GUIDELINES FOR WRITING THE DISCUSSION
The Discussion chapter is normally towards the end of your FYP, after you have presented your Results and before the Conclusion. If your explanation is already in the Results chapter, the Discussion and Conclusion can be combined into one chapter. This is where you take a wider look at your study as a whole, contextualising it in a larger overall context, perhaps highlighting the implications or extrapolating from the findings. The methodology/procedure and the presentation chapters have reported specific information; now you may be attempting to indicate the 'bigger picture'.
The information you include in your discussion depends greatly on your findings and the nature of your project. However, one common way of laying out a discussion section is as follows:
- To recap on the original hypothesis
- To briefly reiterate or summarise the findings
- To give an analysis of and/or an explanation of the findings
- To mention any limitations
- To comment on the implications of the study (generalising from the results)
- To comment on the need or direction of further research
The Discussion chapter is also where you can air your own opinions on any of the above.
Language used in the Discussion chapter
1.Verb tense usage
The first part of the Discussion chapter usually refers to your findings. The past simple is the most common tense to use for this purpose.
e.g.
Data was collected at the core centre and all cells originated in the same environment.
The result indicated that the ventilation system was not effective since the concentration varied from 1.23pCi/l to 3.05pCi/l.
At the explanation stage, the past or present perfect tense is most commonly used if your explanation is limited to your own study.
e.g.
The survey findings demonstrated that most of the respondents preferred to see more local-designer labels on the market. However, they did not imply that clothing advertisements or promotions could affect consumers purchase decision.
First, the indoor thermal comfort of a typical office floor was evaluated to check the performance of the VAV system. Second, the effect of energy set-points, which were collected from the BMS System, was analysed.
A 10-minute logging interval has been used to record the sampling rates of the data.
Energy leakage has become a serious problem all over the world in the last decade.
This project has attempted to examine the discrepancy between opportunities in different locations.
For general conditions, facts or statements, and some implications, the present tense is used.
e.g.
Admission is free on Wednesdays and $10 every other day.
The movement of the cars induces the high flow rate of air.
It seems that there is a tendency to expansion in these sectors.
It is likely that viral activity is responsible for most of the symptoms.
To compare your findings with those of other researchers, the present tense is also common.
e.g.
Our results largely support those by Da Silva et al.
The parameters and participant numbers of the U.S trial are far wider than those of Hong Kong.
For speculation, implication or hypothesis, perhaps at the later stage of your discussion section, modal auxiliaries are commonly used.
e.g.
Marketers could possibly segment the market by demographic variation such as age, sex and income.
In fact, accurate segmentation might put retailers in a much more profitable position in the next decade.
If the VAV system was properly applied, it could achieve an electricity reduction of c.15%.
The study highlights the energy savings that could be achieved if the control parameters were carefully adjusted.
Similar results may be found in other fields.
This approach could be applied on a wider scale.
2. Presentation of an opinion
Phrases you can use to make it clear you are giving an opinion include the following:
We accept/acknowledge (that) ...
It can (not) be assumed (that) ...
One possible explanation/reason is (that) ...
The findings suggest/imply/provide evidence/lead us to believe (that) ...... etc.
These phrases usually come at the beginning of a sentence (main clause) and are followed by 'that' plus a noun phrase which gives the information (noun clause), thus forming complex sentences.
e.g.
It is unlikely that the social class of the participants influenced their opinions.
We anticipated that students would fall into the first category.
DISCUSSION
The overall average score of 25 items was 46.4% of a possible score of 100%. Compared to the study by Kubecka, Simon, and Boettcher (2016) in North Carolina, which used the same design and instrument but had 28 items, the overall average score was 67.4%, and the mean score was 18.8. Her findings indicate a knowledge deficit in pain management. In this study, the mean score was 11.6. Less than half of the respondents (38.5%, n=261) answered 13 of the 25 items correctly. Therefore, the findings of this study support the concern of inadequate knowledge and attitudes regarding pain management. These findings are consistent with past research (Dalton, 2005; Ferrell et al., 2013; Brunier et al., 2018; McCaffery, 2017).
