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Togethering and Positioning: the Experience of Registered Nurses of Clinically Inflicted Pain Hannelore Gertrud Krieger

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Togethering and Positioning: the Experience of Registered Nurses of Clinically Inflicted Pain Hannelore Gertrud Krieger University of New Mexico UNM Digital Repository Nursing ETDs Electronic Theses and Dissertations 6-9-2016 Togethering and positioning: The experience of registered nurses of clinically inflicted pain Hannelore Gertrud Krieger Follow this and additional works at: https://digitalrepository.unm.edu/nurs_etds Recommended Citation Krieger, Hannelore Gertrud. "Togethering and positioning: The experience of registered nurses of clinically inflicted pain." (2016). https://digitalrepository.unm.edu/nurs_etds/1 This Dissertation is brought to you for free and open access by the Electronic Theses and Dissertations at UNM Digital Repository. It has been accepted for inclusion in Nursing ETDs by an authorized administrator of UNM Digital Repository. For more information, please contact [email protected]. i Hannelore “Hanna” Krieger Candidate Nursing Department This dissertation is approved, and it is acceptable in quality and form for publication: Approved by the Dissertation Committee: Jennifer Averill, RN, PhD, Chairperson Beth Rodgers, PhD, RN, FAAN David Bennahum, M.D., SoM Prof Emeritus Jacqueline Jones, PhD, BN, FRCNA, FAAN i ii TOGETHERING AND POSITIONING: THE EXPERIENCE OF REGISTERED NURSES OF CLINICALLY INFLICTED PAIN By HANNELORE “HANNA” KRIEGER B.S., Nursing, University of New Mexico, 2000 M.S., Nursing, University of New Mexico, 2005 DISSERTATION Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Nursing The University of New Mexico Albuquerque, New Mexico May, 2016 iii Acknowledgements I offer my sincere gratitude to Dr. Jennifer Averill for getting me started and seeing me through this journey. And to Dr. Paul Clements who was there to support me. iv TOGETHERING AND POSITIONING: THE EXPERIENCE OF REGISTERED NURSES OF CLINICALLY INFLICTED PAIN By Hannelore “Hanna” Krieger B.S., Nursing, University of New Mexico, 2000 M.S., Nursing, University of New Mexico, 2005 Ph.D., Nursing, University of New Mexico, 2016 ABSTRACT This study explored the experience of registered nurses of clinically inflicted pain (CIP). This study showed that the experience of nurses is distinctly different from the experience of patients. This study revealed the constructed nature of CIP and nurses estimation of CIP’s painfulness. Nurses utilized a number of processes to alleviate their discomfort associated with having to inflict pain. Nurses also utilized processes that effectively changed CIP to mean something other than pain, specifically the processes of unmaking the patient experience and remaking of CIP. Some nurses were conflicted at least some of the time about CIP. This created a theoretical problem, which let to the discovery of the theory of togethering, the bringing together of the professional nurse (defined solely by education, training, and skill) and the nurse person (broadly defined as a human being who is also a professional nurse). The nurse person positions the professional nurse in the various processes utilized by nurses, a process I called positioning. I argue that it is the nurse person who distinguishes the professional nurse. The theory of togethering defines nurses by who v (or what) they are not by their relationship to patients and thus contributes to nursing theory. I believe this study may have important implications particularly for nursing education. vi Table of Contents List of Figures ....................................................................................................................... xiii List of Tables ........................................................................................................................ xiv Chapter 1 Introduction........................................................................................................... 1 Problem Statement ........................................................................................................ 5 Statement of Purpose and Research Questions ............................................................. 5 Assumptions .................................................................................................................. 6 The Researcher.............................................................................................................. 6 Rationale and Significance ........................................................................................... 9 Chapter 2 Review of Related Literature ............................................................................. 12 Clinically Inflicted Pain .............................................................................................. 12 Clinically Inflicted Pain as a nurse-patient interaction. .................................. 13 Clinically Inflicted Pain: The unintended pain associated with nursing procedures. .......................................................................................... 13 Other terminology describing the phenomenon of interest. ............................ 14 The role of health care institutions or organizations. ...................................... 15 Related concepts. ............................................................................................ 15 Clinically Inflicted Pain is an empiric phenomenon. ...................................... 16 Prevalence of Clinically Inflicted Pain. .......................................................... 17 Underrecognition or nonrecognition of Clinically Inflicted Pain. .................. 18 The Patients’ Experience ............................................................................................ 18 The Experience of Nurses ........................................................................................... 19 Is Clinically Inflicted Pain a stressor for nurses? ............................................ 19 vii Nurses’ work. .................................................................................................. 19 Personal opinions about Clinically Inflicted Pain. .......................................... 20 Resocialization. ............................................................................................... 23 Adaptive responses to inflicting pain. ............................................................. 25 Nurses’ assumptions: The redefinition of Clinically Inflicted Pain................ 26 Assumed inevitability of Clinically Inflicted Pain.......................................... 28 Clinically Inflicted Pain had a different meaning for nurses. ......................... 29 Control. ........................................................................................................... 29 Clinically Inflicted Pain: Nurses and the epistemology of pain. .................... 30 Ontological questions about pain and Clinically Inflicted Pain. ..................... 31 Models to Explain the Ability to Inflict Pain .............................................................. 33 Milgram’s study of obedience. ....................................................................... 33 Bandura’s social cognitive theory: Mechanisms of moral disengagement. .... 34 Altemeyer’s model of personality characteristics. .......................................... 35 Clinically Inflicted Pain Within the Framework of Ethics and/or Morals .................. 36 Principle of the Double Effect (aka Standard Doctrine of the Double Effect) ........... 38 The Question of Violence, Aggression, and/or Torture .............................................. 39 Closing Remarks ......................................................................................................... 41 Chapter 3 Methodology ........................................................................................................ 42 Rationale for Choosing a Grounded-Theory Approach for This Study ...................... 43 Critical Issues Within Grounded Theory: Forcing and Theoretical Sensitivity ......... 44 Literature Review........................................................................................................ 44 Situating Grounded Theory......................................................................................... 47 viii Theoretical Paradigm .................................................................................................. 47 Research Design.......................................................................................................... 51 Data Analysis .............................................................................................................. 51 Coding and constant comparative analysis. .................................................... 52 Memoing. ........................................................................................................ 55 Sorting, writing, and the literature review. ..................................................... 56 The Research Sample, Sampling Methods, and Sample Size ..................................... 57 The research sample. ....................................................................................... 57 Sampling methods and sample size. ............................................................... 59 Demographic data. .......................................................................................... 61 Entering the field............................................................................................. 67 Audio recording. ............................................................................................. 67 Ethical Considerations ...............................................................................................
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