‘Myth or reality?’ Preoperative pain planning and management: A critical ethnographic examination and exploration of day surgery preoperative practices

Ford, Claire (2019) ‘Myth or reality?’ Preoperative pain planning and management: A critical ethnographic examination and exploration of day surgery preoperative practices. Doctoral thesis, Northumbria University.

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Abstract

The assessment and management of surgical pain are paramount to good quality perioperative care. Regrettably, patients still declare inadequate satisfaction levels within this important area of practice. Holistic preoperative pain planning and education is a useful strategy to address this issue which has never been fully studied in day case surgery. This thesis has used a critical ethnographic research approach to explore and examine preoperative cultural practices and provide insight into what influences and shapes pain planning, management strategies and interactions with day surgical patients. This methodology observed healthcare interactions in the day case unit through a critical lens, underpinned by critical social theory and a transformative paradigm.
Using Carpspecken’s (1996) analytical enquiry framework, the preoperative practice of one department was investigated over nine months. Both qualitative and quantitative data collection methods were used, including observations, interviews and timings of interactions. One hundred and twenty-four patients and thirty-three healthcare professionals took part in the study, one hundred and thirty hours of practice were observed, and twenty in-depth interviews with healthcare professionals took place. Data were analysed using reconstructive and statistical analysis, and four main themes were identified as having an impact on preoperative interactions. These four themes were:

• The prioritisation of patient safety over pain management.
• A production line culture which negatively impacted on holistic practice.
• The existence of paternalism and power that affected staff and patient autonomy.
• Unconscious gender and surgery bias, which had a direct impact on the levels and depth of preoperative pain conversations and management strategies.

These were explored further in relation to Bourdieu's (1977) sociological theory of habitus and capital, in an attempt to raise awareness of practice culture and increase transparency, in order to challenge the status quo.

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