Treating without Seeing: Pain Management Practice in a Thai Context

Abstract

Pain management is a core nursing function, and it plays a key role in postoperative care. It is important to understand the cultural context of nursing practices and how this affects effective pain management. The aim of this study was to describe the professional and cultural framework within which pain management is practiced on a Thai surgical ward. Spradley's ethnographic methodology was used. Data were collected through 98.5 hours of field observations and interviews at a surgical ward in Thailand. Three themes were constructed that describe the way Thai nurses practiced pain management: (i) complex communications system to address pain and to respond to it, (ii) the essence of Thai-ness, and (iii) a passive approach to pain management. The results indicate that, in the response to discomfort and pain, better pain management will result if there is a shift from functional to patient-centered care. The nursing culture needs to be further researched and discussed, in order to set priorities in line with the goals of national and international organizations for improving postoperative care and promoting patient comfort.

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

“…Moreover, the findings included indications that the nurses employed reflective practice, which was emphasized and understood as being about how the Thai culture and nursing culture influenced their practices on a day-to-day basis in the postoperative ward. As similar to previous studies, we found that the cultural aspects of nursing impact on pain management practices including cultural and religious aspects related to 'Thainess', Buddhism, the nursing profession and nurse-patient, doctor-patient relationships (8)(9)(10)19). Issues in the communication of information about the patients' pain and subsequent treatment of postoperative pain were identified in some part to cause delays and may hamper the adequacy of the use of available analgesics for pain relief.…”

“…Reflective practices helped the nurses to consider how cultural sensitivities might be hindering the interaction between the nurses and the patients, whereas if they engaged their abilities to build trust between the nurses and patients, this might lead to achieving successful pain management when the patients need it (6,9,10,15,29). Communication is vital in the nurse's role and is essential to collaborating with other healthcare professionals and their patients, particularly in relation to improving the overall outcomes of their approaches to the practice of pain management (17,19,30).…”

“…Qualitative methods are especially useful when exploring complex phenomena, and the variety of chosen approaches here, may also offer new ways of examining the nurses' experiences of managing pain. The following approaches were used in this study: 1) making observations of the participants (and conducting go-along interviews) while they worked in the surgical field for a total of 100 hours (17), 2) focus group interviews with 18 nurses, who were divided into three groups of focus-group discussions (FGDs) (18), 3) in-depth interviews (12 nurses) (19), and 4) critical incident interviews with 9 nurses during recurrent visits over a period of ten weeks that collected 69 critical incidents (20). The nurses were chosen in accordance with theoretical sampling as Benner's nursing theory (21) was used for recruiting participants to the FGDs, in-depth interviews and critical incident interviews.…”

Ameliyat sonrasi ağrıya yaklaşımların değerlendirilmesi

“…Ameliyat sonrası ağrının zamanında ve yeterli tedavi edilememesi ağrının kronikleşmesine, solunum sorunlarına, immobilizasyona ve hastanın konfor ve memnuniyetinin azalmasına neden olmaktadır [11][12][13] . Hemşireler ameliyat sonrası ağrı yönetiminde önemli bir rol oynar vebu nedenle ameliyat sonrası ağrı yönetimi kapsamlı bilgi ve beceri gerektirir 14,15 .…”

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

“…A systematic review found that the assessment of pain by physicians and nurses showed moderate to good levels of assessing pain accuracy when compared with the patients' own estimations of pain intensity [ 9 ]. Additionally, emerging evidence recommends that nursing students are trained for competency in effective pain management practices and that training programs for qualified nurses take into consideration the poor levels of pain assessment accuracy observed in providers who have limited clinical experience (<4 years) [ 7 – 10 ].…”