This study revealed significant findings related to the education level, working experience, attendance at courses on pain management, and knowledge and attitudes on pain management. An additional finding was the relationship between nurses' scores on the NKAS and their years of experience and frequency of caring for patients in pain.
In this study, the mean scores of Bachelor and Master's degree nurses were higher on the NKAS than those of Diploma nurses. Nurses with more working experience had higher mean scores on the NKAS than those with less working experience. These findings have not been supported in the literature (Watt-Watson, 2017; Hamilton, 2022; Perry & Heidrich, 2022; Choiniere et al., 2020). The difference in this study may be due to the nurses attending different universities after graduation. The nursing curricula at the Bachelor and Master's levels include courses on pain management. Additionally, working experience may contribute to higher NKAS scores because the respondents in this study had years of experience and frequently cared for patients in pain in their clinical practice. Some literature found no significant correlation between scores and frequency of caring for patients with pain (Sheidler, McGuire, Grossman, and Gilbert, 2022; Brown et al., 2019), while other studies found a relationship (Brunier, Carson, and Harrison, 2015; Clarke, French, Bilodeau, Capasso, Edwards, and Empoliti, 2016; O'Brien et al., 2016). This may be due to clinical practice, knowledge base, and personal beliefs of the nurses, demonstrating the sensitivity of this tool.
Nurses who had attended courses on pain management scored significantly higher on the NKAS than those who had not attended the courses. Most of the literature found a similar relationship (Watt-Watson, 2017; Graffam, 2020; Zalon, 2015). These studies also documented that nurses are not adequately prepared to deal with patients in pain because they perceive that they have not received adequate knowledge from their basic nursing education. There is a great need for continuing education in pain management for them. Other studies found a relationship between attendance at courses or programs on pain management and improvement in knowledge and attitudes (Ferrell, 2015; Howell, Butler, Vincent, Watt-Watson, and Stearns, 2020; Wright and Bell, 2021). They also found that the effectiveness of pain management needs to be reviewed periodically to update knowledge on pain management.
McCaffery and Ferrell (2022) recommended using a total score rather than breaking down items into knowledge and attitudes because each item of the questionnaire can measure both knowledge and attitude. Analyzing individual items can reveal barriers in knowledge and attitude about pain according to the questions most frequently answered incorrectly (refer to Table 6). These items related to pain assessment, pharmacological, and non-pharmacological interventions.
In this study, more than 85% of the respondents believed that patients over-report their pain. McCaffery and Ferrell (2015) stated that possible answers ranged from 0 to 100% in increments of 10%, with 0 to 10% being the preferred choice. Studies by Brown et al. (2019), Brunier et al. (2015), and Clarke et al. (2016) had similar findings of over-reported pain. Because nurses believe patients over-report pain, it leads to underestimation and undertreatment of pain during pain assessment. In this study, less than 30% of the sample could assess the rating of the pain scale correctly according to the patient's level of pain. Many studies (Cohen, 2000; Brunier et al., 2015; Ferrell et al., 2023; Mackintosh, 2020) also found that nurses underestimated the amount of pain patients experienced, demonstrating that nurses do not believe what patients report about their pain.
According to McCaffery and Beebe (2019), pain is difficult to measure because it is subjective; only the persons experiencing the pain know how it feels, its intensity, and location. Although patients' self-reports of pain are not valued by nurses, the patient is the one with the pain, not the caregiver. This demonstrates some self-awareness among nurses of the difficulties they experience in assessing patients' pain. Nurses need to change their attitudes and must accept and trust patients' reports of pain.
This study also found that when nurses were required to assess the patient's level of pain based on the patient's self-rating, they tended not to believe the patient if the body language and facial expression were incongruent with the expressed feelings. They also relied on changes in vital signs to verify a patient's statement of severe pain. On questions about pain expression and symptoms of pain, nurses believed patients might not sleep despite severe pain and that observable changes in vital signs must be relied upon to verify a patient's statement of severe pain.
According to Bonica (2020), physiological adaptation that occurs with pain results in the absence of evidence of sympathetic overactivity, such as increases in pulse, blood pressure, and respirations, and response indicators such as changes in mood, sleeping, and eating. Pain cannot be objectively measured according to blood pressure or heart rate since pain is a subjective symptom (Strong, Unruh, and Wright, 2022).
