title: Healthcare professionals' descriptions of care experiences and actions when assessing postoperative pain - a critical incident technique analysis.
abstract: BACKGROUND
  Pain is a common postoperative symptom, and length of hospital stay after surgery is short which highlights the importance of pain assessments. Experiences of assessing pain are mainly described from the perspective of nurses. In postoperative care, enrolled nurses and physicians also assess pain. It is therefore important to take note of their experiences to improve postoperative pain assessments.
  
  
  OBJECTIVE
  The aim of this study was, through considering critical incidents, to describe care experiences and actions taken by healthcare professionals when assessing postoperative pain.
  
  
  METHODS
  An explorative design employing critical incidents technique analysis was used. A total of 24 strategically selected enrolled nurses, nurses and physicians employed at orthopaedic or general surgery wards in four Swedish hospitals were interviewed. The intention was to reach variation in age, sex, profession and professional experience.
  
  
  RESULTS
  In pain assessments, patient-related facilitators were patients' verbal and emotional expressions including pain ratings, while lack of consistency with observed behaviours was a barrier. Clinical competence, continuity in care and time were healthcare-related facilitators. The actions healthcare professionals took were gathering facts about patients' pain manifestations and adapting to patients' communication abilities. Patient observations, either passive or active were used to confirm or detect pain. Collaboration between healthcare professionals, including consultations with pain experts, social workers and relatives, strengthened understanding of pain.
  
  
  CONCLUSIONS
  Communication skills and working conditions have an impact on performance of pain assessment. Patient comfort without compromising safety is reached by including healthcare professionals' dissimilar responsibilities when collecting patients' and relatives' perspectives on current pain.
authors.affiliation: School of Health Sciences, Jönköping University, Jönköping, Sweden.|Department of Anaesthesia and Intensive Care, Ryhov County Hospital, Jönköping, Sweden.
authors.forename: Lotta
authors.initials: L
authors.lastname: Wikström
authors.affiliation: School of Health Sciences, Jönköping University, Jönköping, Sweden.|Department of Anaesthesia and Intensive Care, Ryhov County Hospital, Jönköping, Sweden.
authors.forename: Kerstin
authors.initials: K
authors.lastname: Eriksson
authors.affiliation: School of Health Sciences, Jönköping University, Jönköping, Sweden.
authors.forename: Bengt
authors.initials: B
authors.lastname: Fridlund
authors.affiliation: School of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden.|Division of Nursing Science, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.|Department of Clinical Neurophysiology, University Hospital, Linköping, Sweden.
authors.forename: Kristofer
authors.initials: K
authors.lastname: Årestedt
authors.affiliation: School of Health Sciences, Jönköping University, Jönköping, Sweden.|Department of Clinical Neurophysiology, University Hospital, Linköping, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Broström
mesh_terms: D002983:Clinical Competence; D005260:Female; D006801:Humans; D008297:Male; D010147:Pain Measurement; D010149:Postoperative Pain; D013548:Sweden
keywords: collaboration; critical incident technique; healthcare professionals; postoperative pain assessment