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Chatchumni, M., Namvongprom, A., Eriksson, H. & Mazaheri, M. (2019). Exploring the different management structures in nurses responses and treating of patients’ postoperative pain: A qualitative triangulation study. Electronic Physician, 11(2), 7536--7543
Open this publication in new window or tab >>Exploring the different management structures in nurses responses and treating of patients’ postoperative pain: A qualitative triangulation study
2019 (English)In: Electronic Physician, ISSN 2008-5842, Vol. 11, no 2, p. 7536--7543Article in journal (Refereed) Published
Abstract [en]

Background: Nurses’ roles are an important aspect of their approaches to pain management and monitoring in the post-operative phase of recovery in a surgical ward. A barrier to successful pain management may be the nurse’s perceptions of the patient in pain, which are confounded by the patterns of communication within individual contexts. We need to study, grasp and understand the complexities of the pain management practice within the context of the surgical ward in order to be able to improve the practices and design appropriate interventions to help patients in need. Objective: The purpose of this study was to explore nurses’ postoperative pain management practices. Methods: This qualitative triangulation study was conducted in a surgical ward at a public hospital in Bangkok (Thailand) from 2012 to 2015. We applied four qualitative methods in the study: 1) observations in a postoperative pain management setting (100 hours); 2) in-depth interviews (12 nurses), 3) three focus group discussions (18 nurses), and 4) narratives relating to 69 critical incidents gathered during recurrent visits over a period of ten weeks (9 nurses). Content analysis, as outlined in grounded theory, was applied. Results: The 40 nursing staff made their observations of the participants by conducting go-along interviews while they worked in the surgical field. The group of nurses comprised of 20 females and 4 males, age-ranged between 21-49 years of age, and their nursing experience ranged from 1-28 years. From our analysis, nurses verified patients’ pain by using double- and triple-control methods to document and record it, thus managing pain by administrative procedures rather than being proactive in providing pain relief. Therefore, communication and information about the patients’ pain and subsequent treatment of postoperative pain caused delays that may hamper the adequate use of available analgesics for pain relief. Levels of experience in communicating between nurses, other professionals, and patients were a main cause of delays in treating and managing pain. Conclusion: The complex communication system that would improve the communication ways leads to better standards of practice and quality of care.

National Category
Nursing
Identifiers
urn:nbn:se:rkh:diva-3012 (URN)10.19082/7536 (DOI)
Available from: 2019-08-09 Created: 2019-08-09 Last updated: 2019-08-09Bibliographically approved
Chatchumni, M., Eriksson, H. & Mazaheri, M. (2019). Towards person-centered pain management in surgical care: Addressing the overlapping pain management systems in nursing education to enhance practice. In: Global Nursing Education Conference: Nursing Education. Paper presented at Nursing Education 2019, Osaka, Japan 24-25 October.. Canada
Open this publication in new window or tab >>Towards person-centered pain management in surgical care: Addressing the overlapping pain management systems in nursing education to enhance practice
2019 (English)In: Global Nursing Education Conference: Nursing Education, Canada, 2019Conference paper, Oral presentation only (Refereed)
Abstract [en]

Since nurses’ work is knowledge-based an ineffective pain management may be the nurse’s perceptions of the patient in pain, which are a barrier of communication between nurses and patients’ pain within individual contexts. The purpose was to explore nurses’ post-operative pain management practices. A qualitative triangulation design was used, applying numerous qualitative methods: observations in a postoperative pain management setting (100 hours); in-depth interviews (12 nurses), three focus group discussions (18 nurses), and narratives relating to 69 critical incidents gathered during recurrent visits over a period of ten weeks (9 nurses). Content analysis, as outlined in grounded theory, was applied.

The findings revealed the complex communication system that were nurses affirmed patient’s pain by using double- and triple-control methods to document and record it. As a consequence, they were managing pain by administrative prescription when the patients had requested rather than being proactive in providing pain relief. Mainly of ineffective succeed of communication tasks and information about the patients’ pain in post-operative pain that was available analgesics as causes delayed for pain relief.

From the findings the complex communication system was discuss within the responding to and addressing patients’ postoperative pain system model, it was most helpful in creating a meaningful way of communicating education can prepare students for effective communication in a complex understanding about pain management, it must seek opportunities to challenge and change the way nurses think address how pain management within different interacting structures in practice and are create new and important ways of communicating with patients.

