Negotiating Expression of Pain in Home Care Nurse-Patient Interactions

2.50
Hdl Handle:
http://hdl.handle.net/10755/147433
Type:
Presentation
Title:
Negotiating Expression of Pain in Home Care Nurse-Patient Interactions
Abstract:
Negotiating Expression of Pain in Home Care Nurse-Patient Interactions
Conference Sponsor:Sigma Theta Tau International
Conference Year:2001
Conference Date:November 10 - 14, 2001
Author:Spiers, Judith
P.I. Institution Name:University of Alberta
Objective: Pain management is a common care-giving activity in home health care nursing. The ability of patients to articulate pain is often crucial to positive outcomes. The interactive behavioral events involved in expressing, understanding, and responding to pain issues is an under-researched issue in nursing. This presentation describes issues related to pain communication between home care nurses and their patients that formed part of the results of a larger study on vulnerability in interpersonal interaction. Design: This qualitative study explored the interactive contexts of vulnerability in home care nurse-patient interactions. Nurse-patient dyad participants were interviewed on admission to the study to elicit their perceptions of home care nursing. Dyads were then videotaped between three to five visits. Immediately following each visit, the nurse and patient were interviewed separately to obtain their perceptions of the visits. Inductive recursive and cyclical analysis of video data was used to identify the interpersonal interactive contexts, including the context of pain. Following this description, the conceptual framework of Face Work (Brown & Levinson 1987) was used to identify the source, direction, action, and consequence of the communicative behavior. Measures/Instruments: The unit of analysis in this research was the speech act, or communication strategy (verbal or non-verbal action, such as word, exchange of dialogue, movement), rather the individual nurse or patient. Face work theory, a theory of interpersonal mutual vulnerability during interaction was used to identify the behavioral events through which nurses and patients indicated vulnerability, responded to expressions of vulnerability, or initiated a challenge to the current interactive relationship. Sample: Study participants consisted of three self-selected nurses and eight patients, creating 10 dyads. A total of 31 visits were recorded - creating over 19 hours of video data and complementary interview data. Setting: The research setting was the homes of patients from a home health care agency in a major urban area in western USA. Names of Variables/Concepts: This research was guided by Brown and Levinson’s (1987) model of facework that conceptualizes how people project and negotiate social identity in interaction. “Face” represents mutual vulnerability in terms of the social identity one wants to claim in a particular interaction. Face work refers to the communication concerned with identifying, constructing and enhancing one’s own and the other person’s sense of public identity, and avoiding or mitigating situations that threaten one’s own or the other person’s face. Findings: Pain was a de facto vulnerability because nurses assumed, investigated, and dismissed it if appropriate, but never ignored the possibility of pain. Nurses used a range of interactive strategies to approach and assess patients’ pain. Patients’ need to be seen as stoic made addressing pain issues highly complex. Nurses needed to support stoicism while ensuring adequate pain relief, or challenge inappropriate stoicism in the least destructive manner. When nurse and patient had dissonant approaches to understanding the experience and quality of pain, the potential for silencing and alienating the patient was greatest. Nurse’s vulnerability was primarily evident in situations of inflicted pain. Mutual vulnerability resulted from helplessness in the face of intractable pain. Conclusions: By looking at the process of interaction as it occurred within a context of face work has provided a unique insight into how discourse frames patients’ ability to endure and suffer. Many communicative strategies, often regarded as non-therapeutic, have been identified as strategically used to mitigate threat to patient stoicism. Many of the comforting, supporting endurance or challenging communication strategies observed in this study were practice based and not available to the nurses’ conscious awareness, yet they had profound effects on their patients. Implications: This study has important implications for understanding the process and outcomes of nursing interactions. Methodologically, it contributes to developing new approaches to understanding communication, interaction, and nurse-patient relationships in complex clinical contexts.
