Journal of Nursing Management, 2012, 20, 187195

Nursing leadership in a chronic pain management group approach

E !N "#$%!&

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/ssociate (rofessor, "epartment of 0ealth $tudies, -acult1 of $ocial $ciences, .ni2ersit1 of $ta2anger, $ta2anger, Nor3a1

4orrespondence Elin "1s2i5 .ni2ersit1 of $ta2anger -acult1 of $ocial $ciences "epartment of 0ealth $tudies N67089 $ta2anger Nor3a1 E6mail: elin*d1s2i5;uis*no

"#$%!& E* > -.'NE$ <2012=+* Journal

of Nursing Management 20, 187195 Nursing leadership in a chronic pain management group approach

/im ?o e@plore and deAate nursing leadership and challenges on organiBational and group le2els 3hen conducting rehaAilitation groups for people suffering from chronic pain* +ac5ground Croup approaches Aased on cogniti2e Aeha2ioural therap1 are generall1 descriAed as effecti2e* eadership in group approaches offered to people suffering from chronic pain is a great challenge for nurses on an organiBational as 3ell as a group le2el* Methods ,ne o2erall leader and nine group leaders conducting 18 groups consti6 tuted the sample* Dualitati2e content anal1sis 3as used A1 identif1ing categories, suAthemes and themes* 'esults ?he results from the content anal1sis re2ealed one main theme <E4omple@it1 in nursing leadershipF= and three suAthemes <E4hallenges in leadership on organi6 Bational le2elF, E4hallenges in leadership on team3or5 le2elF and E4hallenges in leadership on group le2elF* 4onclusions ?he results sho3 ho3 important it is to ha2e @rm o2erall leadership and trained group leaders 3ith a common purpose, interdependent roles and complementar1 s5ills, 3ho are thus 3ell prepared to pre2ent or deal 3ith challenging group processes* !mplications for nursing management ?he leaders of Aoth le2els, 3hich are highl1 interrelated, should ha2e a current theoretical understanding of pain theor1, group leadership s5ills and a cogniti2e Aeha2ioural approach*

&e13ords: chronic pain management, groups, leadership, nurses

/ccepted for puAlication: 7 "ecemAer 2011

!ntroduction
?he e@perience of chronic pain is essentiall1 an indi6 2idual and internal e@perience, and helping the sufferer to interpret the pain and pro2ide an effecti2e treatment are maGor challenges <"a2is 2000=* !n the aAsence of a medical cure for man1 patients suffering from chronic pain, the most appropriate approach is li5el1 to Ae one that addresses cogniti2e, ps1chosocial and Aeha2ioural
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factors related to the pain <?ur5 2002=* "uring the past decade, the group approach has emerged as one of the maGor forms of ps1chological treatment for chronic pain* 'esearch e2aluating the ef@cac1 of such group approaches, including cogniti2e Aeha2ioural therap1 <4+?=, indicates that it can signi@cantl1 reduce pain and impro2e Iualit1 of life among patients presenting 3ith chronic pain <Morle1 et al* 1999, Mc4rac5en > ?ur5 2002, ?ur5 > +ur3in5le 2009=* Nurses ha2e a 5e1 role

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to pla1 in multidisciplinar1 pain management pro6 grammes <"a2is 2000=* 'esearch emphasiBes the importance of nurse6led leadership and care to succeed in approaches directed to3ards coping 3ith chronic pain <Jells6-ederman et al* 2002, 4ourtena1 > 4are1 2008=* Nurses are competent to de2elop and organiBe such programmes and ha2e an essential role in co6 ordinating teams, organiBing treatment and follo36up <"1s2i5 et al* 2010=* !n addition, nurses pla1 a critical role as group leaders, helping patients to adopt life6 changing haAits to reduce disaAilit1 <+ro3n > 'ich6 ardson 2005, "1s2i5 > $tephens 2010=* ?he uniIue s5ills of nursing leadership in chronic pain management are a holistic approach, clinical Gudgement, team3or5 and @rm leadership on o2erall and group le2els* ?his article see5s to address the need for more 5no3ledge 3ithin nursing leadership in chronic pain management*

tidisciplinar1 team should function also seem impor6 tant* /ccording to +ondas <2009=, an effecti2e clinical leadership must Ae Auilt on competence in nursing care as 3ell as research* ?he most comprehensi2e model to guide nurse leaders is the Aiops1chosocialspiritual model* !n this holistic model, chronic pain has ps1chosomatic, Aiological, ps1chological, social and spiritual components that al6 3a1s contriAute to the patientFs disease and illness* ?he spiritual dimension in the model incorporates a Aroad conte@t of 2alues, meaning and purpose in life <"osse1 et al* 2005=*

