ABSTRACT
UNLABELLED: Prior research has questioned the extent to which postoperative retrospective ratings of acute pain actually reflect memory of that pain. To investigate this issue, pain ratings provided by patients who had undergone vascular surgery were compared with estimates of this pain provided by 2 groups of healthy, nonpatient participants with no personal experience of the surgery. Patient participants rated postoperative pain while actually experiencing it and again 4 to 6 weeks after surgery. Nonpatient groups read either a comprehensive information leaflet describing postoperative pain after vascular surgery, or a short general information leaflet about the surgery and provided 2 estimates of the likely nature of the pain, 4 to 6 weeks apart. Compared with patients, both nonpatient groups overestimated pain severity, and nonpatients provided with the comprehensive information leaflet were less consistent in their estimates compared with the other 2 groups. However, qualitative descriptions of the pain provided by the 3 groups shared many similarities. Our findings highlight limitations of inferring pain memory accuracy by comparing ratings given while in pain with those provided retrospectively and demonstrate the need to consider the phenomenological awareness accompanying recollections of prior pain events to advance our understanding of memory for pain. PERSPECTIVE: The observed similarities between pain ratings made by individuals who have experienced a particular pain and estimates made by those without personal experience question whether retrospective pain ratings can be assumed to reflect memory of that pain. The need to adopt new approaches to assess memory for pain is highlighted.
Subject(s)
Memory , Pain Measurement/methods , Pain Measurement/psychology , Pain Threshold/psychology , Pain, Postoperative/psychology , Adult , Aged , Consciousness , Data Collection , Humans , Middle Aged , Observer Variation , Pain Measurement/standards , Pain, Postoperative/diagnosis , Patient Education as Topic/standards , Physician-Patient Relations , Varicose Veins/surgery , Vascular Surgical Procedures/adverse effectsABSTRACT
This paper explores work-based learning and collaborative working in health care by drawing on the findings of a completed study about the influence of nursing knowledge on patient outcomes. A qualitative research approach was used to explore the experiences of nurses in critical care settings. Interviews and analysis produced a descriptive and interpretive account of everyday working and learning for these specialist nurses. Findings showed that nursing knowledge influenced patient outcomes in a number of ways. Nurses draw on bio-scientific knowledge and experience in order to achieve patient outcomes. Moreover, they collaborated with other health professionals in everyday working and learning. The study findings are explored with reference to the literature about situated knowledge, clinical problem solving and work-based learning. The significance of the findings is that the kind of 'collaborative competence' identified here contributes to the achievement of the aims of the NHS plan and ' Working Together, Learning Together' [Department of Health, 2001. Working Together, Learning Together. Department of Health, London]. Despite the centrality of team working and the trend for more work-based learning in NHS contexts, there is a limited evidence base to date about the influence of team working or work-based learning on patient outcomes. The analysis and discussion in this paper adds to this body of knowledge.
