Expressing and responding to pain and stoicism in home-care nurse-patient interactions.

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.