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ThesisUniversity of Akureyri>Heilbrigðisvísindasvið>Meistaraprófsritgerðir>

Please use this identifier to cite or link to this item: http://hdl.handle.net/1946/1225


The essential structure of the challenges of caring for patients with pain : a phenomenological study


Despite medical advances, hospitalised patients continue to suffer because of
deficits in pain management, such as nurses’ under-medication. The aim of this
study was to generate an in-depth understanding of what it is like for nurses to care
for patients with pain. The purpose was to improve patients’ pain management.
The research question was ‘what is the essential structure of nurses’ experience of
caring for patients with pain?’ The research approach was phenomenology: the
Vancouver School of doing phenomenology, and the sampling purposeful. The
researcher participated in twenty dialogues (unstructured interviews), with the ten
nurses who were co-researchers (participants), and were working on adult medical
and surgical wards at three hospitals in Iceland. The data analysis was thematic,
resulting in the essential structure of: ‘the challenges of caring for patients with
Nurses’ experience of caring for patients with pain may be understood by viewing
their role within a goal directed mission, where the nurses who have strong moral
obligation to relieve pain, assumed the role of the patients’ advocates. Their
mission was, however, complicated by several internal and external challenges and
barriers. The most prevailing features were the fear of giving too much, strain of
caring for addicts and terminal patients with pain, absence of or inadequate
prescription, and sometimes lack of access to accountable physicians. A vital factor
was to have decision on palliative care and clear rules about pain management,
since such directives facilitated successful pain relief. One important turning point
on the nurses’ journey was the ‘gate’ where they participated in mutual decisionv
making along with the physician. Within these relations, having a voice was vital
for the nurses while they generally felt that they were being listened to and
respected. Knowing the patient and the physician facilitated all relations. Where
physicians are responsible for all drug prescriptions, the nurses considered that in
general using their influence or pressure was sufficient for them to be granted what
was needed, but sometimes they had to insist and persist to achieve better solutions,
or some closure. Many nurses bypassed the gate by altering the medication on their
own initiative, or using independent nursing interventions. The outcome of the
journey; positive or negative, affected the wellbeing of nurses as well as the
patients, but distress also served as a drive for more action. Nurses’ major coping
strategy was seeking support from nursing colleagues, and specialists in pain
management but other methods also seemed to keep the nurses and their patients
satisfied, even if the outcome was otherwise unsatisfactory.
My conclusion is that, so as to be capable of performing in accord with their moral
and professional obligations, nurses need various coexisting patterns of knowledge
and the optimal organisational environment. Where former studies mainly focus on
single dimensions of pain management, this study brings in multiple factors that
influence nurses’ possibilities of providing satisfactory pain relief, such as
personal, relational and cultural aspects.


Verkefnið er opið nemendum og starfsfólki Háskólans á Akureyri


Katrín Blöndal_e.pdf114KBOpen Phenomenological - efnisyfirlit PDF View/Open
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