Preoperative pain planning and management: A critical ethnographic examination and exploration of day surgery practices

Ford, Claire (2018) Preoperative pain planning and management: A critical ethnographic examination and exploration of day surgery practices. In: British Association of Day Surgery Annual Scientific Meeting 2018, 21st - 22nd June 2018, Sheffield, UK.

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Abstract

Introduction
As postoperative pain is predictable, individualised analgesic requirements should be explored preoperatively. However, while there is an abundance of literature examining pain planning for inpatients, there is limited research investigating whether pain planning is adequate and comprehensive for day surgery patients.

Methods
To examine how culture influences pain planning practices; a critical ethnographic methodological approach was adopted, utilising quantitative and qualitative methods of data collection. Data were analysed using reconstructive analysis and triangulated with the numerical data that was statistically analysed.

Results
Over eight months, 130 hours of practice were observed, incorporating 100 preoperative anaesthetic visits, 24 nurse-led preoperative assessments and in addition, 20 staff interviews were conducted. Four central themes emerged from the data: ‘patient safety’, ‘surgical productivity’, ‘power and paternalism’, and ‘unconscious bias’. Within the culture of the perioperative department, safety was frequently prioritised over holistic pain planning and management. High levels of productivity negatively impacted on the quality of preoperative interactions. Power within interactions was unequal and paternalistic practices limited nursing staff autonomy and patient empowerment. Decisions about pain management were sometimes influenced by healthcare professionals’ negative unconscious biases towards specific surgical specialities and patient gender.

Conclusions
Cultural work-based practices are varied, particularly regarding the length of time spent discussing pain, the language used during pain discussions and the depth and quality of the pain interactions. Healthcare professionals, therefore, need to be cognisant of how these varied cultural practices impact on their interactions and pain planning and management decisions to ensure pain is treated holistically.

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