This is not a paper. There are about ten questions that need to be answered after reading an article, however, You MUST have knowledge in qualitative research in nursing to answer these questions effectively.
QUALITATIVE CRITIQUE ARTICLE
• Select an article to work with. Be sure that is not an integrated summary, review of the literature, state of the science paper or meta-analysis.
• Type your answers directly into the discussion board. Don’t attach it as a document.
• Post the reference, using APA format, for your article immediately in the discussion board – NO duplications allowed. Your next posting should include the following:
1. In the discussion, summarize the research question
2. Summarize the findings.
3. Briefly discuss the choice of research approach, i.e., was a qualitative research approach suitable for the phenomenon being studied?
4. Identify another way that the data could have been collected.
5. List at least three key themes that emerged from the study.
6. List one more question that you would like to have asked of the research subjects.
7. How could you use this study’s findings in your nursing practice?
8. Suggest the most appropriate method of disseminating the findings of this study. . Pay attention of how the points are dispersed to see where you should place your greatest efforts.
CRITERIA POINT VALUE POINTS EARNED COMMENTS
1. Research question summarized 10
2. Summary of findings 10
3. Discussion of research approach 10
4. Identify another way the data could have been collected 5
5. Three key themes identified 10
6. One question that you would have asked 5
7. How could you apply the study to your nursing practice? 15
8. What do you think is the most appropriate method of disseminating the findings of this study?
9. Posted timely responses to two classmates 5
10. Described an appropriate application of both classmates’ selected articles. 20
Barriers to, and facilitators of post-operative
pain management in Iranian nursing:
a qualitative research study
N. Rejeh1 BScN, RN, MScN, F. Ahmadi2 BScN, RN, MScN, PhD,
E. Mohammadi2 BScN, RN, MScN, PhD, M. Anoosheh3 BScN, RN, MScN, PhD
& A. Kazemnejad4 BSc, MSc, PhD
1 PhD Student, 2 Associate Professor, 3 Assistant Professor, 4 Full Professor, Faculty of Medical Sciences,Tarbiat Modares
REJEH N., AHMADI F., MOHAMMADI E., ANOOSHEH M. & KAZEMNEJAD A. (2008) Barriers to, and
facilitators of post-operative pain management in Iranian nursing: a qualitative research study. International
Nursing Review 55, 468–475
Background: Unrelieved post-operative pain continues to be a major clinical challenge, despite advances in
management. Although nurses have embraced a crucial role in pain management, its extent is often limited in
Iranian nursing practice.
Aim: To determine Iranian nurses’ perceptions of the barriers and facilitators influencing their management
of post-operative pain.
Methods: This study was qualitative with 26 participant nurses. Data were obtained through semi-structured
serial interviews and analysed using the content analysis method.
Findings: Several themes emerged to describe the factors that hindered or facilitated post-operative pain
management. These were grouped into two main themes: (1) barriers to pain management after surgery
with subgroups such as powerlessness, policies and rules of organization, physicians leading practice, time
constraints, limited communication, interruption of activities relating to pain, and (2) factors that facilitated
post-operative pain management that included the nurse–patient relationship, nurses’ responsibility, the
physician as a colleague, and nurses’ knowledge and skills.
Conclusion: Postoperative pain management in Iran is contextually complex, and may be controversial.
Participants believed that in this context accurate pain management is difficult for nurses due to the barriers
mentioned. Therefore, nurses make decisions and act as a patient comforter for pain after surgery because of
the barriers to effective pain management.
Keywords: Iran, Nursing, Patient, Post-operative Pain Management, Qualitative Research
Pain and its management remain one of the major clinical problems
confronting healthcare professionals in general and specifically
in surgery settings (Klopfenstein et al. 2000; Klopper et al.
2006). Continuing pain is associated with morbidity and delayed
discharge. Delayed healing, higher complication rates, anxiety,
sleep disturbance, increased suffering and lowered quality of life
are also significant sequelae (Sherwood et al. 2003). Numerous
studies have demonstrated the inadequacy of pain management.
Despite decades of research and the availability of effective
analgesic approaches, many patients continue to experience
Correspondence address: Fazlollah Ahmadi, Department of Nursing, Tarbiat
Modares University, P.O. Box 14155-4838, Tehran, Islamic Republic of Iran;
Tel: +9821-88011001 (ext: 3550,3553); Fax: +9821-88006544;
© 2008 The Authors. Journal compilation © 2008 International Council of Nurses 468
moderate to severe pain following surgery (Gilmartin & Wright
2007; Manias et al. 2005; Schafheutle et al. 2001).
Greater research efforts are needed to identify the factors that
impede or facilitate effective pain management (Weissman et al.
