Examining the role of social context in nurses' pain assessment practice with postoperative clients

Abstract

Pain is a significant symptom in the postoperative period. Inadequately managed pain has been associated with additional postoperative complications and prolonged hospitalization, yet empirical data demonstrate that nurses frequently use inaccurate assessment criteria, and clients report inadequate pain management. Interventions designed to change nurses' assessment of pain have not addressed the impact of the setting in which practice occurs. This study was designed to describe the impact of the sociocultural context of the practice setting on nurses' assessment of postoperative patients' pain.

The study was guided by Bourdieu's theory of practice which proposes that each instance of human practice is a mediation between structures within the individual and structures within the context of practice. Bourdieu describes the practice of individuals, situated within structured social fields, using three foundational concepts: field, capital and habitus.

Initially, a quantitative instrument, The Pain Assessment Inventory , which assesses strategies that nurses use to assess pain in postoperative clients, was developed using classic ethnographic techniques and tested in a sample of one hundred and ninety-three (193) Registered Nurses.

A four phase ethnography was conducted simultaneously on two postoperative units of a large teaching hospital in New England. Using classic ethnographic techniques, data collection and analysis were conducted in distinct phases, designed to address specific research questions: (1) the nature of sociocultural field of nursing pain assessment practice in each unit; (2) the specific assessment strategies used in each field; (3) identification of the predominant nursing pain assessment habitus in each field; and (4) differences in nursing pain assessment habitus between the fields. Data collection methods included participant observation over a six month period; in-depth interviews with twenty nurses; focus groups conducted on each unit, and use of a quantitative survey instrument.

A predominant pattern of nursing pain assessment was observed on each unit. Nurses used assessment criteria from three spheres including the client's narrative of pain, evident criteria demonstrated by the client and a reference typology of expected pain assessment findings. Nurses demonstrated the use of a single sphere of criteria as a primary filter through which data from the other two spheres was processed.