Place, publisher, year, edition, pages
Canada: , 2019
Keywords
Qualitative triangulation, nurse-patient communication, pain management practice, post-operative pain
National Category
Nursing
Identifiers
urn:nbn:se:rkh:diva-3074 (URN)
Conference
Nursing Education 2019, Osaka, Japan 24-25 October.
Available from: 2019-11-12 Created: 2019-11-12 Last updated: 2019-11-13Bibliographically approved
Chatchumni, M., Namvongprom, A., Eriksson, H. & Mazaheri, M. (2018). Engagement and availability in shaping nurses’ management of postoperative pain: a qualitative study. Electronic Physician, 10(8), 7235-7242
Open this publication in new window or tab >>Engagement and availability in shaping nurses’ management of postoperative pain: a qualitative study
2018 (English)In: Electronic Physician, ISSN 2008-5842, Vol. 10, no 8, p. 7235-7242Article in journal (Refereed) Published
Abstract [en]

Background: Studies reporting inadequate nursing care for patients indicate that nurses are negatively affected in such situations, and research is needed to study nursing care in postoperative situations. Objective: To describe situations of postoperative pain management in a surgical ward in Thailand. Methods: A qualitative approach using the Critical Incident Technique was chosen to investigate situations of postoperative pain management from the perspective of surgical nurses in Thailand. Data were collected through multiple semi-structured interviews with nine nurses over a five-week period. Results: The situations of surgical nurses described three elements that heavily influenced the quality of postoperative pain management: engagement in a trustful nurse-patient relationship, availability of pain medication and nursing care when needed, and imbalance between meeting the patient’s needs and completing routine nursing duties. Conclusion: The results help to expand our understanding of how Thai nurses manage pain in postoperative situations and indicate areas that could be improved in terms of how nurses respond to patients’ pain. Nurses challenge existing guidelines and facilitate development of new nursing guidelines and/or policies in pain management.

Keywords
Nurse-Patient Relations, Postoperative pain, Pain management, Trust
National Category
Nursing
Identifiers
urn:nbn:se:rkh:diva-2609 (URN)10.19082/7235 (DOI)30214707 (PubMedID)
Available from: 2018-08-29 Created: 2018-08-29 Last updated: 2018-10-09Bibliographically approved
Mazaheri, M., Ericson-Lidman, E., Öhlén, J. & Norberg, A. (2018). Meanings of troubled conscience and how to deal with it: expressions of Persian-speaking enrolled nurses in Sweden. Scandinavian Journal of Caring Sciences, 32(1), 380-388
Open this publication in new window or tab >>Meanings of troubled conscience and how to deal with it: expressions of Persian-speaking enrolled nurses in Sweden
2018 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 32, no 1, p. 380-388Article in journal (Refereed) Published
Abstract [en]

Introduction

A feature of the healthcare system in Sweden, particularly in the care of older people, is its cultural diversity in terms of having considerable numbers of both caregivers and care recipients with an immigrant background. Considering the influence of culture in ethical decision-making processes, the idea of conscience and the adverse effects of a troubled conscience, it is important to study the concepts of conscience and troubled conscience in culturally diverse populations. There is no published study regarding troubled conscience among immigrant populations that includes enrolled nurses.

Aim

To illuminate the meanings of troubled conscience and how to deal with it among enrolled nurses with Iranian backgrounds working in Swedish residential care for Persian-speaking people with dementia who have emigrated from Iran.

Method

The study was conducted with a phenomenological hermeneutic design. Ten enrolled nurses with an Iranian background, with at least one year's experience of taking care of older people with dementia, were interviewed. The study was reviewed by the Regional Ethical Review Board for ethical vetting of research involving humans. Appropriate measures were taken to ensure confidentiality and voluntary participation.

Results

The meanings of having a troubled conscience for the participants comprise not being a good person, including being an uncaring person, not acting according to one's values and living in a state of unease. Dealing with a troubled conscience involves trying to compensate for the harm one has caused and trying to prevent similar situations by being a responsible caregiver.

Conclusions

The enrolled nurses understood themselves as caring people and not only caregivers. They knew that they should hear their conscience and respond to it by trying to be a caring person and acting according to their values. The findings should be interpreted in the given specific context.

