The role of empowerment in the care of patients who experience severe pain : the nurse’s perspective

Abstract

Hospitalised patients continue to experience significant levels of pain despite advances in pain management knowledge and techniques. Evidence from nurses practicing in specialty and community settings suggests that caring for patients who experience persisting pain has implications, both personally and professionally. This grounded theory study described and explained the effect of caring for patients who experienced severe pain on nurses working in medical and surgical wards of a Western Australian hospital. Data were collected from a sample of 33 nurses through 30 semi-structured interviews and 93 hours of participant observation. Eleven patients who were experiencing severe pain participated in structured observations Audio-recordings of interviews and field notes were transcribed verbatim and analysed using the constant comparative method.The substantive theory of seeking empowerment to provide comfort was developed in this grounded theory study. This substantive theory explained the emotional effects on nurses and their response to caring for patients with severe pain. The provision of comfort to patients and the maintenance of the well-being of the nurse were key elements.The substantive theory of seeking empowerment to provide comfort was developed in this grounded theory study. This substantive theory explained the emotional effects on nurses and their response to caring for patients with severe pain. The provision of comfort to patients and the maintenance of the well-being of the nurse were key elements.In this study, empowerment was found to be an outcome and a process and the core category that integrated the substantive theory. As an outcome, empowerment was the psychological state nurses experienced when they felt able to provide comfort. As a process, empowerment was the means by which nurses sought to avoid the shared problem of feelings of disempowerment to enhance their patients’ and their own wellness. The process of seeking empowerment to provide comfort explained nurses’ actions and interactions to avoid feelings of disempowerment by building connections with patients and colleagues, finding alternative ways to comfort when pain relief was ineffective and quelling emotional turmoil to conserve their resources and protect their own well-being. Nurses were shown to progress through these stages as their experiences of disempowerment escalated.This research illuminates the problem encountered by nurses when they care for patients who experience severe pain and the process they use to manage this problem. A striking finding of this study was the depth of emotional distress experienced by some nurses who felt powerlessness to assist patients in pain. Evidence also emerged of behaviours used by nurses to protect themselves from ongoing feelings of disempowerment. There are significant implications for both patients and nurses in these findings. This study provides direction for interventions to support nurses who practice in acute hospital settings and to facilitate patient comfort and nurse well-being. A number of indications for areas of further research are also provided.