Exposing the complex realities of nursing unresponsive patients' pain in intensive care
- Publication Type:
- Thesis
- Issue Date:
- 2009
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The experience of pain is individual and subjective and only accessible to another by
means of communication. Consequently assessing and managing the pain of a patient
can be one of the most complex and elusive objectives of nursing practice. This is
particularly the situation when critically ill patients are unresponsive as uncertainty
impacts on the nursing aim of providing consistent, quality pain care. For me, as an
intensive care nurse, uncertainty seemed out of place in the technological world of
intricate measurement in the intensive care unit. The research work presented within
this thesis focuses on making sense of and dealing with this disparity.
This study embraces both expressive and explanatory means of discovering and
conveying knowledge. Nurses’ propensity for storytelling inspired the development of
an original, eclectic narrative method; drawing on, and extending the work of a wide
range of philosophers and theorists such as: Labov and Waletsky, Gee, Agar & Hobbs,
Richardson, Mishler, Johnson and Mandler, Reason & Hawkins, Ricoeur and Hegel.
The research processes are comprehensively detailed in order to make apparent the
realities of undertaking such work, and of accommodating the delays created by
ongoing life challenges. In addition, the thesis is presented in a way that increases its
accessibility to nurses working in practice, balanced with the need to work within
established academic processes and structures.
While one still hopes for accurate measures of pain in unresponsive patients, the study
identifies and discusses the few pain cues that nurses ‘see’, and the limited pain
management options nurses ‘do’. Furthermore, the space between ‘seeing’ and ‘doing’,
where nurses ‘think’ and ‘feel’, was filled with rich complexity. Stories emerged of:
learning about pain, nursing intuition and ‘knowing the patient’, decision making,
advocacy for patients, collaboration with doctors, emotional responses of feeling
stressed, frustrated, anguished and inadequate, the nursing mandates of providing
comfort, care and justice, distancing from or connecting with patients.
The innovative narrative situatedness schema arising from this research offers a visual
map of the interrelatedness of the study’s dialectic concepts. The narrative ideas of
constitute/constitutive are juxtaposed with expression/explanation. Additionally, the
philosophical views on epistemology/ontology, synthesised to ‘voice’, are dovetailed
with Robbins’ pairs of human needs; certainty/uncertainty, significance/connection, and
growth/contribution. Such complexity is contained within storytelling. The study
promotes a new valuing of an old skill in highlighting the role of storytelling to further
nursing practice development. This revealing of the complexity of nursing provides a
major step towards the ongoing enhancement of patient care.
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