Method: The study used process-tracing methodology, comprising naturalistic observation and concurrent think aloud by nurses. The study was conducted in three surgical wards in a tertiary teaching hospital in Jeddah, Saudi Arabia. Nurses were eligible to participate if they were permanently employed in surgical wards. Nurses were observed for 4 hours while thinking aloud about their pain assessment and management practices with patients. Observation occurred during the following periods: 08:00-12:00, 14:00-18:00, and 20:00-24:00hrs. An observation checklist and audio recording were used to record verbal protocols. Data were analyzed using protocol analyses, which involved two major steps: informal exploratory analysis and content analysis of statements.
Result: Overall 137 patient-nurse pairs were observed. Of the patients participating, 4.4% experienced no pain, 29.9% experienced mild pain, 49.2% experienced moderate pain and 17.5% experienced severe pain. Nurses’ mean age was 33 years. Of the nurses, 28 (58.3%) were Indian, 18 (37.5%) were Filipino, 1 (2.1%) was Saudi and 1 (2.1%) was Tunisian. In surgical wards, 79.0% of nurses initiated pain assessments, whereby 63.0% were purposefully initiated by nurses and 16.0% occurred opportunistically during medication rounds. On other occasions, 21.0% of pain assessments were initiated by patients, 11.0% when they complained of pain and 10.0% opportunistically during medication rounds. During pain reassessment, 88.1% of nurses asked superficial questions of patients and 11.9% involved patient-initiated complaints of pain. In providing analgesics to patients, nurses tended to follow analgesic prescribed times for administration, which took priority over the time nominated by patients of when they wished to receive an analgesic. Few nurses used pain measurement scales in seeking information.
Conclusion: Most information seeking involved nurses deliberately seeking out information from patients. However, superficial questioning was used to elicit details about the effectiveness of analgesics administered. Rather than using patients as a resource for determining when to administer analgesics, nurses relied mainly on documented orders, which may not have addressed patients’ individualized needs for pain relief. More attention needs to be placed on encouraging nurses to use pain measurement scales in seeking information, in asking clear and targeted questions about patients’ pain experiences, and in using patients as a resource for revising pain management needs.
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