Individual interviews were carried out with three patients who received treatment in the CT- ICU, to explore their views and opinions about their experiences of pain and its management in the CT-CIU. Adult patients were recruited into the study 48 hours after transfer from the CT-ICU into the CT ward, which is a step-down unit of the CT-ICU (high care). These groups of patients were selected to ensure that the CT- ICU experience was still fresh in their memories. Patients were not interviewed in the CT-ICU because of the possibility of being on opioid or narcotic analgesics, sedatives and ventilation. According to Aslan, Badir, Arli and Cakmakci (2009), various factors alter verbal communication with patients in the ICU and thus they interviewed post-cardiac surgery patients, 48 hours after being transferred to the surgical ward from the surgical ICU.
2.5.2.8 Research Design and Method
• Research design
The exploratory, descriptive, qualitative design was used to elicit the opinions of post CT- ICU patients on pain, its assessment and treatment in the CT-ICU.
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• Research method Population
The statistics obtained from the CT-ICU suggested that about 30 patients are admitted each month, including children. All the patients interviewed had undergone cardiothoracic surgery and were adults.
Sample and Sampling Method
Out of the average number of 10 adult patients admitted to the CT-ICU each month, three (n=3) were purposively sampled within 48 hours of their transfer to the CT ward and interviewed for the study. The patients might have spent at least 48 hours in the CT-ICU. The patients were recruited by talking to them and their families and only with their consent. The three patients were recruited over a period of one month.
Inclusion Criteria
• Patients 18 years and above.
• Had undergone cardiac or thoracic surgery.
• Patients who had been in the CT-ICU for more than 24 hours. • Within 48 hours of discharge to the CT ward.
Data Collection Procedure
Permission was obtained in writing from the management of the hospital (nursing and medical) (Appendices E & F) with the consent of the Medical and Nursing Directors of the CT-ICU. Permission was also obtained from the nurse managing the cardiothoracic ward to undertake the data collection in the unit. The patients’ individual interviews were carried out to determine their opinions of their pain management experience in the CT-ICU and how according to them, pain management in the ICU could be improved. Three (n=3) CT-ICU patients, who spent at least 24 hours in the CT-ICU and had been discharged to the CT ward within 48 hours, were purposively sampled with the help of the CT ward manager and
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participated in the individual face-to-face interviews. The patient needed to have spent about 24 hours in the ICU to relate an adequate experience about pain in the CT-ICU.
The researcher recruited the patients from the CT ward with their consent after explaining the purpose of the study to them. All three (n=3) patients interviewed could speak and read English, thus all interviews were done in English. The researcher is not fluent in the different local languages of the selected patients and relatives thus interviews were conducted in English. Patients who agreed to participate in the interview were given the information sheet (Appendix J). The interviews were carried out in empty wards of the unit at the convenience of the patients when they were not undergoing any procedure and permission was granted by the nurse manager. The researcher did the interview, recording and note taking. The patients were again informed about the aim of the study before they agreed to take part in the interview. They were asked to sign a consent form (Appendix K), after reading the information letter again, and to complete a form with their demographic data (Appendix L). The interviews were tape-recorded. Field notes were taken as an additional source of information. Patients were first asked about the experience regarding pain in the CT-ICU and probes were introduced (Appendix L).
2.5.2.9 Data Analysis
Interviews were done within one week of each other and it was realised after the third interview that patients were talking about the same issues and as no new information was emerging, the data collection ended after the interview with the third patient. Verbatim transcription of the tapes was carried out after each interview to understand the data, prepare for subsequent interviews, and prepare the data for analysis (Creswell, 2014). Data collection and data analysis occurred simultaneously to obtain a better understanding and appreciation of the data (De Vos et al., 2011).
Data analysis followed the six steps of qualitative analysis by Creswell (2014) and coding using the eight steps of Tesch (1990 in Creswell, 2014) and followed the same methods employed in analysing the interviews with nurses and doctors (refer to point 2.5.2.3)
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Three major themes and 11 subthemes were identified in the study and presented in Table 4.8 in Chapter Four. The study was then presented as a narrative, with all the themes and sub-themes supported by the patients’ actual quotations about pain in the CT-ICU.