Curtin University, Sir Charles Gairdner Hospital, Edith Cowan University, Australia.
Edith Cowan University, Sir Charles Gairdner Hospital and Murdoch University, Australia.
Int J Nurs Stud. 2015 Jan;52(1):229-39. doi: 10.1016/j.ijnurstu.2014.06.010. Epub 2014 Jun 28.
Hospital patients experience significant pain, which can delay healing and increase the risk of developing chronic pain. Nurses are affected by patients' ongoing pain and may cope with consequent anxiety and helplessness by distancing themselves from such patients. Understanding nurses' responses to patients in severe pain will inform strategies to support their coping, their patients and, ultimately, their retention in the nursing workforce.
The aim of the study was to develop a substantive theory explaining the hospital nurse's perspective of caring for patients in severe pain.
The study used grounded theory method.
Data were collected on four acute care wards in a 610 bed Australian hospital.
The sample included 33 nurse participants and 11 patient participants. Selection criteria for nurse participants were those who worked in the four study wards, cared for patients who experienced severe pain, and consented to be included. Selection criteria for patient participants were those who self-reported pain at intensity of seven or more on a scale of 0-10, were aged 18 years or older, could speak and read English, and consented to be included.
Theoretical sampling directed the collection of data using semi-structured interviews with nurses and participant observation, including structured observations of nurses who cared for patients in pain. Data were analysed using constant comparison method.
Nurse participants encountered a basic psychosocial problem of feelings of disempowerment when their patients experienced persisting severe pain. In response, they used a basic psychosocial process of seeking empowerment to provide comfort in order to resolve distress and exhaustion associated with disempowerment. This coping process comprised three stages: building connections; finding alternative ways to comfort; and quelling emotional turmoil.
The substantive theory proposed a link between the stress of nurses' disempowerment and a coping response that provides direction to support nurses' practice. Strategies indicated include enhanced communication protocols, access to advanced practice nurses, use of nonpharmacological comfort measures, utilization of ward-based pain resource nurses, and unit-specific pain management education. Further research to verify and extend the substantive theory to other settings and nursing populations is warranted.
医院患者经历着严重的疼痛，这可能会延迟康复并增加发展为慢性疼痛的风险。护士会受到患者持续疼痛的影响，他们可能会通过与这些患者保持距离来应对随之而来的焦虑和无助。了解护士对严重疼痛患者的反应，将为支持他们应对、照顾患者以及最终留住护理人员提供策略。
本研究旨在发展一个实质性理论，解释医院护士对照顾严重疼痛患者的看法。
本研究采用扎根理论方法。
数据收集于澳大利亚一家拥有 610 张床位的医院的四个急性护理病房。
样本包括 33 名护士参与者和 11 名患者参与者。护士参与者的入选标准是在四个研究病房工作、照顾经历严重疼痛的患者并同意参与的护士。患者参与者的入选标准是那些自我报告疼痛强度为 7 或以上（0-10 分制）、年龄在 18 岁或以上、能说英语和阅读英语并同意参与的患者。
理论抽样指导使用半结构式访谈和护士参与观察收集数据，包括对照顾疼痛患者的护士进行结构化观察。使用恒定性比较方法分析数据。
护士参与者在患者持续经历严重疼痛时遇到了一种基本的心理社会问题，即感到无能为力。作为回应，他们使用寻求赋权的基本心理社会过程来提供安慰，以解决与无能为力相关的痛苦和疲惫。这个应对过程包括三个阶段：建立联系；寻找安慰的替代方法；平息情绪波动。
提出的实质性理论在护士的无力感压力和提供指导以支持护士实践的应对反应之间建立了联系。建议的策略包括增强沟通协议、获得高级实践护士的支持、使用非药物性舒适措施、利用病房疼痛资源护士以及特定单位的疼痛管理教育。需要进一步研究来验证和将实质性理论扩展到其他环境和护理人群。