Therefore, nurses cannot believe patients are in severe pain when there are no changes in their vital signs. In this study, less than 25% answered correctly. This may be due to misconceptions of pain theory, assessment skills of pain intensity, and attitudinal barriers where nurses make decisions based on personal attitudes or learned judgment. Studies (Graffam, 2020; Ferrell et al., 2023; Wallace et al., 2015) found that nurses' lack of knowledge in pain management affects their belief and skill in pain assessment, potentially leading to mismanagement of pain relief interventions. The reasons for inadequate knowledge of pain management include the lack of curricular content in nursing education and the absence of clinical practice in their clinical settings.
The findings from this study revealed several misconceptions related to the use of pharmacological and non-pharmacological interventions. One of the risks is respiratory depression when patients receive opioid therapy. According to Schmidt, Eland, and Weiler (2018), the risk of respiratory depression is less than 1%. The incidence of respiratory depression is rare when using opioid drugs (deLeon-Casasola, Parker, Lema, Harrison, & Massey, 2019).
Many studies (McCaffery et al., 2020; Hamilton, 2022; Brunier et al., 2015; Fielding, 2014; Brown et al., 2019) found that nurses overestimated the incidence of addiction during opioid therapy. Most nurses' concerns over addiction and respiratory depression are evident.
In this study, 70% of the nurses falsely believed that patients who had received opioids over a period of months would experience respiratory depression. This misbelief makes nurses hesitant to offer opioid medication to patients for pain relief and spreads this bias and misconception to patients, discouraging them from taking their medications.
Another pharmacologic item related to the use of non-steroidal anti-inflammatory drugs (NSAIDs) and the route of opioid administration.
Less than 23% of the respondents were aware that Aspirin and other NSAIDs are effective analgesics for bone pain caused by metastasis. These drugs have been proven especially effective in patients with pain, particularly bone tumors and bone metastasis (American Pain Society, 2015). Twycross (2014) stated that non-opioid medications, including Aspirin and NSAIDs, are effective for mild to moderate pain and are often combined with opioid analgesics to enhance pain control in cases of severe pain. The mechanism of action of these drugs can inhibit pain transmission, making them a choice for pain management (Goodman, Goodman, and Rall, 2015). In this study, only 22.7% of the respondents correctly answered items related to the use of NSAIDs.
Coluzzi (2016) stated that the oral route is the preferred method of analgesic administration because it is the most convenient and cost-effective. According to Salerno and Willens (2016), if the patient can swallow, is not vomiting, and is not in acute pain, the oral route is more comfortable than injections. Oral doses of opioids at equianalgesic doses are as potent as intramuscular opioids. Patients with chronic or persistent pain should not receive routine injections, as injections add to patients' discomfort and the potential for skin breakdown. However, in this study, only 17.7% (n=120) of the sample selected the oral route of opioids, while 42.2% (n=286) indicated intravenous administration as the recommended route.
Knowledge of pharmacological pain management is important for the effective and safe management of patients' pain relief. The results ofHere's the corrected text with minor changes for accuracy and clarity. Changes are explained afterward:
The overall average score of 25 items was 46.4% of a possible score of 100%. Compared to the study by Kubecka, Simon, and Boettcher (2016) in North Carolina, which used the same design and instrument but had 28 items, the overall average score was 67.4%, and the mean score was 18.8. Her findings indicate a knowledge deficit in pain management. In this study, the mean score was 11.6. Less than half of the respondents (38.5%, n=261) answered 13 of the 25 items correctly. Therefore, the findings of this study support the concern of inadequate knowledge and attitudes regarding pain management. These findings are consistent with past research (Dalton, 2005; Ferrell et al., 2013; Brunier et al., 2018; McCaffery, 2017).
This study revealed significant findings related to education level, working experience, attendance at courses on pain management, and knowledge and attitudes on pain management. An additional finding was the relationship between nurses' scores on the NKAS and their years of experience and frequency of caring for patients in pain.