2004). Despite the fact that a variety of research and clinical
studies on all aspects of pain have been conducted in many
countries, the factors affecting pain management have not been
completely identified (Rao 2006). Pain and its management have
been a fairly low priority for receiving time and attention from
healthcare professionals, and nurses seemed to place a lower
priority on activities that directly impacted a patient’s comfort,
such as administering analgesics in an appropriate time frame
(Manias 2003a; Richards & Hubbert 2007). The majority of
studies surrounding the issues of pain management are of a
quantitative nature, with considerably fewer using a qualitative
design (Carr 1999; Clark et al. 2006). A qualitative approach is
valuable for exploring work demands in clinical areas and levels
of accountability surrounding pain management (Rees 2000;
Richards & Hubbert 2007). On the other hand, a comprehensive
understanding of how contextual issues affect pain management
will enable a more comprehensive and targeted approach to
better care (Manias et al. 2005; Schafheutle et al. 2001). Furthermore,
published studies have not explored the interplay between
barriers posed by nurses themselves (ones they may not be aware
of), and those created by the ward setting and policies, within
which they practise (barriers nurses are likely to recognize).
Background: pain management in Iran
There is no qualitative research on pain management in Iran that
gives data and analysis on ‘pain and pain management’. In the
accreditation of hospitals, pain and the evaluation of patients’
pain are not taken into account; there are no acute pain teams;
and there has been no exact algorithm or protocol to address the
problems of post-operative pain.
The only method for controlling post-operative pain in the
surgical wards is pharmacological interventions, and other ways
to prevent pain and the use of non-pharmacological methods are
not popular. Usually, analgesia is prescribed p.r.n. (as required)
by the surgeons in the operating room without any type of systematic
assessment and documentation of pain by the nursing
staff. There is no formal chart for the recording and reporting
A non-governmental organization started work in this field in
1993, but its projects have only been encouraged at conferences
and seminars on the topic of pain but do not appear to influence
practice. Therefore, the persistence of this problem provided
the motivation for the investigator to study this area of nursing
practice from a perspective that differed to those taken previously.
This article reports the findings on the barriers and
facilitators that Iranian registered nurses perceive to affect their
post-operative pain management.
To determine Iranian nurses’ perceptions of the barriers and
facilitators influencing their management of post-operative pain.
Method and participants
A qualitative approach was adopted using semi-structured interviews
with Iranian nurses. The sample consisted of 26 nurses (16
nurses, four head nurses and four supervisors, and two matrons)
all working in general surgery wards in three educational hospitals
in Tehran city. Purposeful sampling was used for the initial
interviews and, according to the emerging codes and categories
data was collected by means of theoretical sampling.
Sampling was targeted based on a set of predetermined
criteria. The researchers made preliminary sampling decisions
to select staff with a minimum of 5-year nursing experience
working in surgical wards, in university-affiliated hospitals. It
was considered that the participants would have sufficient work
experience to enable them to analyse barriers and facilitators
affecting post-operative pain management and its process. The
sampling was based on the maximum variant approach. Sampling
started with a nurse of 20-year experience presented by the
head nurses of a surgical ward and then with selection of a
snowball technique whereby participants were asked to suggest
the names of other participants who worked with high performance
in post-operative pain management, who might be interviewed.
Therefore, sampling extended to other nurses, managers
or supervisors in the same teaching hospital or others. We had
planned to interview nurses with at least 5 years of work experience;
however, emerging codes and categories, especially the
codes related to desensitizing (working a long time had made
nurses grow desensitized), led us to interview a number of novice
nurses with 2-year work experience. Data collection and analysis
proceeded concurrently with the development of themes related
to the reality of the nurses’ perception of barriers influencing
post-operative pain management. Sampling continued until
saturation was reached; this was when no new categories or
Upon agreeing to participate in the research, and after signing
the informed consent sheet nurses were given an appointment
for the interview. Individual semi-structured interviews were
conducted in a private room at the workplace. Permission for
tape-recording the interviews was obtained from each partici-
Post-operative pain management 469
© 2008 The Authors. Journal compilation © 2008 International Council of Nurses
pant. The interviews lasted from 60 to 120 min. The interview
guide consisted of core open-ended questions to allow the
respondents to explain their own viewpoints and experiences as
completely as possible. In congruence with the qualitative
methodology, the opening question for each interview was
‘please share with me how you care for your patient in pain’;
‘please share examples of times when your efforts to manage a
patient’s pain were successful’; and ‘please share examples of
times when your efforts to manage a patient when your efforts to
manage a patient’s pain were unsuccessful’. The participants were
asked to describe one of their own working shifts and then to
explain their own experiences and perceptions on ‘the barriers
and facilitators’ that affected taking action on the post-operative
At the end of each interview session, the researcher asked the
participants to talk about anything they considered important
in the post-operative pain management situation. This could
involve their personal and professional experiences and any
additional comments about their experiences as a nurse in
post-operative pain management.
Data analysis process
Data analysis started at the same time with the data collection
and each interview was transcribed verbatim and analysed before
the next interview took place. The process of interviewing was
stopped when data saturation occurred. The author transcribed
the tape-recorded interviews and the data were analysed
using the method of content analysis (Morse & Field 1995;
Sandelowski 2000). The analysis started by identifying the units
of meanings that could be extracted from the statements, which
were essential for participants’ experiences. It proceeded using
line-by-line coding; codes were freely generated during repeated
discussions between the researchers. Statements that were unrelated
to the study were excluded. Codes with similar meanings
were grouped into categories. The transcripts were reviewed in
order to validate the codes and categories. Regarding trustworthiness,
credibility was established through member check, peer