Exploring the different management structures in nurses responses and treating of patients’ postoperative pain

A qualitative triangulation study

Authors

  • Manaporn Chatchumni RN, PhD, Senior Lecturer, School of Nursing, Rangsit University, Pathumthani, Thailand,Postdoctoral Research Affiliate, Department of Health Sciences, The Red Cross University College, Stockholm, Sweden,,

Keywords:

Pain management, Focus groups, Grounded theory, Analgesics, Pain, Postoperative, Communication

Abstract

Background: Nurses’ roles are an important aspect of their approaches to pain management and monitoring in the post-operative phase of recovery in a surgical ward. A barrier to successful pain management may be the nurse’s perceptions of the patient in pain, which are confounded by the patterns of communication within individual contexts. We need to study, grasp and understand the complexities of the pain management practice within the context of the surgical ward in order to be able to improve the practices and design appropriate interventions to help patients in need.  Objective: The purpose of this study was to explore nurses’ postoperative pain management practices. Methods: This qualitative triangulation study was conducted in a surgical ward at a public hospital in Bangkok (Thailand) from 2012 to 2015. We applied four qualitative methods in the study: 1) observations in a postoperative pain management setting (100 hours); 2) in-depth interviews (12 nurses), 3) three focus group discussions (18 nurses), and 4) narratives relating to 69 critical incidents gathered during recurrent visits over a period of ten weeks (9 nurses). Content analysis, as outlined in grounded theory, was applied. Results: The 40 nursing staff made their observations of the participants by conducting go-along interviews while they worked in the surgical field. The group of nurses comprised of 20 females and 4 males, age-ranged between 21-49 years of age, and their nursing experience ranged from 1-28 years. From our analysis, nurses verified patients’ pain by using double- and triple-control methods to document and record it, thus managing pain by administrative procedures rather than being proactive in providing pain relief. Therefore, communication and information about the patients’ pain and subsequent treatment of postoperative pain caused delays that may hamper the adequate use of available analgesics for pain relief. Levels of experience in communicating between nurses, other professionals, and patients were a main cause of delays in treating and managing pain. Conclusion: The complex communication system that would improve the communication ways leads to better standards of practice and quality of care.

References

Booker SQ. African Americans’ perceptions of pain and pain management: A systematic review. J

Transcult Nurs. 2016; 27(1): 73–80. doi: 10.1177/1043659614526250. PMID: 24841472.

Paradies Y, Truong M, Priest N. A systematic review of the extent and measurement of healthcare provider

racism. J Gen Intern Med. 2014; 29(2): 364–87. doi: 10.1007/s11606-013-2583-1. PMID: 24002624

PMCID: PMC3912280.

Wikström L, Eriksson K, Årestedt K, Fridlund B, Broström A. Healthcare professionals' perceptions of the

use of pain scales in postoperative pain assessments. Appl Nurs Res. 2014; 27(1): 53-8. doi:

1016/j.apnr.2013.11.001. PMID: 24387871

Zhang CH, Hsu L, Zou BR, Li JF, Wang HY, Huang J. Effects of a Pain Education Program on Nurses'

Pain Knowledge, Attitudes and Pain Assessment Practices in China. J Pain Symptom Manage. 2008;

(6): 616-27. doi: 10.1016/j.jpainsymman.2007.12.020. PMID: 18599261.

Aziato L, Adejumo O. An ethnographic exploration of postoperative pain experiences among Ghanaian

surgical patients. J Transcult Nurs. 2015; 26(3): 301-7. doi: 10.1177/1043659614526246. PMID:

Chambers T, Shepler J. Barriers to adult surgical pain management. J Pain. 2018; 19(3), S53. doi:

1016/j.jpain.2017.12.126.

Al-Hashimi M, Scott S, Griffin-Teall N, Thompson J. Influence of ethnicity on the perception and

treatment of early post-operative pain. Br J Pain. 2015; 9(3): 167–72. doi: 10.1177/2049463714559254.

PMID: 26516573, PMCID: PMC4616978.

Maneewat K. Nursing care practices and workplace relations in a Thai surgical ward: An exploration of

clinical decision-making. 23rd International Nursing Research Congress. 2010. Available from:

http://www.nursinglibrary.org/vhl/handle/10755/243190.

Chinnawong T. The influences of Thai Buddhist culture on cultivating compassionate relationships with

equanimity between nurses, patients and relatives: A grounded theory approach. 2007. PhD thesis,

Southern Cross University, Lismore, NSW. Available from: https://epubs.scu.edu.au/theses/374/.

Burnard P, Naiyapatana W. Culture and communication in Thai nursing: A report of an ethnographic study.

Int J Nurs Stud. 2004; 41(7): 755–65. doi: 10.1016/j.ijnurstu.2004.03.002. PMID: 15288798.