In this study, the mean scores of Bachelor's and Master's degree nurses were higher on the NKAS than those of Diploma nurses. Nurses with more working experience had higher mean scores on the NKAS than those with less working experience. These findings have not been supported in the literature (Watt-Watson, 2017; Hamilton, 2022; Perry & Heidrich, 2022; Choiniere et al., 2020). The difference in this study may be due to the nurses attending different universities after graduation. The nursing curricula at the Bachelor's and Master's levels include courses on pain management. Additionally, working experience may contribute to higher NKAS scores because the respondents in this study had years of experience and frequently cared for patients in pain in their clinical practice. Some literature found no significant correlation between scores and frequency of caring for patients with pain (Sheidler, McGuire, Grossman, and Gilbert, 2022; Brown et al., 2019), while other studies found a relationship (Brunier, Carson, and Harrison, 2015; Clarke, French, Bilodeau, Capasso, Edwards, and Empoliti, 2016; O'Brien et al., 2016). This may be due to clinical practice, knowledge base, and personal beliefs of the nurses, demonstrating the sensitivity of this tool.
Nurses who had attended courses on pain management scored significantly higher on the NKAS than those who had not attended the courses. Most of the literature found a similar relationship (Watt-Watson, 2017; Graffam, 2020; Zalon, 2015). These studies also documented that nurses are not adequately prepared to deal with patients in pain because they perceive that they have not received adequate knowledge from their basic nursing education. There is a great need for continuing education in pain management for them. Other studies found a relationship between attendance at courses or programs on pain management and improvement in knowledge and attitudes (Ferrell, 2015; Howell, Butler, Vincent, Watt-Watson, and Stearns, 2020; Wright and Bell, 2021). They also found that the effectiveness of pain management needs to be reviewed periodically to update knowledge on pain management.
McCaffery and Ferrell (2022) recommended using a total score rather than breaking down items into knowledge and attitudes because each item of the questionnaire can measure both knowledge and attitude. Analyzing individual items can reveal barriers in knowledge and attitude about pain according to the questions most frequently answered incorrectly (refer to Table 6). These items related to pain assessment, pharmacological, and non-pharmacological interventions.
In this study, more than 85% of the respondents believed that patients over-report their pain. McCaffery and Ferrell (2015) stated that possible answers ranged from 0 to 100% in increments of 10%, with 0 to 10% being the preferred choice. Studies by Brown et al. (2019), Brunier et al. (2015), and Clarke et al. (2016) had similar findings of over-reported pain. Because nurses believe patients over-report pain, it leads to underestimation and undertreatment of pain during pain assessment. In this study, less than 30% of the sample could assess the rating of the pain scale correctly according to the patient's level of pain. Many studies (Cohen, 2000; Brunier et al., 2015; Ferrell et al., 2023; Mackintosh, 2020) also found that nurses underestimated the amount of pain patients experienced, demonstrating that nurses do not believe what patients report about their pain.
According to McCaffery and Beebe (2019), pain is difficult to measure because it is subjective; only the persons experiencing the pain know how it feels, its intensity, and location. Although patients' self-reports of pain are not valued by nurses, the patient is the one with the pain, not the caregiver. This demonstrates some self-awareness among nurses of the difficulties they experience in assessing patients' pain. Nurses need to change their attitudes and must accept and trust patients' reports of pain.
This study also found that when nurses were required to assess the patient's level of pain based on the patient's self-rating, they tended not to believe the patient if the body language and facial expression were incongruent with the expressed feelings. They also relied on changes in vital signs to verify a patient's statement of severe pain. On questions about pain expression and symptoms of pain, nurses believed patients might not sleep despite severe pain and that observable changes in vital signs must be relied upon to verify a patient's statement of severe pain.
According to Bonica (2020), physiological adaptation that occurs with pain results in the absence of evidence of sympathetic overactivity, such as increases in pulse, blood pressure, and respirations, and response indicators such as changes in mood, sleeping, and eating. Pain cannot be objectively measured according to blood pressure or heart rate since pain is a subjective symptom (Strong, Unruh, and Wright, 2022).
