title: How military nurses rationalize their postoperative pain assessment decisions.
abstract: OBJECTIVE
  This paper is a report of a study to explore how military nurses rationalize their postoperative pain assessment decisions, particularly when these differ from patients' pain self-reports.
  
  
  BACKGROUND
  Postoperative pain is a complex phenomenon influenced by many factors that make assessment difficult. Nurses are taught to believe what patients say about their pain. However, their attitudes to pain are influenced by their cultural background and they may disagree with patients' self-reports. Military nurses belong to a military culture with different pain attitudes that may also influence their postoperative pain assessment.
  
  
  METHODS
  An ethnomethodological ethnography study was carried out in 2003. A purposive sample of 29 British military surgical/orthopaedic Registered Nurses were interviewed to identify their taken-for-granted assumptions and commonsense cultural knowledge surrounding postoperative pain assessment. The data were analysed using a systematic process of inductive reasoning aided by Non-numerical, Unstructured Data for Indexing, Searching and Theorizing (QSR N6, NUD*IST).
  
  
  RESULTS
  Participants told two distinct stories in their postoperative pain narratives. The first, the cultural story, described how military nurses normally assess postoperative pain and revealed taken-for-granted assumptions surrounding this assessment. However, when military nurses believe that patients over- or under-report their pain, the cultural story was challenged through a collective story in which nurses used their commonsense knowledge to account for these differences.
  
  
  CONCLUSIONS
  Postoperative pain assessment within a military culture is complex, but all nurses need to be aware that their socialization into different nursing cultures may influence their attitudes to postoperative pain assessment.
authors.affiliation: School of Health and Social Care, Oxford Brookes University, Oxford, UK. phil.harper28@brinternet.com
authors.forename: Phil
authors.initials: P
authors.lastname: Harper
authors.forename: Steven
authors.initials: S
authors.lastname: Ersser
authors.forename: Mary
authors.initials: M
authors.lastname: Gobbi
mesh_terms: D000884:Anthropology, Cultural; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D019545:Intuition; D008297:Male; D008571:Men / Q000523:psychology; D008888:Military Nursing; D008889:Military Personnel / Q000523:psychology; D009633:Nonverbal Communication; D009723:Nurse-Patient Relations; D015279:Organizational Culture; D010147:Pain Measurement / Q000379:methods / Q000451:nursing*; D010149:Postoperative Pain / Q000208:ethnology* / Q000451:nursing* / Q000523:psychology; D011908:Rationalization; D012718:Set, Psychology; D006113:United Kingdom