The Ghanaian Surgical Nurse and Postoperative Pain Management: A Clinical Ethnographic Insight

Lydia Aziato,Oluyinka Adejumo

doi:10.1016/j.pmn.2012.10.002

Lydia Aziato, Oluyinka Adejumo

Open Access

https://doi.org/10.1016/j.pmn.2012.10.002

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Abstract

Nurses form an indispensable part of the clinical team that manages postoperative pain (POP). Within a particular clinical context, nurses perceive and respond to pain based on specific factors. This study aimed at illuminating the perceptions and responses of Ghanaian surgical nurses regarding their patients' POP. It also identified the factors that influenced nurses' pain responses. A focused ethnography was used, and data were collected through individual interviews. Sampling was performed purposively to include junior, senior, day, and night nurses who cared for surgical patients. Concurrent data analysis was performed and data were saturated with 12 individual interviews. The findings indicated that nurses perceived POP as an individual phenomenon, and nurses responded to patients' pain by administering analgesics and by using nonpharmacologic measures. Factors that influenced the nurses' response were individual factors, such as commitment, discretion, fear of addiction, and organizational factors, such as organizational laxity and challenges of teamwork. The study recommended that nurses should be educated, supported, and encouraged to ensure pain relief after surgery and that they should see pain relief as a priority postoperative care to avert the negative repercussions of poorly managed POP.

Highlights

From the *School of Nursing, University of Ghana, Ghana; †School of Nursing, University of the Western Cape, Bellville, South Africa
The findings indicated that nurses perceived postoperative pain (POP) as an individual phenomenon, and nurses responded to patients’ pain by administering analgesics and by using nonpharmacologic measures
An examination of the literature shows some reasons for inadequate POP management, such as effect of culture, inappropriate attitude of health personnel, patients, and their families, inadequate knowledge of health professionals, and lack of multidisciplinary approach to pain management (Carr, 2002; Mac Lellan, 2006)

Summary

Introduction

From the *School of Nursing, University of Ghana, Ghana; †School of Nursing, University of the Western Cape, Bellville, South Africa. Within a particular clinical context, nurses perceive and respond to pain based on specific factors. Studies have further explored these key barriers; for example, health professionals’ barriers for POP management include lack of knowledge, lack of regular pain assessment, perceived lack of time to conduct pain assessment, prejudice and bias toward patients, and inability to empathize and establish rapport (Manias, Botti, & Bucknall, 2002; Rejeh, Ahmadi, Mohammadi, Kazemnejad, & Anoosheh, 2009). Studies have attributed most of the barriers associated with ineffective pain management to the nurse, perhaps because the nurse is the only health professional who spends 24 hours per day with the patient (Mac Lellan, 2006). Within the Ghanaian clinical context, general nurses and midwives cared for surgical patients. This study sought to understand nurses’ selfreport of how they responded to their patients’ POP and the factors that influenced their pain management decisions. The study reported in this article helped to understand the contextual factors that informed an appropriate clinical guideline

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