title: Understanding inadequate pain management in the clinical setting: the value of the sequential explanatory mixed method study.
abstract: OBJECTIVE
  The purpose of this paper is to critically explore the sequential explanatory mixed method research design and how it can enhance our understanding of pain management.
  
  
  BACKGROUND
  The general prevalence of pain after surgery has not changed significantly over several decades despite the widespread introduction of new pain relieving technologies. The majority of postoperative pain studies use quantitative methods which offer little understanding of the underlying processes of care. Understanding can be illuminated by using an explanatory mixed method research design.
  
  
  METHODS
  Discursive paper.
  
  
  METHODS
  This paper focuses on the methodological considerations when using a mixed method design. Two previously published mixed methods studies illustrate how findings can inform practice. In the first, 85 women undergoing surgery completed questionnaires to measure pain, anxiety and depression. Telephone interviews explored their pain experiences. The second study considered frequency and patterns of anxiety in the immediate pre and postoperative period. Semi-structured telephone interviews, identified contributing events/situations amenable to nursing intervention.
  
  
  CONCLUSIONS
  Reasons for growing popularity, criticisms, paradigmatic considerations and epistemological roots of pragmatism are explored. The two explanatory mixed method studies provide examples of these studies and how 'inferences' from quantitative and qualitative data can inform practice.
  
  
  CONCLUSIONS
  This paper connects quantitative and qualitative data, drawing on two research studies, to give greater understanding to the management of pain. Knowledge of the processes responsible for inadequate pain management can be illuminated by using explanatory mixed methods research designs.
  
  
  CONCLUSIONS
  Nursing requires knowledge which reflects the complexity of human health. The explanatory mixed method study can elucidate the problem under scrutiny, e.g. prevalence of pain or anxiety. The qualitative phase can generates an understanding of contributing factors and insights for care delivery. The implicit desire to change and influence practice makes it relevant for those closely aligned to practice.
authors.affiliation: School of Health & Social Care, Bournemouth University, Royal London House, Christchurch Road, Bournemouth, Dorset, UK. ecarr@bournemouth.ac.uk
authors.forename: Eloise C J
authors.initials: EC
authors.lastname: Carr
mesh_terms: D001007:Anxiety / Q000175:diagnosis; D003863:Depression / Q000175:diagnosis; D005260:Female; D006801:Humans; D010146:Pain / Q000451:nursing; D059408:Pain Management; D011795:Surveys and Questionnaires