Abstract: This study focussed on nursing practice in action. The research goal was to identify nursing-relevant dimensions within a person's experience of being a hospital patient undergoing elective surgery. In order to discover and conceptualize the underlying processes which are present as patients are nursed through this experience, an open question was posed – What is happening here? A qualitative research method ws the most appropriate means of discovering an answer to this question.The particular method chosen was the grounded theory approach developed by Glaser and Strauss. Data were collected in five surgical wards of a large city hospital over a period of five months. The research participants were twenty-one patients and the nurses involved in their care. Primary sources of data were interviews and the nursing records. These were augmented by field notes and accounts of observed incidents relating to the care of each patient.Using the inductive strategies of the grounded theory method, numerous descriptive concepts were generated during the data analysis. These were ordered within an integrating social process derived from anthropology. By this means a founded theory in the form of a theoretical framework – the Nursed Passage – was developed. Within this passage the patient is the passage and nursing is translated into action through the agency of the nurse.The Nursed Passage is a patterned partnership with three key elements. Firstly, the temporal element, characterised by ongoing movement and constant change, is conveyed in the sequence of phases or stages. Secondly the participative element is portrayed as a patterned relationship in which both nurses and patient are actively involved in progressing the patient through the passage. Finally, the contextual element recognises complex factors within the nursing environment which have an impact on the shape of the relationship between patient and nurse.This theoretical framework, generated from the reality of nursing as it occurs in one setting, assigns a specific shape to the encounter between nurses and patient. It identifies the contribution nursing alone can make to optimise each patient's hospital experience. In this way it both complements and facilitates the work of medical and other colleagues with whom nurses work. Thus it serves to revalue nursing in terms that can maximally utilise the registered nurse's knowledge and skill for the benefit of all concerned. Consequently, it has the potential value for nursing practice, education and research

Abstract: This phenomenological study describes the lived experience of pain inflicted in the context of medically prescribed treatment, explores the meanings of such pain for patients who endured it and for nurses whose actions contributed to its generation, and presents a thematic description of the phenomenon of clinically inflicted pain. The study is informed by phenomenology, both in terms of its premises and orientation, and its research design and method.The participants in the study were 14 adult patients, admitted to hospital following burn injuries, or receiving intravenous chemotherapy upon diagnosis of cancer, and 20 nurses involved in their care. Data collection took place over a period of five months and included participant observation and compilation of field notes, and a total of 89 tape-recorded interviews (48 with patients and 41 with nurses). Through the process of hermeneutic interpretation a number of themes were identified and used to describe the phenomenon of clinically inflicted pain and the structure or the lived experience of the patients and the nurses concerned.The phenomenon of clinically inflicted pain is described in terms of four isolated themes: (1) the hurt and painfulness of inflicted pain; (2) handing one's body over to others; (3) the expectation and experience of being wounded, and (4) restraining the body and the voice. These themes point to the embodied nature of pain experience and the extent to which the person is involved not only in the enduring of pain but also in its generation. The broader lifeworld of clinically inflicted pain, often as punishment and almost always a something avoidable, and in turn being constituted by their experiences in terms of losing and seeking to regain a sense of embodied self and of personal situation, and by changed experiences of lived space and lived time.Nurses who themselves helped to generate pain, frequently overlooked the patient's lived experience and thus the essential nature of inflicted pain as painful, wounding, and demanding cooperation and composure from the patient. Instead, the pain frequently become invisible to nurses involved in its infliction, or when it could not be overlooked or ignored, it was perceived inevitable , non-harmful and even as beneficial to patients' recovery. The strategic responses that nurses adopted to pain infliction included detachment from the perceived impact and consequences of their own actions and objectification of the person in pain as a body-object on whom certain tasks had to be performed. An alternative to the strategy of detachment and objectification was involvement in a therapeutic partnership between the nurse and the patient, where shared control over pain infliction and relief helped to sustain trust in the relationship and preserve personal integrity of the patient and the nurse.The study points to dangers for both patients and nurses when clinically pain is ignored, overlooked or treated with detachment. It also points a way toward nursing practice, that is guided by thoughtfulness and sensitivity to patients' lived experience, and awareness of freedom and responsibility inherent in nursing actions, including those involved in inflicting and relieving pain. The study raises questions about nurses' knowledge, attitudes, and actions in relation to clinically inflicted pain, and highlights the need for nursing education and practice to consider the contribution of a phenomenological perspective to the understanding of human experience of pain, and the nursing role in its generation, prevention and relief

Abstract: A report prepared in association with the Nursing Subcommittee of the North Canterbury Geriatrics Advisory Committee