Shih FJ. Triangulation in nursing research: Issues of conceptual clarity and purpose. J Adv Nurs. 1998;

(3): 631–41. doi: 10.1046/j.1365-2648.1998.00716.x. PMID: 9756233.

Thurmond VA. The point of triangulation. J Nurs Scholarsh. 2001; 33(3): 253–8. doi: 10.1111/j.1547- 5069.2001.00253.x. PMID: 11552552.

Flick U. Triangulation in qualitative research. A companion to qualitative research. Sage Press. 2004: 178- 83.

Joslin R, Müller R. Identifying interesting project phenomena using philosophical and methodological

triangulation. IPMA. 2016; 34(6): 1043–56. doi: 10.1016/j.ijproman.2016.05.005.

Carney M. Influence of organizational culture on quality healthcare delivery. Int J Health Care Qual Assur.

; 24(7): 523-39. doi: 10.1108/09526861111160562. PMID: 22204086.

Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item

checklist for interviews and focus groups. Int J Qual Health Care. 2007; 19(6): 349-57. doi:

1093/intqhc/mzm042. PMID: 17872937.

Chatchumni M, Namvongprom A, Eriksson H, Mazaheri M. Thai Nurses’ experiences of post-operative

pain assessment and its’ influence on pain management decisions. BMC Nurs. 2016; 15: 12. doi:

1186/s12912-016-0136-8. PMID: 26933384, PMCID: PMC4772523.

Chatchumni M, Namvongprom A, Sandborgh M, Mazaheri M, Eriksson H. Nurse’s Perceptions of Patients

in Pain and pain management: A focus group in Thailand. Pac Rim Int J Nurs Res Thail. 2015; 19(2): 164- 77.

Chatchumni M, Namvongprom A, Eriksson H, Mazaheri M. Treating without seeing: Pain management

practice in a Thai context. Pain Res Manag. 2016; 2016:9580626. doi: 10.1155/2016/9580626. PMID:

, PMCID: PMC5156806.

Chatchumni M, Namvongprom A, Eriksson H, Mazaheri M. Engagement and availability in shaping

nurses’ management of postoperative pain: a qualitative study. Electron Physician. 2018; 25; 10(8): 7235- 42. doi: 10.19082/7235. PMID: 30214707, PMCID: PMC6122866.

Benner PE. From Novice to Expert: Excellence and Power in Clinical Nursing Practice. Upper Saddle

River, NJ: Prentice Hall; 2001.

Guba EG, Lincoln YS. Competing paradigms in qualitative research. In The Landscape of Qualitative

Research. Sage. Thousand Oaks, CA. 1998: 195–222.

Korstjens I, Moser A. Series: Practical guidance to qualitative research. Part 4: Trustworthiness and

publishing. Eur J Gen Pract. 2018; 24(1): 120-4. doi: 10.1080/13814788.2017.1375092. PMID: 29202616.

Royal College of Anesthesiologists of Thailand & Thai Association for the Study of Pain. Clinical

Guidance for Management of Acute Postoperative Pain. 2011. Available from: http://www.tasp.or.th/wp- content/uploads/2017/02/POSTOPERATIVE_PAIN_2554.pdf.

Al Samaraee A, Rhind G, Saleh U, Bhattacharya V. Factors contributing to poor post-operative abdominal

pain management in adult patients: a review. Surgeon. 2010; 8(3): 151–8. doi:

1016/j.surge.2009.10.039. PMID: 20400025.

Yin HH, Tse MM, Wong FK. Systematic review of the predisposing, enabling, and reinforcing factors

which influence nursing administration of opioids in the postoperative period. Jpn J Nurs Sci. 2015; 12(4):

–75. doi: 10.1111/jjns.12075. PMID: 25781037.

Ruben MA, van Osch M, Blanch-Hartigan D. Healthcare providers’ accuracy in assessing patients’ pain: A

systematic review. Patient Educ Couns. 2015; 98(10): 1197–206. doi: 10.1016/j.pec.2015.07.009. PMID:

Pain T, Kingston G, Askern J, Smith R, Phillips S, Bell L. How are allied health notes used for inpatient

care and clinical decision-making? A qualitative exploration of the views of doctors, nurses and allied

health professionals. Health Inf Manag. 2017; 46(1): 23–31. doi: 10.1177/1833358316664451. PMID:

van Dijk JF, Schuurmans MJ, Alblas EE, Kalkman CJ, van Wijck AJ. Postoperative pain: knowledge and

beliefs of patients and nurses. J Clin Nurs. 2017; 26(21-22): 3500-10. doi: 10.1111/jocn.13714. PMID:

Powell R, Scott NW, Manyande A, Bruce J, Vogele C, Byrne-Davis LM, et al. Psychological preparation

and postoperative outcomes for adults undergoing surgery under general anaesthesia. Cochrane Database

Syst Rev. 2016; 5: CD008646. doi: 10.1002/14651858.CD008646.pub2. PMID: 27228096.

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Published

2021-12-14