Exploring the different management structures in nurses responses and treating of patients’ postoperative pain: A qualitative triangulation study

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.

A Scoping Review of Pain Management Education Programs (PMEPs): Do They Prepare Nurses to Deal with Patients’ Postoperative Pain?

“…In all of the studies, the programs improved nurses' ability to practice across a variety of inpatient and outpatient settings, and nurses' practices in managing patient's pain improved after they completed the program. These results support our findings in previous studies, particularly in addressing issues relating to the “Responding to and addressing patients' postoperative pain system model,” with the overlapping of pain management systems [ 6 ]. According to our previous study results, we found that nurses assessed patients' pain by using double- and triple-control methods to document and record it, which created delays in treating and managing pain when providing pain relief [ 6 ].…”

“…These results support our findings in previous studies, particularly in addressing issues relating to the “Responding to and addressing patients' postoperative pain system model,” with the overlapping of pain management systems [ 6 ]. According to our previous study results, we found that nurses assessed patients' pain by using double- and triple-control methods to document and record it, which created delays in treating and managing pain when providing pain relief [ 6 ]. We critiqued this model while taking into consideration the unnecessary complexity of the communication and information systems when providing pain relief to perioperative patients, which often caused delays in the recovery phases and in managing the patients' pain [ 6 ].…”

“…These methods were clearly described and were appropriately matched to each study's research aim, adding to the credibility and reliability of the results. A variety of methods were used for collecting and analyzing the data, such as using both quantitative and qualitative analysis of survey results [ 14 ], using a cross-sectional design to analyze questionnaire, medical records, and interview data [ 16 ], as well as quantitative measuring of the effectiveness of the intervention by using a pre- and posttest design, using a survey before and after implementation [ 1 , 6 , 17 ].…”

“…According to our previous study results, we found that nurses assessed patients' pain by using double- and triple-control methods to document and record it, which created delays in treating and managing pain when providing pain relief [ 6 ]. We critiqued this model while taking into consideration the unnecessary complexity of the communication and information systems when providing pain relief to perioperative patients, which often caused delays in the recovery phases and in managing the patients' pain [ 6 ]. Our research also suggests ways in which nursing education can enhance practice by promoting person-centered pain management in surgical care.…”

“…Furthermore, nurses' pain management practices are complex and involve a variety of different management structures that are interconnected and codependent on each other. Previous research illustrates that pain management does not follow one standard set of practices; it differs between healthcare professionals and includes several complex structures within which nurses must navigate in managing the patient's pain [ 6 ]. It has been suggested that management structures influence nurses' practices, and, when responding to and addressing patients' postoperative pain, these reside within a complex model consisting of nursing culture in assessing pain scores and managing pain; nurses' responses to patients in pain, and nurses' own experiences of assessing and managing pain [ 6 ].…”