al. 1999; Apfelbaum, et al. 2003; IASP, 2011). According to previous research, it is shown that beliefs, attitudes, and cultures are important for nursing assessment, and the nursing care of post-operative pain (Edwards, et al. 2001; Sjöström, Owe Dahlgren & Haljamäe, 2000; Phengjard, Yousiri, & Petpichetchian, 2003).
In Thailand, as well as internationally, there is a general culture of development for nurses to play key roles in the management of post-operative pain. Hence, there is a need to study, to grasp and to understand the complex assessments of the varying nursing roles regarding post- abdominal surgeries. The relationships between ‘perceptions’ of pain and ‘pain management’; their cultural perceptions; their values, their beliefs and their fundamental knowledge all entwined need to be further studied. Therefore, this study aims to describe a surgical ward nurse’s perception of pain and pain management.
Definitions of pain, and pain management, after abdominal surgery.
Pain is an individual, subjective experience and a multi-dimensional phenomenon, related to six dimensions which include; physiological, sensorial, effectual, cognitive, behavioral, and socio-cultural dimensioned (McCaffery, 1968; McGuire, 1992). In accordance with those definitions, the primary aim of post-operative care is to manage pain at the lowest possible levels, given different modules of attendance and care guidelines, to help improve post-operative experiences and to reduce the suffering and shorten the recovery period (Samaraee, et al. 2010; IASP, 2011).
Abdominal pain, as a cause of suffering, is a vital sign of physical illness, and possible tissue injuries, that present patients to hospitals. Previous studies have shown that more than 50 % of people with abdominal pain require emergency abdominal surgery (Heading, 1999; Samaraee, et al. 2010).
Nurses play an important role in post-operative pain management, especially between 24 and 72 hours after surgery (Vallano, et al., 1999; Apfelbaum, et al., 2003; IASP, 2011). Pain management activities include; giving information and advice, giving sufficient pain medication to reduce that pain and using appropriate nursing therapeutics. Such therapeutics may include; active listening, acknowledging and valuing the individual’s and/or family’s perspectives, being empathetic, applying physical strategies such as breathing exercises, turning and positioning, wound supports, therapeutic hot and cold touches and massages and psychological and behavioral strategies. The latter may include cognitive behavioral strategies, stress management, patient and family education, self-management counseling groups, and other collaborations within the multi-disciplinary teams of experts (Poomnikom, 2000; Richards & Hubbert, 2007; Rejeh, et al. 2008; Suwanraj, 2010; IASP, 2011).
Perception is the organization, identification and interpretation of sensory information in order to represent and understand the environment. This perception involves signals in the nervous system, which in turn result from physical stimulation of the sense organs (Goldstein, 2009). Previous research studies by Back & Larrabee (1966) indicate that nurses’ perceptions should be positively correlated with patient perceptions. However, the studies found that there was a lack of correlation between these variables, suggesting four possible explanations for these. The suggestions included that: (i) The nurses may not have documented all nursing care given for treatment or prevention of pain; (ii) The lack of correlations may have been related to the tendency of patients to over-rate nursing and hospital care; (iii) It was possible that patients were unable to evaluate some aspects of their care; (iv) Nurses and patients do not always agree on a definition of quality nursing care.
Nurses have typically defined ‘quality’ as a conformance to standards of care, and patients usually have an undefined quality of care. This study by Rejeh, et al. (2008) recommended the need of improved communication between nurses and patients that can lead to a mutual definition of quality care. Patient satisfaction is directly related to a patient’s intent to return for treatment, where it is known that they will receive the best quality of care. A patient’s intent to recommend a place of quality, in today’s performance criteria, is of very high fundamental importance in environments of strong economic and highly competitive markets.
Additionally, previous studies by Sjöström (1995) and Cohen, et al (2009) revealed that the main factors resulting in insufficient pain management were related to both patients and healthcare providers, including physicians and nurses. Barriers found in patients included a fear of the side effects of pain medication and refusal to take medication (Rejeh, et al. 2008; Suwanraj, 2010).
Nurses are sometimes cited as contributors to the problems of inadequate pain management (Richards & Hubbert, 2007). Knowledge deficits may causes nurses to hold negative beliefs and attitudes toward opioid analgesics, in the under-estimated assessment of post-operative pain (Edwards, et al. 2001; Sjöström, Owe Dahlgren & Haljamäe, 2000; Phengjard, Yousiri, & Petpichetchian, 2003). A survey study by Horbury, Henderson & Bromley (2005) of 886 nurses showed that 50 % of nurses had insufficient knowledge, and negative attitudes, about pain, mostly in post-operative patients.
In Thailand, some descriptive research studies were carried out to explore the knowledge and practices of Thai nurses in pain management. Two studies showed that 58% and 54% of nurses had a fair level of pain management knowledge and practice respectively. (Yimyaem, et al. 2006; Charuluxananan, et al. 2009). The interesting finding of one study by Songkong, Petpichetchian, &Sae-Sia, in 2008, revealed that the clinical judgment of pain management within the nursing community was at a good level. However, the clinical judgment regarding the pain management of nurses was not significantly correlated with the actual pain management behavior of nurses. It can, therefore, be concluded that the situations that have surfaced and arisen from previous studies of insufficient pain management by Thai nurses are quite clearly not defined.
This was a focused group design. This study was based on focus group data with extracted themes stemming from the nurse members viewpoint about perception of pain and pain management after abdominal surgery on a surgical ward. They include an open question such as. “Can you talk about what you see in the nursing care and pain management for patients during abdominal surgery?” based on the participant's response to supplementary questions as asked (Baker, 1996; Sjöström, et al. 2000). The study that formed part of the focused group design consisted of three focused group interviews, with 6 registered nurses (RNs) in each group, in which the interviews conducted were a convenient normally distributed sample of RNs at Nopparatrajathanee Hospital, Thailand.
Subsequent to ethical approval forms within the relevant organizations, invitations to attend a discussion session upon the ...