A Study Of Pain Behaviours In Postoperative Patients

ABSTRACT

Sarah R. Addison: A Study of Pain Behaviours in Postoperative Patients

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

observation and of concurrently collecting, coding and analysing

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.