A study of nurses' inferences of patients' physical pain

Aim. The aim of this study was to establish if postregistration education and clinical experience influence nurses’ inferences of patients’ physical pain. Background. Pain is a complex, subjective phenomenon making it an experience that is elusive and difficult to define. Evaluation of an individual's pain is the product of a dynamic, interactive process that frequently results in ineffective pain management. Educating nurses should address the deficit, however the clinical environment is thought to be most influential in the acquisition of knowledge. Design. A series of vignettes was used to consider nurses’ inferences of physical pain for six hypothetical patients; these were employed within a self‐administered questionnaire that also addressed lifestyle factors of patients in pain, general attitudes and beliefs about pain management and general knowledge of pain control. Method. One hundred questionnaires were distributed; 86 nurses returned the questionnaire giving a response rate of 86%. Following selection of the sample 72 nurses participated in the study: 35 hospice/oncology nurses (specialist) and 37 district nurses (general). Data analysis was carried out using SPSS and qualitative analysis of the written responses. Results. The specialist nurses tended to infer lower levels of physical pain than the general nurses when considering the patients in the vignettes. Conclusion. Education and clinical experience influence nurses’ knowledge, attitudes and beliefs about pain. However, it would appear that the specialist nurses’ working environment and knowledge base engenders a practice theory divide, resulting in desensitization to patients’ physical pain. Relevance to clinical practice. It is suggested that the specialist nurses use defence mechanisms to protect them from the conflict that arises from working within the clinical environment. These cognitive strategies have the potential to ease cognitive dissonance for the nurse, but may increase patient suffering.