Browsing by Author "Madjar, Irena"

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    The experience of pain in surgical patients : a cross-cultural study : a thesis...for the degree of Master of Arts in Nursing Studies at Massey University
    (Massey University, 1981) Madjar, Irena
    The purpose of this study was to describe and compare the experience of pain in surgical patients from two cultural groups, and to identify similarities and differences in their conceptualizations of pain, and attitudes and behavioural responses to pain. An integral part of the study was to generate hypotheses and concepts which may contribute to the formulation of substantive theory in the area of care of patients in acute pain. The design of the study was influenced by a qualitative approach to research, with the basic expectation that explanation would emerge from the data collected. The methodology used was that of supplemented participant-observation. Thirty three adults (20 Anglo-Australians and 13 Yugoslavs), admitted for abdominal surgery to one of three hospitals in Sydney and Wollongong, Australia, were observed throughout their period of hospitalization. In addition, non-structured interviews were conducted with each patient prior to surgery, and prior to discharge from hospital; verbal self-reports, visual analogue scales, and behavioural observation check lists were used; and information about peri-operative interventions (including analgesic drugs) was collected. The findings relate primarily to: (a) the experience of pain in terms of the intensity, duration, and quality of pain, and pain-related behaviours; (b) the relief of pain in terms of the use and perceived effectiveness of analgesic drugs and other pain-relieving measures, with special reference to patient preferences for social company during the experience of pain; and (c) the prospective and retrospective evaluation of the experience in terms of pre-operative fears, fulfilment of expectations, and positive and negative aspects of the experience. The findings support the hypothesis that while some behavioural differences exist between Anglo-Australian and Yugoslav patients, the greatest degree of difference between the two groups is found in their underlying attitudes to pain. In addition, a number of more specific conclusions are presented, followed by a discussion of implications for clinical practice and for further research.
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    Pain as embodied experience : a phenomenological study of clinically inflicted pain in adult patients : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Nursing at Massey University
    (Massey University, 1991) Madjar, Irena
    This phenomenological study describes the lived experience of pain inflicted in the context of medically prescribed treatment, explores the meanings of such pain for patients who endured it and for nurses whose actions contributed to its generation, and presents a thematic description of the phenomenon of clinically inflicted pain. The study is informed by phenomenology, both in terms of its premises and orientation, and its research design and method. The participants in the study were 14 adult patients, admitted to hospital following burn injuries, or receiving intravenous chemotherapy upon diagnosis of cancer, and 20 nurses involved in their care. Data collection took place over a period of five months and included participant observation and compilation of field notes, and a total of 89 tape-recorded interviews (48 with patients and 41 with nurses). Through the process of hermeneutic interpretation a number of themes were identified and used to describe the phenomenon of clinically inflicted pain and the structure of the lived experience of the patients and nurses concerned. The phenomenon of clinically inflicted pain is described in terms of four related themes: 1) the hurt and painfulness of inflicted pain; 2) handing one's body over to others; 3) the expectation and experience of being wounded, and 4) restraining the body and the voice. These themes point to the embodied nature of pain experience and the extent to which the person is involved not only in the enduring of pain but also in its generation. The broader lifeworld of clinically inflicted pain involves patients in the experience of constituting such pain, often as punishment and almost always as something unavoidable, and in turn being constituted by their experiences in terms of losing and seeking to regain a sense of embodied self and of personal situation, and by changed experiences of lived space and lived time. Nurses who themselves helped to generate pain, frequently overlooked the patient's lived exerience and thus the essential nature of inflicted pain as painful, wounding, and demanding cooperation and composure from the patient. Instead, the pain frequently became invisible to nurses involved in its infliction, or when it could not be overlooked or ignored, it was perceived as inevitable, non-harmful, and even as beneficial to patients' recovery. The strategic responses that nurses adopted to pain infliction included detachment from the perceived impact and consequences of their own actions and objectification of the person in pain as a body-object on whom certain tasks had to be performed. An alternative to the strategy of detachment and objectification was involvement in a therapeutic partnership between the nurse and the patient, where shared control over pain infliction and relief helped to sustain trust in the relationship and preserve personal integrity of the patient and the nurse. The study points to dangers for both patients and nurses when clinically inflicted pain is ignored, overlooked, or treated with detachment. It also points a way toward nursing practice that is guided by thoughtfulness and sensitivity to patients' lived experience, and awareness of freedom and responsibility inherent in nursing actions, including those involved in inflicting and relieving pain. The study raises questions about nurses' knowledge, attitudes, and actions in relation to clinically inflicted pain, and highlights the need for nursing education and practice to consider the contribution of a phenomenological perspective to the understanding of human experience of pain, and the nursing role in its generation, prevention, and relief.