Patient assessment of postoperative pain management – Orthopaedic patients compared to other surgical patients

Measuring person-centred pain management: Development of a questionnaire using the fundamentals of care framework

AIM

To develop and test a questionnaire using the Fundamentals of Care framework to measure person-centred pain management.

DESIGN

Cross-sectional exploratory descriptive design.

METHODS

Development in three phases: (a) literature search for questionnaires measuring person-centred pain management, (b) seven-step process developing items using thematic analysis, (c) initial feasibility and validity testing. Theoretical and empirical evidence was used, including the 'Strategic and Clinical Quality Indicators in Postoperative Pain management' questionnaire, the Fundamentals of Care framework and person-centredness principles. Theoretical experts (n = 2) reviewed the questionnaire, further evaluated by providers (n = 5) and patients (n = 5) using a think-aloud process, and by additional questions in the questionnaire answered by n = 100 patients. The questionnaire was tested February to March 2021, at four surgical wards in a university hospital.

RESULTS

The evaluation showed initial support for feasibility and validity, and the questionnaire was found to represent and be sensitive to capture the patients' experiences of person-centred pain management and being easy to answer. The 100 patients with acute abdominal pain who answered the questionnaire (aged 18-89 years, 46 women and 54 men), identified missing elements of fundamental care in their pain management, indicating that the questionnaire is sensitive to capture specific areas for improvement.

CONCLUSION

This first attempt at transforming the essential components of person-centred pain management into measurable items in a questionnaire was found promising. The questionnaire is suggested to be further tested for psychometric properties and patient benefit to provide clinical guidance in acute surgical care to meet the patient care need of pain management.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

The developed questionnaire addresses the need of nurses and nursing leaders to evaluate the delivery of person-centred pain management in acute surgical care, to relieve the patient from pain.

PATIENT OR PUBLIC CONTRIBUTION

Patients and providers were involved in testing the questionnaire.

Management of Persistent Coccygodynia and Health Behavior: A Survey Study on Patients with Coccygodynia of Age 41 to 69 years

Objectives: Coccygodynia, with trauma as a common etiologic factor, is a clinical condition of pain around the coccygeal region. This research aimed at investigating the level of satisfaction in surgical and non- surgical treatment of coccygodynia among Turkish patients and their health behavior. Methods: There is no dearth of studies on coccygodynia; however, a clear gap in research exists of studying coccygodynia patient satisfaction of specific age groups. Turkish patients aged 41 to 69 years and suffering from coccygodynia in different public sector clinics were the respondents in this research. The major criteria of sampling were Turkish patients of coccygodynia, aged 41 to 69 years, satisfied with both surgical and non-surgical methods of treatment, and varying in the nature of the infection. Results: The study found out that coccygodynia patients had a higher probability to receive timely, successful treatment; and that there exists a positive relationship between coccygodynia patients' health behavior and coccygodynia treatment satisfaction.Conclusion: This research is a significant contribution understanding the patients with coccygodynia, and whether they improved their health in a better way with surgical or non-surgical method of treatment.

The Prevalence of Pain in the First 24 Hours After Surgery: A Multicenter Study

PURPOSE

This study was conducted to determine the prevalence and severity of postoperative pain in the first 24 hours after surgery and to emphasize the importance of postoperative pain assessment.

DESIGN

A descriptive study.

METHODS

This study was carried out on May 21, 2019 with 898 patients who had completed the postoperative 24th hour in the surgical clinics of 10 training and research hospitals in Istanbul, the capital of Turkey. Point prevalence was used in the study. Data were collected using a questionnaire developed by the researchers and the Revised American Pain Society Patient Outcome Questionnaire. Descriptive statistics were presented as frequency, percentage, mean, and standard deviation. Nonparametric tests were used for data without normal distribution (Kolmogorov-Smirnov Test, P < .05). Two-group comparisons were performed using the Mann-Whitney U test. The Kruskal Wallis-H test was used for the comparison of three or more groups. Statistical significance was set as P < .05.

FINDINGS

The three main types of surgery were general surgery with 31.8%, gynecologic surgery with 12.9%, and orthopedic surgery with 12.7%. The mean lowest level of pain felt by the patients included in the study in the first 24 hours was 3.90 ± 2.94, and the mean highest level of pain was 6.38 ± 4.45.

