Seeking empowerment to comfort patients in severe pain: A grounded theory study of the nurse's perspective

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Abstract

Background

Hospital patients experience significant pain, which can delay healing and increase the risk of developing chronic pain. Nurses are affected by patients’ ongoing pain and may cope with consequent anxiety and helplessness by distancing themselves from such patients. Understanding nurses’ responses to patients in severe pain will inform strategies to support their coping, their patients and, ultimately, their retention in the nursing workforce.

Objectives

The aim of the study was to develop a substantive theory explaining the hospital nurse's perspective of caring for patients in severe pain.

Design

The study used grounded theory method.

Settings

Data were collected on four acute care wards in a 610 bed Australian hospital.

Participants

The sample included 33 nurse participants and 11 patient participants. Selection criteria for nurse participants were those who worked in the four study wards, cared for patients who experienced severe pain, and consented to be included. Selection criteria for patient participants were those who self-reported pain at intensity of seven or more on a scale of 0–10, were aged 18 years or older, could speak and read English, and consented to be included.

Methods

Theoretical sampling directed the collection of data using semi-structured interviews with nurses and participant observation, including structured observations of nurses who cared for patients in pain. Data were analysed using constant comparison method.

Results

Nurse participants encountered a basic psychosocial problem of feelings of disempowerment when their patients experienced persisting severe pain. In response, they used a basic psychosocial process of seeking empowerment to provide comfort in order to resolve distress and exhaustion associated with disempowerment. This coping process comprised three stages: building connections; finding alternative ways to comfort; and quelling emotional turmoil.

Conclusions

The substantive theory proposed a link between the stress of nurses’ disempowerment and a coping response that provides direction to support nurses’ practice. Strategies indicated include enhanced communication protocols, access to advanced practice nurses, use of nonpharmacological comfort measures, utilization of ward-based pain resource nurses, and unit-specific pain management education. Further research to verify and extend the substantive theory to other settings and nursing populations is warranted.

Section snippets

Background

Pain in hospitalized patients remains a global problem despite improved pain management over the last 40 years (Sawyer et al., 2010, Wadensten et al., 2011). Unrelieved pain slows recovery and put patients at risk of chronic pain (Macintyre et al., 2010). Nurses are also affected by patients’ persisting pain, with implications for pain management practice (Blomberg et al., 2008, Blomqvist, 2003). From a personal perspective, nurses may have feelings of anxiety and helplessness (Blondal and

Aim

The aim of this study was to develop a substantive theory explaining the experience of caring for patients with severe pain from the perspective of nurses working in hospital wards. Severe pain was defined as pain self-reported by patients at an intensity of seven or more on a numerical scale of zero to ten, where zero represents no pain and ten represents the worst pain imaginable.

Setting

The study was conducted in a 610 bed public hospital in an Australian city of over 1.4 million people. Data were

Findings

This study developed the substantive theory of seeking empowerment to provide comfort to explain nurses’ experience of caring for patients in severe pain and their subsequent actions, including interactions with patients and colleagues. Nurses shared a regard for well-being that shaped their perceived roles as comfort providers and interpretation of effectiveness in that role. Severe pain was conceptualized as a distressing, incapacitating and nontherapeutic experience that threatened patients’

Discussion

While there is much to understand about the human experience of caring for patients who suffer with pain, the focus of this paper is the BPP used by nurses to manage feelings of disempowerment in such situations. Understanding dynamic coping processes used by nurses to resolve stress and exhaustion provides direction for interventions to empower pain management practice.

A strength of this study is that the findings are of practical significance and provide direction for theory development.

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