The challenge of caring for patients in pain: from the nurse's perspective

Abstract

AIM: To increase understanding of what it is like for nurses to care for patients in pain. BACKGROUND: Hospitalised patients are still suffering from pain despite increased knowledge, new technology and a wealth of research. Since nurses are key figures in successful pain management and research findings indicate that caring for suffering patients is a stressful and demanding experience where conflict often arises in nurses' relations with patients and doctors, it may be fruitful to study nurses' experience of caring for patients in pain to increase understanding of the above problem. DESIGN: A phenomenological study involved 20 dialogues with 10 experienced nurses. RESULTS: The findings indicate that caring for a patient in pain is a 'challenging journey' for the nurse. The nurse seems to have a 'strong motivation to ease the pain' through moral obligation, knowledge, personal experience and conviction. The main challenges that face the nurse are 'reading the patient', 'dealing with inner conflict of moral dilemmas', 'dealing with gatekeepers' (physicians) and 'organisational hindrances'. Depending upon the outcome, pain management can have positive or negative effects on the patient and the nurse. CONCLUSIONS: Nurses need various coexisting patterns of knowledge, as well as a favourable organisational environment, if they are to be capable of performing in accord with their moral and professional obligations regarding pain relief. Nurses' knowledge in this respect may hitherto have been too narrowly defined. RELEVANCE TO CLINICAL PRACTICE: The findings can stimulate nurses to reflect critically on their current pain management practice. By identifying their strengths as well as their limitations, they can improve their knowledge and performance on their own, or else request more education, training and support. Since nurses' clinical decisions are constantly moulded and stimulated by multiple patterns of knowledge, educators in pain management should focus not only on theoretical but also on personal and ethical knowledge.