An ethnography of pain assessment and the role of social context on two postoperative units

Aim. This paper is a report of a study to examine nursing assessment of pain across two postoperative units. Background. Postoperative pain management remains problematic. While the nursing unit, as the context, has been described as influencing pain assessment practice, the nature of this influence remains unexplored. Method. The study was conducted in the United States of America on two postoperative units of one teaching hospital in 2003-2004. Bourdieu's approach to ethnography was used. This applies traditional ethnographic techniques in sequential phases designed to illuminate: (1) relative positions of agents in a field of practice, (2) social capital in the field, and (3) the habitus of agents. Multiple data collection techniques appropriate to each phase were employed, including participant observation and individual interviews. Findings. A predominant pattern of pain assessment existed on each unit. Nurses used assessment criteria from three spheres, i.e. the client's narrative, evident criteria and a reference typology of assessment findings. Nurses used a single sphere as a primary filter through which data were processed. This filter was distinctive for each unit, and consistent with the unique pattern of nursing pain assessment on each unit. Conclusion. Nurses' pain assessment practice is profoundly shaped by the social context of the unit on which practice occurs. Bourdieu's' theory of practice is a useful lens through which to examine the social context of pain assessment practice.