Nurses' and student nurses' inferences of pain and psychological distress
Poor pain assessment contributes to inadequate postoperative pain relief. Studies in the US suggest that nurse education might make students less sensitive to patients' experience of pain. This research set out to examine this process in the United Kingdom and to explore the experience of the students during their common foundation programme (CFP). 217 students completed the Standard Measure of Inferences of Suffering Questionnaire (SMIS) before and after their CFP. Their inferences of psychological distress increased as studies in the US had found but unlike these studies no change was found in their inferences of pain. Inferences of pain and psychological distress were affected by the age of the cases, while gender affected only the latter. None of the characteristics of the students were related to their inferences Of 51 qualified nurses who completed the SMIS, 5 with high inferences and 5 with low inferences, rated patients for whom they were caring. Over half of their ratings were different from those of the patients' and there was no relationship between their SMIS scores and the tendency to over or under estimate patients' pain casting doubt on the validity of the SMIS. Interviews with 15 students following their CFP showed that they experienced a wide range of strong emotions when caring for patients in pain. Their relatively junior status in the wards seemed to place them in difficult positions and provided them with little support. Theories of desensitisation, cognitive dissonance and acculturation have been proposed to explain decreasing sensitivity to pain. The lack of a significant change in students' inferences of pain and the analysis of their interviews suggest that their experiences are more varied than these theories suggest. These findings have important implications for both nurse education and the mechanisms to support student nurses in clinical practice.