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Acute pain for postoperative patients in Kuwait : a study of how surgical nurses assess postoperative pain

Hussain, M 2015, Acute pain for postoperative patients in Kuwait : a study of how surgical nurses assess postoperative pain , PhD thesis, University of Salford.

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Background Proper management of pain is necessary to help patients recover quickly during postoperative care. Failure to promptly assess and manage pain could lead to complications in postoperative situations and can also increase the length of required hospital stays, create or add to elements of chronic post-surgical pain and overall poor health outcomes for the patients. Nurses play crucial roles in assessing postoperative pain, however despite advances in nursing care, there is evidence from a range of research which suggests that patients still suffer considerable levels of postoperative pain. In Kuwait’s healthcare setting, there is a paucity of literature on how nurses perform pain assessment and whether this leads to significant pain relief amongst patients. This research addressed this apparent vacuum in current research literature by exploring the experiences of nurses and patients in Kuwait in postoperative scenarios – focusing in particular on postoperative pain. This work also utilised the findings to help to provide a suggested framework through which the quality of care received by patients in surgical wards in Kuwait could be improved. Aims and Objectives This study aimed to explore how Kuwaiti nurses assess pain in postoperative patients in hospital settings in Kuwait and also to examine postoperative patients’ self-reported experiences of pain. Specifically, this study aimed to address the following objectives: - To explore the roles and responsibilities of surgical nurses in postoperative pain assessment; - To determine the knowledge and perceptions of nurses working in Kuwait on pain assessment; - To investigate the postoperative pain experiences of patients in surgical wards; and identify potential factors that could affect how patients respond to postoperative pain. This was intended to help to provide a framework for dealing with the main aim of this thesis which was to look at how nurses assess postoperative pain in Kuwait, and whether the current methods for doing so represented best practice when compared to other regions or institutions. Methodology This study utilises a qualitative methodology based on a Grounded Theory (GT) approach to social research. This encourages theory building throughout the work and is used to explore concepts relating to pain and how this is influenced by a range of socio-economic and cultural factors. In addressing these issues the experiences of nurses and patients in a hospital ward in a Kuwaiti hospital was established as the research case study. Ten nurses and ten patients were invited to take part in the study through purposive sampling techniques outlined within a grounded theory approach. Inclusion and exclusion criteria were established to ensure that only adult patients aged 18 years old and above who will give their informed consent to participate in the study would be included. Nurses who have at least one-year experience in a surgical ward were also invited to take part in the study. Data Analysis Data was analysed through a grounded theory approach based on key elements of the models espoused by Strauss and Corbin (2008) and Charmaz (2006). This began with a process of data familiarisation once the interviews had taken place, followed by processes of axial and open coding, selective coding, and the generation of categories and themes. In accordance with the grounded theory methodology data analysis and collection of data occurred simultaneously. The main aim of the data analysis was to help generate theories that explain the nurses and patients’ experiences in pain assessment during postoperative care in Kuwait’s healthcare setting. Results and Recommendations The research found evidence to suggest that many patients in the Kuwaiti healthcare system in postoperative scenarios are experiencing difficulties in addressing issues relating to postoperative pain. This was evidenced by patient participants in the study who felt de-legitimised and an undercurrent of distrust between the nurses and the patients. This was mirrored in the responses of some nurses, who also expressed concern that some patients were exaggerating their pain - determining their own opinions and perhaps devaluing the direct experiences of the patients themselves. In addition the research suggests that there are ongoing social power issues in Kuwait and an apparent lack of autonomy which is creating a culture of blame. Although there are clear resource issues, it is apparent that this lack of autonomy and the levels of distrust between patients, nurses and doctors need to be addressed urgently to ensure that postoperative pain care in Kuwaiti hospitals is improved. In Kuwait these issues of a lack of autonomy and an apparent lack of focus on the subjective nature of pain in relation to robust assessment methods has manifested as a cultural norm. As a result there is a need to begin to address formal education of nurses, the level of power and autonomy given to nurses and the establishment of standardised pain assessment procedures more rigorously and definitively. This can be achieved by ensuring that the nurse-doctor professional relationship is improved through better communication structures, more effective training programmes in treating pain, and by challenging a culture where patient’s opinions and feelings on pain are not addressed by medical professionals. This study has provided evidence based data sets which can be utilised in further developing the nursing curricula in Kuwait across both undergraduate and postgraduate nursing programmes and also across many aspects of in-service education within the hospital units themselves.

Item Type: Thesis (PhD)
Themes: Health and Wellbeing
Schools: Schools > School of Nursing, Midwifery, Social Work & Social Sciences > Centre for Nursing, Midwifery, Social Work & Social Sciences Research
Funders: Kuwait culture office
Depositing User: M Hussain
Date Deposited: 09 Nov 2015 15:25
Last Modified: 09 Nov 2015 15:25

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