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Pain as embodied experience : a phenomenological study of clinically inflicted pain in adult patients : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Nursing at Massey University
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 of the lived
experience of the patients and nurses concerned.
The phenomenon of clinically inflicted pain is described in terms of four related
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 involves patients in the
experience of constituting such pain, often as punishment and almost always as
something unavoidable, 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 exerience and thus the essential nature of inflicted pain as painful, wounding,
and demanding cooperation and composure from the patient. Instead, the pain
frequently became invisible to nurses involved in its infliction, or when it could not be
overlooked or ignored, it was perceived as 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 inflicted 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.