Post-operative pain management practice : Current situation and challenges within nursing practice in a Thai context

Sammanfattning: 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