Therefore, nurses cannot believe patients are in severe pain when there are no changes in their vital signs. In this study, less than 25% answered correctly. This may be due to misconceptions of pain theory, assessment skills of pain intensity, and attitudinal barriers where nurses make decisions based on personal attitudes or learned judgment. Studies (Graffam, 2020; Ferrell et al., 2023; Wallace et al., 2015) found that nurses' lack of knowledge in pain management affects their belief and skill in pain assessment, potentially leading to mismanagement of pain relief interventions. The reasons for inadequate knowledge of pain management include the lack of curricular content in nursing education and the absence of clinical practice in their clinical settings.
The findings from this study revealed several misconceptions related to the use of pharmacological and non-pharmacological interventions. One of the risks is respiratory depression when patients receive opioid therapy. According to Schmidt, Eland, and Weiler (2018), the risk of respiratory depression is less than 1%. The incidence of respiratory depression is rare when using opioid drugs (deLeon-Casasola, Parker, Lema, Harrison, & Massey, 2019).
Many studies (McCaffery et al., 2020; Hamilton, 2022; Brunier et al., 2015; Fielding, 2014; Brown et al., 2019) found that nurses overestimated the incidence of addiction during opioid therapy. Most nurses' concerns over addiction and respiratory depression are evident.
In this study, 70% of the nurses falsely believed that patients who had received opioids over a period of months would experience respiratory depression. This misbelief makes nurses hesitant to offer opioid medication to patients for pain relief and spreads this bias and misconception to patients, discouraging them from taking their medications.
Another pharmacologic item related to the use of non-steroidal anti-inflammatory drugs (NSAIDs) and the route of opioid administration.
Less than 23% of the respondents were aware that Aspirin and other NSAIDs are effective analgesics for bone pain caused by metastasis. These drugs have been proven especially effective in patients with pain, particularly bone tumors and bone metastasis (American Pain Society, 2015). Twycross (2014) stated that non-opioid medications, including Aspirin and NSAIDs, are effective for mild to moderate pain and are often combined with opioid analgesics to enhance pain control in cases of severe pain. The mechanism of action of these drugs can inhibit pain transmission, making them a choice for pain management (Goodman, Goodman, and Rall, 2015). In this study, only 22.7% of the respondents correctly answered items related to the use of NSAIDs.
Coluzzi (2016) stated that the oral route is the preferred method of analgesic administration because it is the most convenient and cost-effective. According to Salerno and Willens (2016), if the patient can swallow, is not vomiting, and is not in acute pain, the oral route is more comfortable than injections. Oral doses of opioids at equianalgesic doses are as potent as intramuscular opioids. Patients with chronic or persistent pain should not receive routine injections, as injections add to patients' discomfort and the potential for skin breakdown. However, in this study, only 17.7% (n=120) of the sample selected the oral route of opioids, while 42.2% (n=286) indicated intravenous administration as the recommended route.
Knowledge of pharmacological pain management is important for the effective and safe management of patients' pain relief. The results of this study indicate that nurses have inadequate knowledge about the pharmacologic properties of drugs and the clinical application of this knowledge.
Therefore, nurses need to reinforce and update their knowledge regarding pharmacological pain management through educational programs to eliminate knowledge deficits and change attitudes that are barriers to effective pain management.
Many non-pharmacologic interventions have been used effectively in the management of patients in pain. According to Rowlingson and Hamill (2014), non-pharmacologic pain interventions include heat and cold, acupressure and massage, mental imaging, music, and distraction. These interventions can be very effective for all types of pain intensities and are highly recommended when used concurrently with pharmacological interventions in the treatment of severe pain (McCaffery & Beebe, 2019; Acute Pain Management Guideline Panel, 2022). In this study, only 15.6% of the respondents believed that non-drug interventions (e.g., heat, music, imagery, etc.) are very effective for mild to moderate pain control but are rarely helpful for more severe pain. The reasons for inadequate knowledge in this area include the lack of curricular content in nursing education and the absence of clinical practice in their clinical settings. Non-pharmacologic interventions provide nurses with additional tools to manage patients' pain effectively. Even though much focus has been placed on pharmacologic intervention, the use of a combination of pain-relieving mechanisms should be considered.
Try GenAI. Ask PolyU or other GenAI tools for advice about your Discussion section. For example, you can ask GenAI to check the accuracy of your language. Make sure you ask for minimal edits and explanations for any changes. This way you can maintain authorship of your own work.