Nurses' Perceptions and Attitudes Toward Use of Oral Patient-Controlled Analgesia

Nurses' knowledge and attitudes toward patient-controlled analgesia for postoperative pain control in a tertiary hospital in South Korea

BACKGROUND

This study investigated the knowledge and attitude of surgical ward nurses toward patient-controlled analgesia (PCA) to develop educational material for nurses on the use of PCA.

METHODS

This study was a cross-sectional study comprising 120 nurses from eight surgical wards in a tertiary hospital in South Korea. A questionnaire addressing 6 domains of knowledge of and attitudes towards PCA was conducted over 1 week and analyzed using descriptive and inferential statistical methods. Knowledge was measured on a categorical scale of 0 and 1 (20 points), and attitude was measured on a Likert scale of 1 to 4 points (60 points).

RESULTS

The total score quantifying the knowledge of and attitudes toward PCA of surgical ward nurses was 59.5 ± 5.5 out of 80.0 points. The average age of the subjects was 28.58 ± 5.68 years old, and nurses above the age of 28 had significantly greater knowledge and better attitudes (61.7 ± 5.5) than those below the age of 28 (57.9 ± 4.9) (p < .001). Nurses working on the upper abdominal surgical ward had significantly greater knowledge (16.2 ± 1.9) than nurses working on other wards (thorax: 14.0 ± 2.3, lower abdominal: 15.4 ± 1.9, and musculoskeletal: 14.5 ± 2.2) (p = .001). Nurses who received education about PCA had significantly better attitudes (45.3 ± 4.6) than those who did not (41.3 ± 3.5) (p < .001). The average correct answer rate for knowledge of opioid analgesics was lower (68.2%) than that for knowledge of the basic configuration of PCA equipment (73.3%) and areas to be identified and managed when using PCA (84.6%), and there was a significant correlation with attitudes toward side effect management (p < .05, r = .19).

CONCLUSIONS

There was a significant correlation between the knowledge and attitude of nurses regarding opioid use in PCA. Older nurses with greater clinical experience on the surgical wards who had received PCA education had a better attitude toward PCA. Therefore, newly trained nurses on surgical wards with no experience of PCA education should undergo an intensive education program on opioid analgesics used in PCA.

Factors Relating to Nurses' Knowledge and Attitudes Regarding Pain Management in Inpatients

PURPOSE

To describe factors associated with nurses' attitudes or lack of knowledge regarding pain management in adult inpatients.

DESIGN

Transverse descriptive survey-based study.

METHODS

This was a transverse descriptive survey-based study. The population was obtained through nonprobabilistic convenience sampling. The Knowledge and Attitudes Survey Regarding Pain was made available to 470 nurses at a tertiary level hospital. Associations were sought with the unit where assigned, years of experience, specific training on pain, and postgraduate education.

RESULTS

The sample included 134 nurses with a mean age of 41.6 ± 10.8 years; 87% were women, 64% worked rotating shifts, 64% had more than 10 years of experience, and 31% had specific training in pain management. The greatest number of correct responses was obtained from nurses with specific training in pain management (p = .001) and nurses who worked in units of surgical hospitalization (p = .004). The lack of training was associated with a deficit in knowledge and inadequate attitudes about pain management. In nurses with less than 10 years of experience, worse results were observed in knowledge, whereas the unit of work was decisive in the results about attitude (p < .05).

CONCLUSIONS

Among the nurses surveyed, some knowledge gaps were detected, as were certain inappropriate attitudes, associated with lack of training, lack of experience, and being assigned to specific hospitalization units.

A Prospective Randomized Trial of an Oral Patient-Controlled Analgesia Device Versus Usual Care Following Total Hip Arthroplasty

BACKGROUND

Multimodal pain management for surgery patients may include the use of a combination of scheduled oral pain medications with as-needed (PRN) oral opioids. Multiple concurrent time demands on nursing staff frequently cause delays in the delivery of oral PRN pain medication compromising pain management.

PURPOSE

Postoperative pain control was compared using a wireless oral patient-controlled analgesia device for the delivery of oxycodone with a control group receiving PRN oxycodone from nursing staff.

METHODS

Thirty patients were prospectively randomized into each of 2 groups after total hip arthroplasty. Patient demographics, pain scores, drug dose data, and physical therapy data were collected from chart reviews. Additional data were obtained from patient and nursing surveys.

RESULTS

Device patients recorded statistically lower pain scores while taking lower doses of oxycodone on postoperative Day 1 as compared with the control group. Patient surveys indicated that those in the device group reported lower pain scores 24 hours prior to discharge, albeit not statistically different from the control group. Men in the device group reported statistically lower pain scores with physical therapy than men in the control group. Findings from the nursing survey indicate that nurses favored the device over nurse-administered PRN.

CONCLUSION

Patients using the wireless patient-controlled analgesia (PCA) (oral) device had less pain at rest and with activity (men) while taking lower doses of oxycodone with each dose. Nursing surveys indicated that nursing staff in this orthopedic postoperative unit found the device easy to use, reliable, and efficient. They also recommended its adoption for those capable of using it.

