The Similarities and Differences of Nurse-Postoperative Patient Dyads’ Attitudes, Social Norms, and Behaviors Regarding Pain and Pain Management

Abstract

Purpose

Pain is an expected symptom in surgical patients, despite advances in pharmacology, surgical procedures, and perioperative care. The aim of this study was to examine the similarities and differences between nurse-postoperative patient dyads of the same or differing cultures/ethnicities with regard to perceptions, social norms, and behaviors related to pain and pain management.

Design

This was a descriptive qualitative study.

Methods

The sample consisted of six nurses (2 Hispanic, 2 Black, 2 Caucasian) and 12 patients of the same and different culture/ethnicity than their nurse) on a postoperative unit within 48 hours of surgery. A structured interview guide was developed to explore the attitudes, social norms, and behaviors of nurses related to pain and pain management, and a separate interview guide was developed for postoperative patients. All transcripts were analyzed and coded using Carini's principles.

Findings

Nurses used the pain scale to quantify pain intensity but did not conduct a comprehensive pain assessment. Nurses were concerned about opioid side effects and addiction and hesitated to provide opioids after the first postoperative day. Patients expected complete and immediate pain relief, with no worry about short-term opioid use. Patients did not believe that culture played a role in their care, but nurses were more comfortable caring for patients from the same cultural background. The use of complementary and nonpharmacologic pain management techniques was not well known by nurses and patients, but should be used in conjunction with medications.

Conclusions

Nursing education stresses cultural competence, but nurses emphasize "treating all patients the same," which creates a cognitive dissonance, with implications for education. Nurses should conduct a comprehensive pain assessment to inform pain management and nonpharmacologic and complementary therapies should be available on the postoperative unit.