The reactions of nurses to the pain of their patients: a personal construct analysis

This study of the impact of hospitalised patients pain upon nurses was generated by three concerns: 1. How does the pain nurses encounter as part of their work contribute to their occupational stress? 2. Why does acute pain, a common feature of the experience of hospitalised patients, continue to be mismanaged? 3. How do the ways nurses deal with their emotions about pain influence the way they manage pain relief? The professional image of the nurses as carer and pain reliever is incompatible with the reality of the nurse faced with exposure to intense pain for long periods of time. Burns nurses must subject patients to repeated and painful-albeit therapeutic-procedures. These carers are necessarily also inflictors of pain. Most nurses feel responsible for pain control yet their control over resources to alleviate pain is limited. This affects neonatal nurses especially. These two groups of nurses, burns and neonatal, are the focus of this study. From the literature and from concepts of personal construct theory, I developed a preliminary personal construct model of nurses' reactions to patients' pain. This model was tested and elaborated upon from analyses of interview data collected from 65 nurses working in the burns and neonatal intensive care units of four university teaching hospitals over a period of two and a half years. Interview data (comprising responses to two open-ended questions) were scored for positive and negative affect and for the strategies used by the nurses to cope with pain. Hypotheses derived from the preliminary model were tested statistically and the results were incorporated into a new model. I used the results of qualitative analyses to elaborate on this model. Four types of coping strategies were used by the nurses: distancing, engaging, social support and role reconstruction. Distancing was the most commonly adopted strategy. Engaging was a more assertive strategy and was more frequently adopted by neonatal nurses. Social support was more commonly used by burns nurses. Role reconstruction was used only by a small number of nurses. It is apparent that nurses have received little guidance from theoretical and research literature on ways of dealing with pain that are consistent with their identity as nurses. Public debate is necessary for nurses to be able to reconstruct their roles so that the gap between the practice and the rhetoric of nursing is narrowed and nurses develop more useful coping strategies. When health care professionals develop means of protecting themselves and their patients from the consequences of the paradoxical nature of their work, the psychological health of nurses is likely to be enhanced.