Repository Posting Date:
26-Oct-2011
Date of Publication:
10-Nov-2001
Sponsors:
Sigma Theta Tau International

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleNegotiating Expression of Pain in Home Care Nurse-Patient Interactionsen_GB
dc.identifier.urihttp://hdl.handle.net/10755/147433-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Negotiating Expression of Pain in Home Care Nurse-Patient Interactions</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Sigma Theta Tau International</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2001</td></tr><tr class="item-conference-date"><td class="label">Conference Date:</td><td class="value">November 10 - 14, 2001</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Spiers, Judith</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">University of Alberta</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">jude.spiers@ualberta.ca</td></tr><tr><td colspan="2" class="item-abstract">Objective: Pain management is a common care-giving activity in home health care nursing. The ability of patients to articulate pain is often crucial to positive outcomes. The interactive behavioral events involved in expressing, understanding, and responding to pain issues is an under-researched issue in nursing. This presentation describes issues related to pain communication between home care nurses and their patients that formed part of the results of a larger study on vulnerability in interpersonal interaction. Design: This qualitative study explored the interactive contexts of vulnerability in home care nurse-patient interactions. Nurse-patient dyad participants were interviewed on admission to the study to elicit their perceptions of home care nursing. Dyads were then videotaped between three to five visits. Immediately following each visit, the nurse and patient were interviewed separately to obtain their perceptions of the visits. Inductive recursive and cyclical analysis of video data was used to identify the interpersonal interactive contexts, including the context of pain. Following this description, the conceptual framework of Face Work (Brown &amp; Levinson 1987) was used to identify the source, direction, action, and consequence of the communicative behavior. Measures/Instruments: The unit of analysis in this research was the speech act, or communication strategy (verbal or non-verbal action, such as word, exchange of dialogue, movement), rather the individual nurse or patient. Face work theory, a theory of interpersonal mutual vulnerability during interaction was used to identify the behavioral events through which nurses and patients indicated vulnerability, responded to expressions of vulnerability, or initiated a challenge to the current interactive relationship. Sample: Study participants consisted of three self-selected nurses and eight patients, creating 10 dyads. A total of 31 visits were recorded - creating over 19 hours of video data and complementary interview data. Setting: The research setting was the homes of patients from a home health care agency in a major urban area in western USA. Names of Variables/Concepts: This research was guided by Brown and Levinson&rsquo;s (1987) model of facework that conceptualizes how people project and negotiate social identity in interaction. &ldquo;Face&rdquo; represents mutual vulnerability in terms of the social identity one wants to claim in a particular interaction. Face work refers to the communication concerned with identifying, constructing and enhancing one&rsquo;s own and the other person&rsquo;s sense of public identity, and avoiding or mitigating situations that threaten one&rsquo;s own or the other person&rsquo;s face. Findings: Pain was a de facto vulnerability because nurses assumed, investigated, and dismissed it if appropriate, but never ignored the possibility of pain. Nurses used a range of interactive strategies to approach and assess patients&rsquo; pain. Patients&rsquo; need to be seen as stoic made addressing pain issues highly complex. Nurses needed to support stoicism while ensuring adequate pain relief, or challenge inappropriate stoicism in the least destructive manner. When nurse and patient had dissonant approaches to understanding the experience and quality of pain, the potential for silencing and alienating the patient was greatest. Nurse&rsquo;s vulnerability was primarily evident in situations of inflicted pain. Mutual vulnerability resulted from helplessness in the face of intractable pain. Conclusions: By looking at the process of interaction as it occurred within a context of face work has provided a unique insight into how discourse frames patients&rsquo; ability to endure and suffer. Many communicative strategies, often regarded as non-therapeutic, have been identified as strategically used to mitigate threat to patient stoicism. Many of the comforting, supporting endurance or challenging communication strategies observed in this study were practice based and not available to the nurses&rsquo; conscious awareness, yet they had profound effects on their patients. Implications: This study has important implications for understanding the process and outcomes of nursing interactions. Methodologically, it contributes to developing new approaches to understanding communication, interaction, and nurse-patient relationships in complex clinical contexts. </td></tr></table>en_GB
dc.date.available2011-10-26T09:32:22Z-
dc.date.issued2001-11-10en_GB
dc.date.accessioned2011-10-26T09:32:22Z-
dc.description.sponsorshipSigma Theta Tau Internationalen_GB
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