Patient- and Nurse-Controlled Analgesia: 22-Year Experience in a Pediatric Hospital

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.

A PRISMA Systematic Review on the Safety and Efficacy of Patient-Controlled Analgesia (PCA) in Pediatrics

PROBLEM

Effective pain management is the key to improving not only patient outcomes but also patient satisfaction. Patient controlled analgesia (PCA) is a pain management method that allows the patient to self-administer their medication. Because of the great variety of physical and cognitive abilities in the pediatric population, involvement of a nurse or parent proxy is necessary.

PURPOSE

The purpose of this study was to ascertain the most effective approaches to PCA in pediatric settings.

ELIGIBILITY CRITERIA

Criteria for articles selection were as follows: (a) published in a peer-review journal, (b) between 2014 and 2019, (c) in English, (d) directly addressing the issues of safety and efficacy of patient-controlled analgesia by proxy in the pediatric patient population.

SAMPLE

Databases used in the search included CINAHL Plus with Full Text, DynaMed, MedLine with Full Text, and ScienceDirect. Combinations of the following keywords were used to search each database: "nurse controlled analgesia", "parent controlled analgesia", "patient controlled analgesia by proxy", "NCA", "P/NCA", "PCA by proxy", "pediatrics", "children", "pediatric patients". Database searches yielded 172 results. Articles that were duplicated, missing inclusion criteria or did not directly address the issues of safety and efficacy of PCA by proxy were removed. Eleven articles fit the selection criteria.

RESULTS

Eleven articles were included in the final report. The themes that emerged from the analysis included pain management of neonates and infants, children with developmental disabilities, children with cancer, as well as the sources and possible solutions to errors in medication preparation.

CONCLUSIONS

It was concluded that PCA by proxy remains a safe and efficient method of pain administration for the pediatric population, with the exception of children suffering from developmental and neurological disabilities.

IMPLICATIONS

PCA by proxy, although presenting challenges, remains a safe and efficient way of pain management across different pediatric populations, such as infants and neonates or children with cancer, both inpatient and outpatient, and new technologies could positively influence the safety of this method of pain management. Conversely, children with developmental and neurological disabilities do not benefit from this method of pain management and are more prone to experiencing adverse effects.

Review of adjuvants to local anesthetics in peripheral nerve blocks: Current and future trends

In recent anesthetic practice, peripheral nerve blocks (PNBs) are used extensively for surgical anesthesia and nonsurgical analgesia. PNBs offer many benefits over other anesthetic techniques in a certain population of patients, and in some specific clinical setting, that may contribute to faster and safer pain relief, increased patient satisfaction, reduced hospital stay, and decreased overall healthcare cost. The technique involves the injection of the anesthetic in the vicinity of a specific nerve or bundle of nerves to block the sensation of pain transmitting to a specific portion of the body. However, the length of analgesia when a single anesthetic is used for PNB may not last long. Therefore, the practice of adding an additional agent called adjuvant has been evolved to prolong the analgesic effect. There are many such adjuvants available that are clinically being used for this purpose imparting great efficacy and safety to the anesthetic process. The adjuvants molecules are generally classified as opioids, alpha-2 agonist, steroids, etc. Most of them are safe to use and show little or no adverse event related to neurotoxicity and tissue damage. Although there is extensive use of such adjuvants in the clinical field, none of the molecules is approved by the FDA and is used as an off-label drug. The risk to benefit ratio must be assessed while using such an agent. This review will try to delineate the basic need of adjuvant in peripheral nerve block and will discuss the advantages and limitations of using different adjuvants and will discuss the future prospect of such application.

Opioid Seeking Behaviors and Diversion in Hospitalized Pediatric Patients: A Case Series

All nurses have a responsibility for monitoring their patients for signs of substance misuse or substance use disorder. Adolescents and young adults are at risk for substance use. Prescription medications may be used by adolescents for non-medical reasons such as to feel high, to assist with sleep, to avoid negative feelings or thoughts or to avoid withdrawal symptoms after chronic use. Some adolescents with legally prescribed medications have been asked to divert those medications by giving them to someone else. Drug diversion by employees is often reported in healthcare settings, but diversion of medications done by patients is far less commonly reported. This paper is a report of two patients with complex medical issues and chronic pain who diverted opioid medications while hospitalized. Hiring clinical staff, such as nurses, working in Drug Diversion Prevention positions will provide knowledge and expertise to facilitate investigations and to help reduce risks for diversion in healthcare settings. In addition, nurses with concerns about patient diversion should discuss these concerns with the care team. Organizational leaders need to support their teams by providing education and resources so staff feel comfortable addressing these challenging situations.