Keywords
troubled conscience, enrolled nurse, dementia, immigrant, Persian-speaking, residential care
National Category
Nursing
Identifiers
urn:nbn:se:rkh:diva-2429 (URN)10.1111/scs.12472 (DOI)28799165 (PubMedID)
Available from: 2017-08-11 Created: 2017-08-11 Last updated: 2018-03-15Bibliographically approved
Mazaheri, M., Ericson-Lidman, E., Zargham-Boroujeni, A., Öhlén, J. & Norberg, A. (2017). Clear conscience grounded in relations: Expressions of Persian-speaking nurses in Sweden. Nursing Ethics, 24(3), 349-361
Open this publication in new window or tab >>Clear conscience grounded in relations: Expressions of Persian-speaking nurses in Sweden
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2017 (English)In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 24, no 3, p. 349-361Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Conscience is an important concept in ethics, having various meanings in different cultures. Because a growing number of healthcare professionals are of immigrant background, particularly within the care of older people, demanding multiple ethical positions, it is important to explore the meaning of conscience among care providers within different cultural contexts.

RESEARCH OBJECTIVE: The study aimed to illuminate the meaning of conscience by enrolled nurses with an Iranian background working in residential care for Persian-speaking people with dementia.

RESEARCH DESIGN: A phenomenological hermeneutical method guided the study.

PARTICIPANTS AND RESEARCH CONTEXT: A total of 10 enrolled nurses with Iranian background, aged 33-46 years, participated in the study. All worked full time in residential care settings for Persian-speaking people with dementia in a large city, in Sweden.

ETHICAL CONSIDERATIONS: The study was approved by the Regional Ethical Review Board for ethical vetting of research involving humans. Participants were given verbal and written study information and assured that their participation was voluntary and confidential.

FINDINGS: Three themes were constructed including perception of conscience, clear conscience grounded in relations and striving to keep a clear conscience. The conscience was perceived as an inner guide grounded in feelings, which is dynamic and subject to changes throughout life. Having a clear conscience meant being able to form a bond with others, to respect them and to get their confirmation that one does well. To have a clear conscience demanded listening to the voice of the conscience. The enrolled nurses strived to keep their conscience clear by being generous in helping others, accomplishing daily tasks well and behaving nicely in the hope of being treated the same way one day.

CONCLUSION: Cultural frameworks and the context of practice needed to be considered in interpreting the meaning of conscience and clear conscience.

Keywords
Care provider, conscience, dementia, immigrant, Persian-speaking residential care
National Category
Nursing
Identifiers
urn:nbn:se:rkh:diva-2121 (URN)10.1177/0969733015603442 (DOI)26385903 (PubMedID)
Available from: 2016-02-25 Created: 2016-02-03 Last updated: 2017-07-07Bibliographically approved
Chatchumni, M., Namvongprom, A., Eriksson, H. & Mazaheri, M. (2017). Using Critical Incident Technique to understand pain management situations in Thailand. In: : . Paper presented at 28th Annual Scientific Meeting of TASP Transformation: From Knowledge to Clinical Skills in Pain Medicine. May 3rd-5th , 2017 Venue: Sheraton Hotel, Hua Hin, Phetchaburi, Thailand..
Open this publication in new window or tab >>Using Critical Incident Technique to understand pain management situations in Thailand
2017 (English)Conference paper, Poster (with or without abstract) (Refereed)
Abstract [en]

Background: Nursing care is an important concern in the field of pain management as it addresses situated efforts to achieve a person-centered care in pain management. Although it is clear that the effectiveness of the pain management practice needs to be improved, there is limited knowledge about the pain management practices of Thai nurses. This study address if Critical Incident Technique be a used to increase our understanding of Pain management in a Thai context.

Methods: Critical Incident Technique was used to explore postoperative pain management provided by nurses in a surgical ward in Thailand. A purposive sample of nine registered nurses over a five-week period using a semi-structured interview guide were conducted and collected. 

Findings: All 69 situations were used to illustrate the successful and unsuccessful aspects of managing postoperative pain, and included Engagement is a manner of commitments, Availability is characteristic in the practicalities of managing pain for the patients, and Imbalance is being inconsistency between the patients' needs and nurses maintain their undertaking routines. 

Discussion: Nurses’ experience helped to grasp and understand how nurses treat pain in the postoperative setting; this study was conducted in order to further the understanding of this topic. The result show that Critical Incident Technique can serve to expand our knowledge how existing guidelines are facilitated by nurses. Further, the knowledge gained can serve as foundation to development of new nursing guidelines and/or policies in pain management, including improving nursing skills and education programs in pain management settings. 

