• H Willson.
• Acute Pain Nurse, Royal Berkshire and Battle Hospitals NHS Trust, Reading, England.
• J Adv Nurs. 2000 May 1; 31 (5): 1145-54.

AbstractFracture of the neck of femur, or hip, has become common in older females and the resulting pain is often a factor in inhibiting early mobilization following surgical repair. Since the administration of analgesia is dependant upon decision-making of the nurse, this study concentrated on what influences nurses in the administration of analgesia to patients following surgical repair of a fractured hip. A review of the literature identifies the main influencing factors as nurses' lack of knowledge and the drug prescription, and suggests that education is the key enabler. However, much of this research is limited to controlled situations outside the clinical setting with a focus on the internal processes of decision-making. This ethnographic multiple-case study aimed to analyse factors which influence nurses' decision-making in the clinical setting and define behaviours in context. Following periods of participant observation and observation of documentation, semi-structured interviews were conducted to explore further the rationale behind nurses' decisions. Factors found to influence decision-making were: time, organization of care, influence of shift worked, impact of the multidisciplinary team (MDT), concerns over the use of opioid analgesia, and information giving and collection. These influences were found to be dependant on location (ward), and shift, with the factor of time providing a tension between all influences. The study findings suggest that education alone will not improve the administration of analgesia. It recommends that the voice of patients is heard more clearly, that the administration of analgesia is separated from the routine drug round, that attention is paid to how decision-making by nurses is supported in clinical settings, and that education be organized on a multidisciplinary basis. In addition, further research should be carried out in the clinical setting.

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