Barriers to, and facilitators of post-operative pain management in Iranian nursing: a qualitative research study.
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.


OBJECTIVE
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.


RESULTS
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.


CONCLUSIONS
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.
Rejeh
N
N
Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
Ahmadi
F
F
Mohammadi
E
E
Anoosheh
M
M
Kazemnejad
A
A
D000328:Adult; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003144:Communication Barriers; D003299:Cooperative Behavior; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D007492:Iran; D008297:Male; D008875:Middle Aged; D024802:Nurse's Role / Q000523:psychology; D009723:Nurse-Patient Relations; D015404:Nursing Methodology Research; D009741:Nursing Staff, Hospital / Q000193:education / Q000458:organization & administration / Q000523:psychology*; D010147:Pain Measurement / Q000451:nursing; D010149:Postoperative Pain / Q000175:diagnosis / Q000451:nursing* / Q000517:prevention & control / Q000523:psychology; D019555:Physician-Nurse Relations; D011209:Power, Psychological; D017009:Professional Autonomy; D036301:Qualitative Research; D020377:Self Efficacy; D011795:Surveys and Questionnaires; D013997:Time Factors