- Title
- Factors influencing decision-making in postoperative pain management of older people: a critical ethnography
- Creator
- Phelan, Caroline
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2019
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Aim: The aim of this critical ethnography was to examine decision-making among nurses, doctors and older patients regarding postoperative pain management. Method: A critical ethnography was used to examine the interactions between clinicians and patients for its utility in uncovering the influence these interactions had on decision-making. Habermas' Theory of Communicative Action was used to provide a framework to the analysis and dual process theory was used in this study as the decision-making model. Nurses (n=21) and doctors (n=8) working on a general surgical ward in a large tertiary referral hospital were recruited. Patients over the age of 65 (n=6) were also recruited. One hundred and nine hours of ethnographic observations were undertaken on the study ward of the interactions between clinicians and patients and forty-five hours of interview transcripts (eight hours and forty minutes with patients, thirteen hours and five minutes with medical staff and twenty-three hours and fifteen minutes with nursing staff) were analysed. Findings: Emergent themes from the data were analysed to provide a comprehensive understanding of the complex nature of decision-making in pain management. The findings revealed an inherent connection between communication and decision-making, and the communicative interactions between patients, nurses and doctors revealed the central theme of the thesis, decision-making is a social transaction linguistically mediated. The clinicians created and maintained a culture on the study ward, through their clinical practice and language, that acknowledged the subjective nature of pain, normalised the pain experience for patients within the postoperative environment and encouraged participation and collaboration with patients. The subjective quality of pain introduced uncertainty into the clinical environment and clinicians developed communication techniques to diminish the impact this uncertainty had on their decision-making. The agents of decision-making—patients, nurses and doctors—constructed an understanding of postoperative pain through language, communicating with one another in a process Habermas referred to as communicative interaction. This linguistically mediated meaning of pain influenced the participants’ expression of pain, assessment of pain and their decision-making. Conclusion: The social aspects of decision-making play a crucial role in pain management. Decision-making is a product of the environment in which it occurs; the patient and the clinician interacting within the greater setting of the acute surgical ward, the acute hospital and society. The subjective nature of pain was recognised by the participants who communicated with one another to either enhance or hinder decision-making.
- Subject
- decision making; pain; postoperative pain; older people; critical ethnography
- Identifier
- http://hdl.handle.net/1959.13/1401045
- Identifier
- uon:34862
- Rights
- Copyright 2019 Caroline Phelan
- Language
- eng
- Full Text
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| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | ATTACHMENT01 | Thesis | 6 MB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Abstract | 288 KB | Adobe Acrobat PDF | View Details Download |