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Post-operative pain management practice: Current situation and challenges within nursing practice in a Thai context
Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. (HVV)ORCID iD: 0000-0002-1123-1336
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Patients’ recovery after surgery is one of the most important health processes in planned hospital healthcare and has a direct impact on welfare and welfare systems. Therefore, what nurses do in the im­mediate postoperative period is of vital importance. This thesis addresses the question of understanding how nurses work in managing post-operative pain by exploring their daily nursing practices and experiences in responding to the patient in pain within a Thai cultural context.

The project applied a qualitative methodology where the local culture and its day-to-day practices of pain management were studied by using observations, focus groups, in-depth interviews and a critical incident interview approach with nurses. Informants were recruited at a public hospital in Bangkok in a surgical ward. In all, 100 hours of observations, 39 interviews and 69 descriptions of critical incidents related to nurse’s pain management were gathered. The data analysis followed the principles of qualitative research.

The findings showed that, although there is a clearly defined approach to pain management, the response system followed by the nurses to address patients’ pain is complex and includes much lead time between assessing patients’ pain and the nurses responding to the pain. Furthermore, nurses are caught in what is labeled a patient pa­radigm, where evidence of pain often is double- and triple-checked by scoring and recording signs that are then subject to confirmation by a third party. Underpinning this is a culture of pain management cultivated between the nurses that rests first and foremost on their own experiences and a working/professional culture where nurses offer each other practical help in urgent situations, but seldom discuss event-based strategies together. Nevertheless, when nurses described situations when they were successful in practicing pain management, they considered their own engagement and their availability of time, space and therapeutic options to be important.

Keywords: Culture of nursing, Nursing in pain management, Pain assessment, Perception of pain, Pain management, Pain post-operative

Place, publisher, year, edition, pages
Västerås: Mälardalen University , 2016.
Series
Mälardalen University Press Dissertations, ISSN 1651-4238 ; 204
Keyword [en]
Culture of nursing, Nursing in pain management, Pain assessment, Perception of pain, Pain management, Pain post-operative
National Category
Health Sciences
Research subject
Care Sciences
Identifiers
URN: urn:nbn:se:mdh:diva-31674ISBN: 978-91-7485-272-1 (print)OAI: oai:DiVA.org:mdh-31674DiVA: diva2:932506
Public defence
2016-08-30, Raspen, Mälardalens högskola, Eskilstuna,, 13:00 (English)
Opponent
Supervisors
Available from: 2016-06-02 Created: 2016-06-01 Last updated: 2016-08-09Bibliographically approved
List of papers
1. Nurses’ perceptions of patients in pain and pain management: a focus group study in Thailand
Open this publication in new window or tab >>Nurses’ perceptions of patients in pain and pain management: a focus group study in Thailand
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2015 (English)In: Pacific Rim International Journal of Nursing Research, ISSN 1906-8107, Vol. 19, no 2, 164-177 p.Article in journal (Refereed) Published
Abstract [en]

In Thailand, nurses have a key role in the assessment of symptoms and advising on pain management in patients with post-operative in a surgical ward. This study provides insight into nurses’ perceptions of patients in pain and subsequent pain management. A focus group discussion method was used with 18 registered nurses working in surgical wards. The data were analysed using qualitative content analysis. The participants’ descriptions of their perceptions of patients in pain and pain management were condensed into four themes. Two themes revolved around their perceptions of patient pain, uncomfortable patient, and restricted mobility and changed mood. The two remaining themes comprised intolerable pain would be managed, and managing pain through our own experience seems to be of importance in their professional assumption that evidence-based practice is inadequate for patients’ postoperative care. It is suggested that nurses work to a organized pain assessment guideline and pain management models according to cultural contexts. This should be developed within an understanding of the nurse-patient relationship, and specifically holistic nursing models of care can play an important role in bridging the connection between training and practice, not only between personal and professional perceptions of pain and selected strategies, but also between professional knowledge and nurses’ perceptions of patients in pain.The findings may have relevance for other similar contexts and settings.

National Category
Nursing
Identifiers
urn:nbn:se:mdh:diva-28237 (URN)000366099700007 ()
Available from: 2015-06-11 Created: 2015-06-11 Last updated: 2016-06-02Bibliographically approved
2. Treating without seeing: Pain management practice in a Thai context
Open this publication in new window or tab >>Treating without seeing: Pain management practice in a Thai context
(English)In: Pain Research & Management, ISSN 1203-6765, E-ISSN 1918-1523Article in journal (Refereed) Submitted
National Category
Health Sciences
Identifiers
urn:nbn:se:mdh:diva-31700 (URN)
Available from: 2016-06-02 Created: 2016-06-02 Last updated: 2017-11-30Bibliographically approved
3. Thai Nurses' experiences of post-operative pain assessment and its' influence on pain management decisions
Open this publication in new window or tab >>Thai Nurses' experiences of post-operative pain assessment and its' influence on pain management decisions
2016 (English)In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 15, no 1, 12Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: While many studies have addressed various issues with regards to pain management, there is limited knowledge about how nurses assess pain in surgical wards. This study aimed to describe Thai nurses' experiences of pain assessment in a surgical ward.

METHODS: A cross-sectional explorative study was conducted. Participants were selected through theoretical sampling. Data was collected through interviews with twelve registered nurses working in surgical wards. Qualitative content analysis guided the analysis of the data.

RESULTS: Nurses use a double/triple check system, communicated to the healthcare team via records and protocols, and they used their skills and experiences in pain assessment. The results showed that nurses missed the opportunity to include the patients' self-reported pain in their accounts. Though much evidence of pain was collected, this did not seem to benefit the patients. Furthermore, the nurses were not using instruments to measure pain, which illustrates the potential unreliability of professionals who have differing opinions concerning the patients' pain.

CONCLUSIONS: Thai nurses worked based on a 'patient-evidence' paradigm when assessing patients in pain; this should be shifted to an evidence-based paradigm. Furthermore, by including the patients' self-reported pain in their assessment, nurses would both improve the quality of the pain assessment and empower patients in their pain management. Pain management practices in Thailand should be improved through education, training, supportive innovation, and collegial competence development in order to improve the quality of care in the post-operative field.

National Category
Health Sciences
Research subject
Care Sciences
Identifiers
urn:nbn:se:mdh:diva-31375 (URN)10.1186/s12912-016-0136-8 (DOI)000377515800001 ()26933384 (PubMedID)2-s2.0-84962081921 (Scopus ID)
Available from: 2016-04-04 Created: 2016-04-04 Last updated: 2017-11-30Bibliographically approved
4. Engagement and availability shapes agency-based maneuvering in nurse’s pain management: A critical incident study
Open this publication in new window or tab >>Engagement and availability shapes agency-based maneuvering in nurse’s pain management: A critical incident study
(English)In: Contemporary Nurse: health care across the lifespan, ISSN 1037-6178, E-ISSN 1839-3535Article in journal (Refereed) Submitted
National Category
Health Sciences
Identifiers
urn:nbn:se:mdh:diva-31702 (URN)
Available from: 2016-06-02 Created: 2016-06-02 Last updated: 2017-11-30Bibliographically approved

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