A Study of Pain Behaviours in Postoperative Patients

Abstract

This study was designed to investigate behaviours which appeared to be related to pain postoperatively of forty patients on the third and fourth day after major abdominal surgery and nurses' responses to such behaviours. The method employed to identify and analyse these behaviours was that of participant bservation and of concurrently collecting, coding and analyzing data from the empirical situation. Two main categories of patients' behaviours which were conceptualized as indicators of pain were identified from 292 behaviours drawn from the data. Indicators of pain which could be primarily seen by others were termed visual and those which could be primarily heard were termed auditory indicators. Subcategories emerged out of these two categories. Three categories of nurses' responses were isolated; promise to give medication, giving medication and giving advice. Patterns emerged out of both patient's behaviours and nurses' responses. Patterns of Patients' Behaviours 1. From exhibiting visual indicators of pain to exhibiting auditory indicators of pain. 2. Exhibiting only visual indicators of pain. In the 80 observation periods, there were 50 incidents of exhibiting only visual indicators of pain (pattern 2) and 30 incidents where patients moved from exhibiting visual indicators of pain to exhibiting auditory indicators of pain (pattern l). The findings showed that the nature of the indicators of pain demonstrated was related to the age of the patient, the type of surgery, previous surgery experience and time lapse after surgery. Patterns of Nurses' Responses (as related to prior patient behaviours indicating the presence of pain) were discovered to be: 1. Responding to auditory indicators 2. Responding to some visual indicators 3. Not responding at all (most frequent). It is suggested that some indicators are associated with a high degree of pain and others with a low degree of pain. One hundred and sixty“three (163) indicators of a high degree of pain were isolated and 129 of a low degree of pain. The proportion of high and low pain indicators was related to the type of surgery and time lapse after surgery. There were 17 responses to these indicators, 15 to indicators of a high degree of pain and 2 to indicators of a low degree of pain. Indicators of pain occurred in clusters and each cluster usually contained some which were associated with high pain and some with low pain. Four patterns of outcomes of behaviours followed the already identified behaviours; disappearance of the pain indicators, indicators of a high degree of pain were predominant and remained, indicators of a high degree of pain were predominant but changed to a predominance of indicators of a low degree of pain, and indicators of a low degree of pain were predominant and remained. The findings alr,o showed that there were more visual indicators, 23h, than auditory indicators, $8, and yet most of the small number of nurses' responses were given to auditory indicators of pain. This suggests that nurses need to place emphasis on the continuous visual aspect of observation as well as the continuous assessment, planning, intervention and evaluation of intervention. Leaders of nursing can have periodic observation with nurses and encourage them to examine situations by asking questions of how, what, when, and why about the situations concerned. They can also record their observations and attempt to identify logical relationships.