National Category
Nursing
Identifiers
urn:nbn:se:rkh:diva-2379 (URN)
Conference
28th Annual Scientific Meeting of TASP Transformation: From Knowledge to Clinical Skills in Pain Medicine. May 3rd-5th , 2017 Venue: Sheraton Hotel, Hua Hin, Phetchaburi, Thailand.
Available from: 2017-05-09 Created: 2017-05-09 Last updated: 2017-05-23Bibliographically approved
Pietilä Rosendahl, S., Söderman, M. & Mazaheri, M. (2016). Immigrants with dementia in Swedish residential care: an exploratory study of the experiences of their family members and Nursing staff. BMC Geriatrics, 1(16), 1-12, Article ID 200.
Open this publication in new window or tab >>Immigrants with dementia in Swedish residential care: an exploratory study of the experiences of their family members and Nursing staff
2016 (English)In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 1, no 16, p. 1-12, article id 200Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:Worldwide, there is a growing population of older people who develop dementia in a country other than that of their origin. When their dementia has reached an advanced stage, residential care is most often needed. People with dementia in Sweden are often cared for in group homes. For immigrants, this may mean a linguistically challenging care environment for both healthcare staff and the patients' family members. The aim of this study was to explore and describe the experiences of family members and professional caregivers regarding the care provided to immigrants with dementia in group homes in Sweden.

METHODS:An exploratory, descriptive study with a qualitative approach was chosen. In-depth semi-structured interviews were conducted with nine professional caregivers and five family members of people with dementia with Finnish, Estonian, Hungarian and Ingrian backgrounds; all were chosen purposefully. All people with dementia had lost their Swedish language skills as their second language. The data was analysed using qualitative content analysis.

RESULTS:Three main categories and seven subcategories were identified. The first main category: A new living situation comprised the subcategories: adjusting to new living arrangements and expectations regarding activities and traditional food at the group home, the second main category: Challenges in communication with the subcategories: limited communication between the immigrant with dementia and the Swedish-speaking nursing staff and the consequences of linguistic misunderstandings and nuanced communication in a common language and the third main category: The role of the family member at the group home with the subcategories: a link to the healthy life story of the family member with dementia and an expert and interpreter for the nursing staff.

CONCLUSIONS:The family member played a crucial role in the lives of immigrants with dementia living in a group home by facilitating communication between the nursing staff and the PWD and also by making it possible for PWD to access the cultural activities they wanted and which professional caregivers were either not able to recognise as needed or could not deliver.

Keywords
Communication, Dementia, Family member, Group home, Nursing
National Category
Nursing
Identifiers
urn:nbn:se:rkh:diva-2133 (URN)10.1186/s12877-016-0200-y (DOI)26772758 (PubMedID)
Available from: 2016-02-03 Created: 2016-02-03 Last updated: 2017-11-30Bibliographically approved
Manaporn Chatchumni, M., Namvongprom, A., Eriksson, H. & Mazaheri, M. (2016). Thai Nurses’ experiences of post-operative pain assessment and its’ influence on pain management decisions. BMC Nursing, 15, Article ID 12.
Open this publication in new window or tab >>Thai Nurses’ experiences of post-operative pain assessment and its’ influence on pain management decisions
2016 (English)In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 15, article id 12Article in journal (Refereed) Published
Abstract [en]

Background

While many studies have addressed various issues with regards to pain management, there is limited knowledge about how nurses assess pain in surgical wards. This study aimed to describe Thai nurses’ experiences of pain assessment in a surgical ward.

Methods

A cross-sectional explorative study was conducted. Participants were selected through theoretical sampling. Data was collected through interviews with twelve registered nurses working in surgical wards. Qualitative content analysis guided the analysis of the data.

Results

Nurses use a double/triple check system, communicated to the healthcare team via records and protocols, and they used their skills and experiences in pain assessment. The results showed that nurses missed the opportunity to include the patients’ self-reported pain in their accounts. Though much evidence of pain was collected, this did not seem to benefit the patients. Furthermore, the nurses were not using instruments to measure pain, which illustrates the potential unreliability of professionals who have differing opinions concerning the patients’ pain.

