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Patient management of pain after cardiac surgery
AORN JOURNAL
is being perceived by their patients as caring. Only when caring behaviors are mutually perceived can the goal of making patients feel cared for be achieved. CYNTHIA SPRY, RN, MSN, CNOR CHAIRMAN CIMM~EE 1987-1988 NURSINGRESEARCH
K B King et al, “Patient management of pain after cardiac surgery,”Nursing Research 36 (May/ June 1987) 145-150. Using patient-controlled analgesia for postoperative pain management is gaining popularity. This has been based, in part, on the notion that increasing personal control over a patient’s health care increases his or her perception of well-being. The purpose of this study was to compare the effect of self-administered versus nurseadministered pain medication in cardiac surgical patients. Factors investigated were the patients’ desire for control, their perception of pain intensity, how pain disrupted their daily activities, emotional responses to pain, and use of pain medication over time. A randomized experimental design was used. One hundred and four patients who were scheduled for cardiac surgery were available for the study. Of those, 17 patients refused to participate for the following reasons: 10 said they wanted the nurses to give them their medication; five were advised by family members to not participate; one wanted to participate but did not want to complete the questionnaire; and one refused to participate without giving a reason. Patients started the study after leaving the surgical intensive care unit (SICU). Desire for control was measured on the day of admission with the Krantz Health Opinion Survey. Researchers used a seven-point scale ranging from “not at all” to “the worst it could be” to measure pain intensity, interference with daily activities caused by pain, and emotional upset caused by pain. These measurements were taken the day after leaving the SICU, the day before discharge from the hospital, and three weeks after discharge. A pain score was also compiled from the amount of pain medication taken by the patient during 750
OCTOBER 1987, VOL. 46, NO 4
the in-hospital recovery period. The Bi-polar Profile of Mood States was used as a general measure of both positive and negative mood states. Patients completed this on the day before discharge from the hospital and three weeks after discharge. Results showed there were no major differences between the self-administered and the nurseadministered groups on any of the dependent measures. Subjects in both groups used nearly equal amounts of pain medication. The authors offer several thought-provoking interpretations of the data. The data certainly offer a number of questions for future research into strategiesfor pain management in the acute-care setting. One of the measures that may have added to this study was patient satisfaction. Perioperative nursing implications. Although this study demonstrated no differences in the perception of pain between patients receiving selfmedication or nurse-administered medication, it did demonstrate that patients can safely administer their own pain medication after cardiac surgery. Perioperative nurses caring for cardiac surgery patients may wish to give this choice to their patients. RN, DNSc, CCRN SUSANB. CHRISTOPH, C~MMITTEE 1987-1988 NURSINGRESEARCH
L L LaMontagne, “Children’s preoperative coping: Replication and extension,” Nurszng Research 36 (May/June 1987) 163-167. The purpose of this study was to examine the relationship between children’s preoperative coping with surgery and their locus of control, age, and the amount of preoperative information given to them. It was designed to evaluate whether previous findings of significant correlations between these variables and coping would hold true in a broader age range of children. The sample included 42 children (19 female and 23 male) between the ages 8 and 18 years (13 years median age) who were scheduled to undergo minor elective surgery (eg, orthopedic procedures, tonsillectomy, and herniorrhaphy). The subjects were interviewed preoperatively and assessed as using one of the three coping modes: avoidance, active, or avoidance-active.
is being perceived by their patients as caring. Only when caring behaviors are mutually perceived can the goal of making patients feel cared for be achieved. CYNTHIA SPRY, RN, MSN, CNOR CHAIRMAN CIMM~EE 1987-1988 NURSINGRESEARCH
K B King et al, “Patient management of pain after cardiac surgery,”Nursing Research 36 (May/ June 1987) 145-150. Using patient-controlled analgesia for postoperative pain management is gaining popularity. This has been based, in part, on the notion that increasing personal control over a patient’s health care increases his or her perception of well-being. The purpose of this study was to compare the effect of self-administered versus nurseadministered pain medication in cardiac surgical patients. Factors investigated were the patients’ desire for control, their perception of pain intensity, how pain disrupted their daily activities, emotional responses to pain, and use of pain medication over time. A randomized experimental design was used. One hundred and four patients who were scheduled for cardiac surgery were available for the study. Of those, 17 patients refused to participate for the following reasons: 10 said they wanted the nurses to give them their medication; five were advised by family members to not participate; one wanted to participate but did not want to complete the questionnaire; and one refused to participate without giving a reason. Patients started the study after leaving the surgical intensive care unit (SICU). Desire for control was measured on the day of admission with the Krantz Health Opinion Survey. Researchers used a seven-point scale ranging from “not at all” to “the worst it could be” to measure pain intensity, interference with daily activities caused by pain, and emotional upset caused by pain. These measurements were taken the day after leaving the SICU, the day before discharge from the hospital, and three weeks after discharge. A pain score was also compiled from the amount of pain medication taken by the patient during 750
OCTOBER 1987, VOL. 46, NO 4
the in-hospital recovery period. The Bi-polar Profile of Mood States was used as a general measure of both positive and negative mood states. Patients completed this on the day before discharge from the hospital and three weeks after discharge. Results showed there were no major differences between the self-administered and the nurseadministered groups on any of the dependent measures. Subjects in both groups used nearly equal amounts of pain medication. The authors offer several thought-provoking interpretations of the data. The data certainly offer a number of questions for future research into strategiesfor pain management in the acute-care setting. One of the measures that may have added to this study was patient satisfaction. Perioperative nursing implications. Although this study demonstrated no differences in the perception of pain between patients receiving selfmedication or nurse-administered medication, it did demonstrate that patients can safely administer their own pain medication after cardiac surgery. Perioperative nurses caring for cardiac surgery patients may wish to give this choice to their patients. RN, DNSc, CCRN SUSANB. CHRISTOPH, C~MMITTEE 1987-1988 NURSINGRESEARCH
L L LaMontagne, “Children’s preoperative coping: Replication and extension,” Nurszng Research 36 (May/June 1987) 163-167. The purpose of this study was to examine the relationship between children’s preoperative coping with surgery and their locus of control, age, and the amount of preoperative information given to them. It was designed to evaluate whether previous findings of significant correlations between these variables and coping would hold true in a broader age range of children. The sample included 42 children (19 female and 23 male) between the ages 8 and 18 years (13 years median age) who were scheduled to undergo minor elective surgery (eg, orthopedic procedures, tonsillectomy, and herniorrhaphy). The subjects were interviewed preoperatively and assessed as using one of the three coping modes: avoidance, active, or avoidance-active.