The Effect of Patient-Controlled Oral Analgesia for Acute Abdominal Pain after Discharge

BACKGROUND

During hospitalization, patients who were admitted with acute abdominal pain must be prepared to care for themselves at home after discharge to continue established treatment, promote recovery, and avoid readmission.

AIMS

Our aim was to investigate the quality of pain management after discharge, when patient-controlled oral analgesia was compared with standard care for patients admitted to hospital with acute abdominal pain. The primary outcome measures were pain intensity and patient perception of care. The secondary outcome measures were pain interference with activity, affective experiences, side effects, and use of analgesics.

DESIGN

A questionnaire study measuring the effect of an intervention on patient-controlled oral analgesics.

SETTINGS

An emergency department and a surgical department in Denmark.

PARTICIPANTS

Patients admitted to hospital with acute abdominal pain.

METHODS

A pre- and postintervention study was conducted in an emergency department and a surgical department with three subunits. Data were collected using a Danish modified Revised American Pain Society Patient Outcome Questionnaire with five subscales (scale 0-10) completed in weeks 1 and 4 after discharge.

RESULTS

In total, 117 patients were included. The median scores at week 1 and week 4 in the control and intervention groups were, respectively, 2/1 and 1/0 on the pain subscale (p = .11/.16), 3/0 and 3/0 on the activity subscale (p = .19/.80), 1/0 and 0/0 on the emotional subscale (p = .02/.72), 1/0 and 1/0 on the side effect subscale (p = .95/.99), and 8/5 and 7/7 on the patient perception subscale (p = .35/.49). There was no significant difference in the use of analgesics at week 1.

CONCLUSIONS

Patient-controlled oral analgesia during the hospital stay did not improve the quality of pain management after discharge.

Patient-controlled oral analgesia for acute abdominal pain: A before-and-after intervention study on pain intensity and use of analgesics

AIM

To compare the use of patient-controlled oral analgesia with nurse-controlled analgesia for patients admitted to hospital with acute abdominal pain. The primary outcome measure was pain intensity. The secondary outcome measures were the use of analgesics and antiemetics.

BACKGROUND

Inadequate pain management of patients with acute abdominal pain can occur during hospital admission. Unrelieved acute pain can result in chronic pain, stroke, bleeding and myocardial ischemia.

METHODS

A before-and-after intervention study was conducted in an emergency department and a surgical department with three subunits. Data were collected from medical charts and analyzed using chi-squared and Kruskal-Wallis tests.

RESULTS

A total of 170 patients were included. The median pain intensity score, using the numeric ranking scale, was 2.5 and 2 on Day 2 (p = 0.10), 2 and 2 on Day 3 (p = 0,40), 2.5 and 0 on Day 4 (p = 0.10), 2 and 0 on Day 5 (p = 0.045) in the control and intervention group, respectively. The percentage of patients receiving analgesics was 93 and 86 on Day 2 (p = 0.20), 91 and 75 on Day 3 (p = 0.02), 89 and 67 on Day 4 (p = 0.009) and 80 and 63 on Day 5 (p = 0.39). The use of antiemetics was similar in the two groups.

CONCLUSION

Patient-controlled oral analgesia significantly reduced the numerical ranking pain scale score on Day 5 and the consumption of analgesics on Days 3 and 4 after hospital admission. Patient-controlled oral analgesia is feasible as pain management for patients, but only with minor impact on experienced pain intensity and use of analgesics.

Can consistent benchmarking within a standardized pain management concept decrease postoperative pain after total hip arthroplasty? A prospective cohort study including 367 patients

BACKGROUND

The number of total hip replacement surgeries has steadily increased over recent years. Reduction in postoperative pain increases patient satisfaction and enables better mobilization. Thus, pain management needs to be continuously improved. Problems are often caused not only by medical issues but also by organization and hospital structure. The present study shows how the quality of pain management can be increased by implementing a standardized pain concept and simple, consistent, benchmarking.

METHODS

All patients included in the study had undergone total hip arthroplasty (THA). Outcome parameters were analyzed 24 hours after surgery by means of the questionnaires from the German-wide project "Quality Improvement in Postoperative Pain Management" (QUIPS). A pain nurse interviewed patients and continuously assessed outcome quality parameters. A multidisciplinary team of anesthetists, orthopedic surgeons, and nurses implemented a regular procedure of data analysis and internal benchmarking. The health care team was informed of any results, and suggested improvements. Every staff member involved in pain management participated in educational lessons, and a special pain nurse was trained in each ward.

RESULTS

From 2014 to 2015, 367 patients were included. The mean maximal pain score 24 hours after surgery was 4.0 (±3.0) on an 11-point numeric rating scale, and patient satisfaction was 9.0 (±1.2). Over time, the maximum pain score decreased (mean 3.0, ±2.0), whereas patient satisfaction significantly increased (mean 9.8, ±0.4; p<0.05). Among 49 anonymized hospitals, our clinic stayed on first rank in terms of lowest maximum pain and patient satisfaction over the period.

CONCLUSION

Results were already acceptable at the beginning of benchmarking a standardized pain management concept. But regular benchmarking, implementation of feedback mechanisms, and staff education made the pain management concept even more successful. Multidisciplinary teamwork and flexibility in adapting processes seem to be highly important for successful pain management.