| Learning Objective #1: Describe the impact of the sociocultural context of the nursing unit on the pain assessment practice of an individual nurse. | |||
| Learning Objective #2: Describe the process whereby nurses synthesize data from three spheres to conduct assessment of pain in postoperative clients. |
Inadequately managed postoperative pain is associated with negative client outcomes, yet empirical data demonstrate that nurses frequently use inaccurate assessment criteria and clients report inadequate pain management. While the nursing unit environment has been described as a barrier to pain assessment and management, almost no empirical work has directly examined the impact of the practice setting on individual practice. Therefore, this study was designed to describe the impact of the sociocultural context of the practice setting on nurses’ assessment of postoperative clients’ pain. Method
This ethnographic study was conducted simultaneously on two postoperative units at a teaching hospital in New England. Using classic ethnographic techniques, data collection and analysis were conducted in distinct phases designed to address: (1) the nature of the sociocultural field of nursing pain assessment practice in each unit; (2) the specific assessment strategies used in each field; and (3) differences in nursing pain assessment practice between fields. Data collection methods included participant observation; in-depth interviews with nurses; focus groups, and a quantitative instrument. Findings
A predominant pattern of 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 use of a single sphere of criteria as a primary filter through which data from the other two spheres was processed. This filter was distinctive for each unit, and was consistent with the two unique patterns of nursing pain assessment demonstrated on the two units. Conclusions
In this study, nurses’ pain assessment practice was clearly shaped by the sociocultural context of the specific nursing unit on which practice occurred. Interventions aimed at improving pain assessment should address the nature of the nursing unit environment and its’ impact on the individual nurse.
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