CONCLUSIONS

Postoperative pain is a subjective phenomenon and may be affected by factors such as type of surgery, previous experience of surgery, duration of surgery, the length of the surgical incision, the type of anesthesia, the quality of postoperative care, individual characteristics and experiences, and fear anxiety; thus, the experience of pain may vary from person to person.

Experience of Pain and Satisfaction with Pain Management in Patients After a Lumbar Disc Herniation Surgery

PURPOSE

The descriptive study was performed to assess patients' pain experienced in the early postoperative period of a lumbar disc herniation surgery and their satisfaction with the pain management administered.

DESIGN

This was a descriptive and cross-sectional study conducted from May 8 to November 8, 2017.

METHODS

Data collection was performed during interviews through the Patient Information Form (20 questions), Turkish version of clinical quality indicators in the Postoperative Pain Management questionnaire (19 questions). The questionnaire included 14 items and 3 subdimensions named nursing interventions, pain management, and the environment. The remaining 5 questions were related to pain management satisfaction and pain severity. Questionnaire items scored on a 1 to 5 Likert scale. The higher the total score obtained from the questionnaire is the satisfaction with pain management increases.

FINDINGS

The mean score obtained from the total questionnaire was 51.4 (standard deviation: 6.6).Characteristics of patients with lumbar disc herniation did not influence the total score obtained from the instrument and its sub-dimensions (P > .05). Overall satisfaction with pain management was high (mean: 8.3; standard deviation: 1.6) on the 0 to 10 visual analog scale. There was a statistically significant difference between the length of hospital stay, the type of anesthesia used, having more pain than expected, and the satisfaction score of patients (P < .05). As the length of procedure increases, the average and current pain scores increase as well (P < .05).

CONCLUSIONS

Results of this study indicate that despite pain experienced after the lumbar disc herniation surgery, patients' satisfaction with pain management was high. Encouraging nurses to implement systematic and evidence-based practices in pain management may help alleviate patients' pain after surgery and reduce variety of pain management practices among nurses.

Postoperative pain documentation in a hospital setting: A topical review

Background and aims

Nursing documentation supports continuity of care and provides important means of communication among clinicians. The aim of this topical review was to evaluate the published empirical studies on postoperative pain documentation in a hospital setting.

Methods

The review was conducted through a systematic search of electronic databases: Web of Science, PubMed/Medline, CINAHL, Embase, Ovid/Medline, Scopus and Cochrane Library. Ten studies were included. Study designs, documented postoperative pain information, quality of pain documentation, reported quality of postoperative pain management and documentation, and suggestions for future research and practice improvements were extracted from the studies.

Results

The most commonly used study design was a descriptive retrospective patient record review. The most commonly reported types of information were pain assessment, use of pain assessment tools, useof pain management interventions, reassessment, types of analgesics used, demographic information and pain intensity. All ten studies reported that the quality of postoperative pain documentation does not meet acceptable standards and that there is a need for improvement. The studies found that organization of regular pain management education for nurses is important for the future.

Conclusions

Postoperative pain documentation needs to beimproved. Regular educational programmes and development of monitoring systems for systematic evaluation of pain documentation are needed. Guidelines and recommendations should be based on the latest research evidence, and systematically implemented into practice.

Implications

Comprehensive auditing tools for evaluation of pain documentation can make quality assessment easier and coherent. Specific and clear documentation guidelines are needed and existing guidelines should be better implemented into practice. There is a need to increase nurses’ knowledge of postoperative pain management, assessment and documentation. Studies evaluating effectiveness of high quality pain documentation are required.

Assessment of post-operative pain management among acutely and electively admitted patients - a Swedish ward perspective

RATIONALE, AIMS AND OBJECTIVES

Swedish health care is regulated to involve the patient in every intervention process. In the area of post-operative pain, it is therefore important to evaluate patient experience of the quality of pain management. Previous research has focused on mapping this area but not on comparing experiences between acutely and electively admitted patients. Hence, the aim of this study was to investigate the experiences of post-operative pain management quality among acutely and electively admitted patients at a Swedish surgical department performing soft-tissue surgery.

METHODS

A survey study design was used as a method based on a multidimensional instrument to assess post-operative pain management: Strategic and Clinical Quality Indicators in Postoperative Pain Management (SCQIPP). Consecutive patients at all wards of a university hospital's surgical department were included. Data collection was performed at hospital discharge.