/ group6Aased chronic pain6management programme

.sing a group approach has man1 ad2antages in the treatment of chronic pain* -irst, according to &eefe et al* <2002=, a group pro2ides a setting in 3hich pa6 tients suffering from chronic pain can Ae in touch 3ith others 3ho ha2e similar proAlems* $econd, group therap1 can help patients gain a Aetter understanding of pain and in@uencing factors* ?hird, patients can Ae taught effecti2e coping s5ills* -inall1, group approaches ma5e it possiAle to treat a larger numAer of patients in a cost6effecti2e 3a1 <&eefe et al* 2002=* 4onducting group therap1 3ith patients 3ith chronic pain is not al3a1s a straightfor3ard affair, and a numAer of dif@6 cult clinical issues can arise* /mong these, proAlems such as dealing 3ith patient e@pectations, anger and emotional distress are emphasiBed <&eefe et al* 2002=* ?he relational st1le of the counsellor should Ae one of concern, acceptance, genuineness and empath1* .nderl1ing the techniIue, there should Ae a consistent, positi2e relationship Aet3een counsellor and patient <#alom 2005=* ?he leader must Ae alert to an1 potential factors that might compromise group collaAoration* ?o succeed, Mac&enBie <1990= notes that good record6 5eeping is a necessar1 part of group approaches and suggests a report form for monitoring and measuring change in group processes* /s mentioned pre2iousl1, the comple@it1 of li2ing 3ith chronic pain reIuires a @e@iAle and multifaceted approach* ?herefore, 3hen organiBing and conducting these groups, a coordinated multidisciplinar1 team 3ith constant and effecti2e communication Aet3een the memAers is necessar1* Jor5ing in a team ma1 ha2e se2eral ad2antages* ?he multidisciplinar1 team plans inter2entions 3ith speci@c training that identif1 roles for each memAer and related teaching topics* 'egular meetings allo3 the programme to Ae monitored and adGusted* ?eam3or5 also pro2ides an opportunit1 for

?heoretical frame3or5 Nursing leadership

eadership has Aeen de@ned in terms of traits, Aeha26 iours, interaction patterns, role relationships and administrati2e positions <#u5l 2010=* eadership is aAout change* Moreo2er, nursing leadership deals 3ith leadership roles on different le2els in professional 3or5 and is descriAed as the heart of the nurse manager role <Cender 2008=* !t is concerned 3ith the care of 2ul6 neraAle persons, such as those suffering from chronic pain, and includes their health as 3ell as their rehaAil6 itation <+ondas 2009=* !n this article, nursing leadership focuses on the administration and implementation of a rehaAilitation programme offered to people suffering from chronic pain* ?his leadership ta5es place on t3o le2els: o2erall nurse leadership on an organiBational le2el and nurse leadership at group le2el* ,ur chronic pain management programme, 3hich includes a 4+? approach, illustrates different leadership tas5s for nur6 ses <"1s2i5 > $tephens 2010, "1s2i5 et al* 2010=* eadership related to chronic pain management groups is aAout na2igation Aet3een nursing care and different nursing leadership roles* /s such, leadership aAilit1 is said to Ae fundamental in in@uencing a group to achie2e its 2isions and goals <#u5l 2010=* ?his im6 plies that se2eral s5ills are needed to succeed 3hen performing leadership <Cermain > 4ummings 2010=* &no3ledge aAout group processes and counselling must constitute the platform* .nderstanding of chronic pain as a comple@ phenomenon including Aiops1chosocial spiritual factors is another important aspect of nursing competence <"osse1 et al* 2005=* !deas of ho3 a mul6

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H 2012 +lac53ell (uAlishing td Journal of Nursing Management, 2012, 20, 187195