An Ethnography of the Culture of Pain in a Non-Pediatric Emergency Department

Cummings, Jo Ann F.

doi:10.1016/j.pedhc.2013.07.005

Cited by 2 publications

(1 citation statement)

References 175 publications

(430 reference statements)

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“…However, other studies have reported that physicians and nurses document pain assessment without asking patients about pain, suggesting that documented scores may reflect staff judgment rather than patient report. 43,44 Ambiguity within current guidelines about whether pain scores should be documented according to patient report or a combination of patient report and staff judgment suggests that practice will be variable.…”

Section: Discussionmentioning

confidence: 99%

The Reality of Pain Scoring in the Emergency Department: Findings From a Multiple Case Study Design

Sampson

Goodacre

O’Cathain

2019

Annals of Emergency Medicine

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Background: At times of increasing pressure on emergency departments, and the need for research into different models of service delivery, little is known about how to recruit patients for qualitative research in emergency departments. We report from one study which aimed to collect evidence on patients' experiences of attending emergency departments with different models of general practitioners, but faced challenges in recruiting patients. This paper aims to identify and reflect on the challenges faced at all stages of patient recruitment, from identifying and inviting eligible patients, consenting them for participation and finally to engaging them in interviews and make recommendations based on our learning. Methods: A thematic analysis was carried out on field-notes taken during research visits and meeting minutes of discussions to review and improve patient recruitment throughout the study. Results: The following factors influenced the success of patient recruitment in the emergency department setting: complicated or time-consuming electronic health record systems for identifying patients; narrow participant eligibility criteria; limited research nurse support; and lack of face-to-face communication between researchers and eligible patients. Conclusions: This paper adds to the evidence for improving patient recruitment in different settings, with a focus on qualitative research in emergency departments. Our findings have implications for future studies attempting to recruit patients in similar settings.

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Section: Discussionmentioning

confidence: 99%

The Reality of Pain Scoring in the Emergency Department: Findings From a Multiple Case Study Design

Sampson

Goodacre

O’Cathain

2019

Annals of Emergency Medicine

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Why is pain management so difficult in the Emergency Department? A systematic mixed studies review and thematic synthesis of staff perceptions of enablers and barriers to pain management within the Emergency Department

Sampson

Johnson

2023

Emerg Med J

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IntroductionPain is the most common presenting feature within the ED, yet undertreatment of pain in the ED is a well-documented problem worldwide. Despite the development of interventions to address this problem, there is still limited understanding of how pain management can be improved within the ED. This systematic mixed studies review aims to identify and critically synthesise research exploring staff views of barriers and enablers to pain management to understand why pain continues to be undertreated in the ED.MethodsWe systematically searched five databases for qualitative, quantitative and mixed methods studies reporting ED staff views of barriers and enablers to pain management in the ED. Studies were quality assessed using the Mixed Methods Appraisal Tool. Data were extracted and qualitative themes were generated by deconstructing data then developing interpretative themes. Data were analysed using convergent qualitative synthesis design.ResultsWe identified 15 297 articles for title/abstract review, reviewed 138 and included 24 in the results. Studies were not excluded due to low quality, although lower scoring studies contributed less data to the analysis. Quantitative surveys focused more on environmental factors (eg, high workload and bureaucratic restrictions), while qualitative studies revealed more insight about attitudes. We developed five interpretative themes from the thematic synthesis: (1) pain management is seen as important but not a clinical priority; (2) staff do not recognise the need to improve pain management; (3) the ED environment makes it difficult to improve pain management; (4) pain management is based on experience, not knowledge; and (5) staff lack trust in the patient’s ability to judge pain or manage it appropriately.ConclusionsOverly focusing on environmental barriers as principal barriers to pain management may mask underlying beliefs that hinder improvements. Improving feedback on performance and addressing these beliefs may enable staff to understand how to prioritise pain management.

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An Ethnography of the Culture of Pain in a Non-Pediatric Emergency Department

Cited by 2 publications

References 175 publications

The Reality of Pain Scoring in the Emergency Department: Findings From a Multiple Case Study Design

The Reality of Pain Scoring in the Emergency Department: Findings From a Multiple Case Study Design

Why is pain management so difficult in the Emergency Department? A systematic mixed studies review and thematic synthesis of staff perceptions of enablers and barriers to pain management within the Emergency Department

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