Spiers Judith
Clinical Sciences, Faculty of Nursing, University of Alberta, Edmonton, AB, Canada.
Scand J Caring Sci. 2006 Sep;20(3):293-301. doi: 10.1111/j.1471-6712.2006.00407.x.
Addressing pain and suffering are critical issues for home-care nurses. Pain is frequently experienced by people living at home with chronic illnesses, as well as acutely ill people discharged early from hospitals. The purpose of this qualitative ethology study was to explore and describe the interactions and experiences expressing and responding to pain in home-care nurse-patient interactions. A qualitative video ethology design was appropriate to inductively describe micropatterns of communicative behaviour in natural settings. Ten home-care nurse-patient dyads were videotaped over multiple visits. Data consisted of 31 videotaped visits (over 19 hours) and accompanying participant interviews. Recursive and cyclical qualitative analysis was used to describe the patterns of communication with which stoicism or endurance of pain and suffering was supported or challenged. Dominant patterns of interaction were concerned with: negotiating appropriate forms of stoicism; negotiating ways to express, understand and measure pain and suffering; and dealing with intractable or inflicted pain. The methodology of this study allows an in-depth view of typical nurse-patient interactions. It explores the subtle communicative expertise of nurses by investigating the types of communication used in nursing encounters and by explicating behavioural patterns of expressing and responding to suffering. Observational research of interaction-as-it-occurs must continue to better understand how nurses and patients co-construct personal identities of suffering and stoicism.
解决疼痛和痛苦问题是家庭护理护士面临的关键问题。患有慢性疾病的居家患者以及早期出院的急性病患者经常会经历疼痛。这项定性行为学研究的目的是探索和描述家庭护理护患互动中表达和应对疼痛的互动及经历。定性视频行为学设计适合归纳描述自然环境中沟通行为的微观模式。对十对家庭护理护患组合进行了多次访视的录像。数据包括31次录像访视（超过19小时）及相应的参与者访谈。采用递归和循环定性分析来描述支持或挑战对疼痛和痛苦的坚忍或忍耐的沟通模式。主要的互动模式涉及：协商适当的坚忍形式；协商表达、理解和衡量疼痛及痛苦的方式；以及处理难以忍受或人为造成的疼痛。本研究方法能深入了解典型的护患互动。它通过调查护理过程中使用的沟通类型以及阐释表达和应对痛苦的行为模式，探索护士的微妙沟通技巧。对实时互动的观察性研究必须持续进行，以便更好地理解护士和患者如何共同构建痛苦和坚忍的个人身份。
