226 Research in brief .iLi ?^L ;1 .U'f'

The nursing management of post-operative pain: policies, politics andstrategies

JOSEPHINE EVANS MSc, BScN, RGN, DN, DIPN(LOND),RCNT, RNT, FETCSenior Nurse (Professional Development), South Manchester HealthAuthority (Joint appointment with the Polytechnic of Huddersfteld),Department of the Chief Nurse, Main Corridor, Withington Hospital,Nell Lane, Manchester M2() SLR, UK

Introduction

The literature indicates that there is a eontinuing failure toprovide adequate pain relief following surgery, and thatfrom a patient's perspective post-operative pain remainsmoderate to severe for a significant amount of patients(Cohen, 1980; Weiss et al., 1983; Seers, 1987). It is againstsuch findings that this exploratory study was designed, inorder to elicit the beliefs and dispositions of registeredgeneral nurses regarding their nursing management ofpost-operative pain.

Methods

A qualitative field-work design was used. This took theform of in-depth audio-taped interviews with 20 wardsisters/charge nurses randomly selected from general sur-gical units in hospitals throughout the north-west ofEngland. Using the technique of constant comparativeanalysis, preliminary data arising from the first fiveunstructured 'conversational-type' interviews was codedand used as the basis for the formation of six conceptualcategories entitled:• ward populations,• learning about pain,• policies and politics of pain management,• comfort and care,• assessment and evaluation, ' '• pam does matter.

A semi-structured format was then used to obtain morespecific information in these six categories from 15respondents in the second part of the study.

Discussion of findings

A continuous theme to emerge from all the interviews wasthat of the importance of effective relief of post-operativepain to the participants. There was a strong belief that thepower to make pain relief 'happen' for patients restsultimately with the (registered) nurse. Responses sug-gested that the group saw themselves as mediators of painrelief other than solely in the realms of administration ofanalgesia. Although the latter was viewed as of paramount

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consequence there was also a recognition of the advantagesof helping patients through 'comfort' measures, incorpor-ating nurse-orientated physical and psychosocialapproaches, including relaxation, massage and touch. Thismay have reflected the finding that different 'populations'of surgical patients (some with complex and terminalconditions) with different pain trajectories (Fagerhaugh &Strauss, 1977) co-existed on all the wards giving rise toproblematic patterns of pain management. There was acollective perception that many constraints were impedingthe effective nursing management of post-operative pain.These included insufficient pain education for nursing andmedical staff (particularly in the realms of administrationof narcotic analgesia), defective policy decisions, poorinterprofessional communications and a shortfall in bothhuman and financial resources.

The lack of formal assessment and documentation ofpain and pain relief reported by the majority of respon-dents was not seen as a contributory factor in reducingeffective surgical pain management.l y j i r i u ' j l l . / . ' i ' , ^ . ) ) n l j i i l . y f ; ! - : • ( ! . ) ; ' • ' j i ' i J f t i ' i f ' i

Implicationsi n f . r i

Despite the exploratory nature of the study, there appearto be some implications for nursing practice, educationmanagement and research.

Nurse educators and practitioners themselves would.seem to need to be continually aware of their individualresponsibility to maintain up-to-date knowledge of painrelief. At the same time managers need to continue tofacilitate nurses to meet fully their challenging and vitaltask of helping surgical patients to achieve a comfortableand speedy post-operative 'quality' recovery.

A possible area for future research is suggested as beingthe introduction of'action research' multidisciplinary paineducational programmes in the clinical area. IJy thisapproach present and potential skills could be aflirmed anddeveloped and skill defects and deficiencies addressedwithin a communicative and quality aware 'real' environ-ment.

References

Cohen F.L. (1980) Post surgical pain relief; patient's status andnurses' medication choices. Pain 9, 26.S-274.

Fagcrhauj jh S.Y. & Strauss A. (1977) Politics of Pain Management:Stall Patient Interaction. Addison Wesley, London.

Sccrs K. (1987) I'crccptions ol Pain Ntirsing limes. 8.1(48), ^^-^').Weiss O.F., Sriwatankul K., AUoza J.L., Wintraub M., Lasagna L.

(198.1) Attitudes of patients, houscstafTand nurses towards post-operative analfjcsic care. .'Inasthesia £f .Inalgesiii 62(1), 70 74.

This study was completed in the final year o( an MSc programme atthe University of Salford.