Defending against patients' pain - A qualitative analysis of nurses' responses to children's postoperative pain

Objective: Cognitive approaches to clinical communication attribute deficit s in communication to lack of skill. We examined, instead, emotional influe nces on communication by finding out how nurses construed patients who were in pain, and how these constructions were related to the emotional challen ge of patients' pain and to deficits in clinical communication. Methods: Da ta, analyzed qualitatively, included: (i) direct observations of verbal int eractions of 13 nurses with 16 children after orthopedic surgery; (ii) stan dardized open-ended interviews with the nurses, patients and parents. Resul ts: Nurses tried to prevent children from displaying pain behavior. When pa in behavior did occur, they construed pain as unreal, unwarranted or not de serving help. These findings were apparent in observations of, and intervie ws with, nurses and also in parents' and children's accounts of nurses' beh avior. Conclusion: We identified behavioral and cognitive strategies whereb y clinicians defend themselves emotionally against patients' pain, and whic h compromise communication with patients in pain. (C) 2001 Elsevier Science Inc. All rights reserved.