RESULTS

In total, 160 patients participated, of whom 40 patients were acutely admitted. A significant difference between acutely and electively admitted patients was observed in the SCQIPP area of environment, whereas acute patients rated the post-operative pain management quality lower compared with those who were electively admitted.

CONCLUSIONS

There may be a need for improvement in the areas of post-operative pain management in Sweden, both specifically and generally. There may also be a difference in the experience of post-operative pain quality between acutely and electively admitted patients in this study, specifically in the area of environment. In addition, low levels of the perceived quality of post-operative pain management among the patients were consistent, but satisfaction with analgesic treatment was rated as good.

Surgical nurses in teaching hospitals in Ireland: understanding pain

BACKGROUND

Nurses play a crucial role in pain management and must be highly knowledgeable to ensure their practices are of a high standard.

AIM

The purpose of this study was to determine the baseline level of knowledge and attitudes regarding pain of nurses working in three teaching hospitals in Dublin.

METHODS

This descriptive study explored the knowledge and attitudes of nurses regarding pain management. A modified version of the 'Knowledge and Attitudes Survey Regarding Pain' tool was used to collect data. The sample comprised a convenience sample of 94 nurses working in the acute surgical wards of three hospitals.

FINDINGS

Three per cent of respondents achieved a passing score of 80% or greater. Results revealed that the mean percentage score overall was 65.7%. Widespread knowledge deficits were noted in this study, particularly in the domain of pharmacological management of pain. Further analysis revealed respondents had an inaccurate self-evaluation of their pain management knowledge.

CONCLUSION

The results of this study support the concern of inadequate knowledge and attitudes of nurses regarding pain. Educational and quality improvement initiatives in pain management should be used, which could foster and enhance nurses' knowledge base in the area of pain and possibly improve practices.

Assessment of quality of care in acute postoperative pain management

BACKGROUND/AIM

Managing of acute postoperative pain should be of great interest for all hospital institutions, as one of the key components of patients satisfaction, which indicates quality, as well as the outcome of treatment. The aim of this study was to assess the quality of nursing care in managing acute postoperative pain and to establish factors which influence patients assessment of the same.

METHOD

The investigation was conducted on the sample of 135 patients hospitalized in surgical clinics of the Clinical Centre of Vojvodina in Novi Sad in the form of cross-sectional study, by interviewing patients during the second postoperative day and collecting sociodemographic variables, type of surgical procedure and applied analgesic therapy which were taken from their medical documentation. The modified questionnaire of the Strategic and Clinical Quality Indicators in Postoperative Pain Management (SCQIPP) was used as the instrument of the investigation. The data were processed with suitable mathematical statistics methods such as multivariate analyses of variance (MANOVA), discriminative and other parametric procedures and methods. Roy's test, Pearson's coefficient contingency (X), multiple correlation coefficient (R) were conducted amongst other univariant procedures.

RESULTS

The mean score for the individual items of SCQIPP questionnaire was between 2.0 and 4.7 (scale range 1-5) and the percentage of patients answers "strongly agree" ranged from 4.4 to 77%. The smallest number of positive answers were given by the patients for the item "In order to assess pain intensity, some of the staff asked me at least once in the morning, in the afternoon and in the evening to show the number from 0-10". Most of the patients (57%) evaluated severe pain during the previous 24 hours, as moderate pain, which represents significantly greater number of patients which complain of severe pain and mild pain (p < 0.001). The analysis of patients evaluation (MANOVA p < 0.05 and discriminative p < 0.05) indicates the existence of significant difference between the assessment of nursing care quality in managing acute postoperative pain as regards to clinics as the place for pain management, patient's sex and his expectations. Evaluation from "communication" subscale gives the greatest contribution (24.9%) to the difference between the observed clinics, and the greatest contribution (25.7%) to the difference in evaluation of nursing care quality as regards to patients' sex has the evaluations from "procedure" subscale.

CONCLUSION

The results of this study show a useful evidence and identify aspects of nursing care in postoperative management of acute pain which are still to be improved. According to the patients' answers the priority should be given to a regular assessment of the intensity of postoperative pain and evaluation of the effects of analgesic therapy.