Conclusions

Thai nurses worked based on a ‘patient-evidence’ paradigm when assessing patients in pain; this should be shifted to an evidence-based paradigm. Furthermore, by including the patients’ self-reported pain in their assessment, nurses would both improve the quality of the pain assessment and empower patients in their pain management. Pain management practices in Thailand should be improved through education, training, supportive innovation, and collegial competence development in order to improve the quality of care in the post-operative field.

Keywords
Pain, Nursing, Management, post operative
National Category
Nursing
Identifiers
urn:nbn:se:rkh:diva-2181 (URN)10.1186/s12912-016-0136-8 (DOI)26933384 (PubMedID)
Available from: 2016-02-29 Created: 2016-02-29 Last updated: 2017-11-30Bibliographically approved
Chatchumni, M., Namvongprom, A., Eriksson, H. & Mazaheri, M. (2016). Treating without Seeing: Pain Management Practice in a Thai Context. Pain Research & Management, Article ID 9580626.
Open this publication in new window or tab >>Treating without Seeing: Pain Management Practice in a Thai Context
2016 (English)In: Pain Research & Management, ISSN 1203-6765, E-ISSN 1918-1523, article id 9580626Article in journal (Refereed) Published
Abstract [en]

Pain management is a core nursing function, and it plays a key role in postoperative care. It is important to understand the cultural context of nursing practices and how this affects effective pain management. The aim of this study was to describe the professional and cultural framework within which pain management is practiced on a Thai surgical ward. Spradley’s ethnographic methodology was used. Data were collected through 98.5 hours of field observations and interviews at a surgical ward in Thailand. Three themes were constructed that describe the way Thai nurses practiced pain management: (i) complex communications system to address pain and to respond to it, (ii) the essence of Thai-ness, and (iii) a passive approach to pain management. The results indicate that, in the response to discomfort and pain, better pain management will result if there is a shift from functional to patient-centered care. The nursing culture needs to be further researched and discussed, in order to set priorities in line with the goals of national and international organizations for improving postoperative care and promoting patient comfort

National Category
Nursing
Identifiers
urn:nbn:se:rkh:diva-2310 (URN)10.1155/2016/9580626 (DOI)28044071 (PubMedID)
Available from: 2016-12-01 Created: 2016-12-01 Last updated: 2017-07-14Bibliographically approved
Ehrlich, K., Boström, A.-M., Mazaheri, M., Heikkilä, K. & Emami, A. (2015). Family caregivers’ assessments of caring for a relative with dementia: A comparison of urban and rural areas. International Journal of Older People Nursing, 10(1), 27-37
Open this publication in new window or tab >>Family caregivers’ assessments of caring for a relative with dementia: A comparison of urban and rural areas
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2015 (English)In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 10, no 1, p. 27-37Article in journal (Refereed) Published
Abstract [en]

AIM: This study aimed to describe and compare urban and rural family caregivers' reactions to caring for a relative with dementia and to examine the associations between caregiving and socio-demographic factors.

BACKGROUND: Most studies on family caregivers' experiences caring for older people with dementia have been conducted in urban areas, and little is known about the experiences of family caregivers living in rural areas.

DESIGN: A cross-sectional study design was used.

METHODS: A total of 102 caregivers (response rate 85%) from urban (n=57) and rural (n=46) areas completed the Caregiver Reaction Assessment (CRA) Scale and demographic information. Data were analysed using descriptive and inferential statistics and linear regression models.

RESULTS: Overall, family caregivers reported high satisfaction even if they also reported high impact on finances and daily living. Rural caregivers experienced a higher negative impact on finances but reported more support from family members than urban caregivers. Age, gender and relationship were significantly associated with four of the five CRA subscales. Educational level and geographical setting were not associated with any of the CRA subscales.

CONCLUSIONS: The results of the study raise questions about the financial situation of older female caregivers and on the expectations of built-in family structures in urban and rural areas. Further studies focusing on the meaning and constitution of a family would help us to understand how these factors influence family caregiving both in rural and urban areas.

IMPLICATIONS FOR PRACTICE: To provide person-centred care and to avoid stereotyped caregiving, a better picture of traditions in family caregiving can improve a more differentiated and appropriate professional caregiving pliable with the cultural context in which it is carried out.

Keywords
Dementia, rural, urban, relative, family member
National Category
Nursing
Identifiers
urn:nbn:se:rkh:diva-2110 (URN)10.1111/opn.12044 (DOI)24433340 (PubMedID)
Available from: 2016-02-25 Created: 2016-02-03 Last updated: 2017-11-30Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-3589-318X

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