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Patient satisfaction with postoperative pain management despite experiencing high levels of pain
Literature
Patient Satisfaction with Postoperative Pain Management Despite Experiencing High Levels of Pain Sjiiling M, Nordahl G This research report commences with a review of the literature related to problems caused by inadequate pain control. The research purpose is related to the current literature and is explained as 'to investigate whether the patients had received pre-operative information about post-operative pain and pain control and whether this had influenced their experience of post-operative pain'. In addition it aimed to 'measure the patients' experienced level of pain after surgery' and 'to evaluate overall satisfaction with pain management and nursing care, and whether this had any effect on their experience of pain'. The samples were taken from three wards in a Swedish Clinic and used a survey of 59 patients undergoing hip and knee arthroplasty. Structured interviews were used to collect data relating to preoperative information, general satisfaction with care and the patients' assessment of their postoperative pain. A previously validated visual analogue scale (VAS) was used to assess the patients' worst experience of pain at rest and on movement. This was done retrospectively on the fourth postoperative day. Appropriate ethical and practical issues in the data collection process are explained clearly. Other influences on pain were found to have no effect on the experience of pain, for example analgesia prescription, age, gender and previous surgery. However, there was a significant difference between the patients' experiences of pain on the three wards, but there is no explanation of why this occurred or what other significant factors may have been involved. The results showed that 70% of the patients experienced under treated pain following knee arthroplasty compared to 48% of the hip surgery patients. While 49% of all the patients had received pre-admission information on pain and its treatment, this group had a slight tendency to experience more pain on movement. Despite these experiences of pain the patients were generally satisfied with the way their pain was managed. The reason given for this is that the patients' chronic pain was worse than the acute pain of surgery which they knew would be short lived and would diminish their long-term, chronic pain. This study raises several questions such as why the VAS was used only once, would repeated use have given more interesting results, could the patients accurately recall and differentiate their worst pain on movement and pain at rest? Despite these questions the authors raise several useful pointers for practice development and consideration. These are:
reviews
I I I
9 There remains a gap in nurse education on pain management 9 Nurses need to have increased confidence in administration of appropriate prescribed analgesia 9 There needs to be an organized pain management system to support nursing staff 9 Nurses need to give analgesia in advance of moving patients 9 It is easier to prevent pain than to treat it. In many respects these findings are not new, they have been seen in other patient groups but have been further confirmed with this study of hip and knee arthroplasty patients.
European Nurse 1998; 3(4): 264-273 Hypothermia Edwards S L This article focuses on the nursing role and treatment of accidental hypothermia, which for orthopaedic nurses includes hypothermia in the elderly, as a result of trauma or major surgery and therapeutically induced hypothermia for re-implantation of lost digits or limbs. There are slight variations in the definitions of hypothermia, but the author has clearly referenced and defined what they mean by mild (32.2-35~ moderate (28-32. I~ and severe (<28~ hypothermia. There is an explanation of the differences between the temperature sites used: oral, axillary, rectal, tympanic and oesophageal. The implication of gaining accurate readings at each site is discussed along with the different thermometers that can be used (glass, chemical, electronic and tympanic membrane). The physiological changes that occur with hypothermia are explained and the need for an accurate physical examination. The re-warming methods of passive external re-warming, active external re-warming and active internal re-warming, are each described. The need for controlled use of warmed intravenous fluids during re-warming is discussed along with the appropriate observations that are needed.
Professional Nurse 1999; 14(4): 253-258
The Controversy Over Traction for Neck and Lower-Back Pain Saunders HD This review of research articles raises many valid points about the use of randomized controlled trials (RCT) in researching the treatments for neck and low back pain. This evaluative review uses a questioning and critical approach to the reviewing of research reports. The author demonstrates the flaws
Patient Satisfaction with Postoperative Pain Management Despite Experiencing High Levels of Pain Sjiiling M, Nordahl G This research report commences with a review of the literature related to problems caused by inadequate pain control. The research purpose is related to the current literature and is explained as 'to investigate whether the patients had received pre-operative information about post-operative pain and pain control and whether this had influenced their experience of post-operative pain'. In addition it aimed to 'measure the patients' experienced level of pain after surgery' and 'to evaluate overall satisfaction with pain management and nursing care, and whether this had any effect on their experience of pain'. The samples were taken from three wards in a Swedish Clinic and used a survey of 59 patients undergoing hip and knee arthroplasty. Structured interviews were used to collect data relating to preoperative information, general satisfaction with care and the patients' assessment of their postoperative pain. A previously validated visual analogue scale (VAS) was used to assess the patients' worst experience of pain at rest and on movement. This was done retrospectively on the fourth postoperative day. Appropriate ethical and practical issues in the data collection process are explained clearly. Other influences on pain were found to have no effect on the experience of pain, for example analgesia prescription, age, gender and previous surgery. However, there was a significant difference between the patients' experiences of pain on the three wards, but there is no explanation of why this occurred or what other significant factors may have been involved. The results showed that 70% of the patients experienced under treated pain following knee arthroplasty compared to 48% of the hip surgery patients. While 49% of all the patients had received pre-admission information on pain and its treatment, this group had a slight tendency to experience more pain on movement. Despite these experiences of pain the patients were generally satisfied with the way their pain was managed. The reason given for this is that the patients' chronic pain was worse than the acute pain of surgery which they knew would be short lived and would diminish their long-term, chronic pain. This study raises several questions such as why the VAS was used only once, would repeated use have given more interesting results, could the patients accurately recall and differentiate their worst pain on movement and pain at rest? Despite these questions the authors raise several useful pointers for practice development and consideration. These are:
reviews
I I I
9 There remains a gap in nurse education on pain management 9 Nurses need to have increased confidence in administration of appropriate prescribed analgesia 9 There needs to be an organized pain management system to support nursing staff 9 Nurses need to give analgesia in advance of moving patients 9 It is easier to prevent pain than to treat it. In many respects these findings are not new, they have been seen in other patient groups but have been further confirmed with this study of hip and knee arthroplasty patients.
European Nurse 1998; 3(4): 264-273 Hypothermia Edwards S L This article focuses on the nursing role and treatment of accidental hypothermia, which for orthopaedic nurses includes hypothermia in the elderly, as a result of trauma or major surgery and therapeutically induced hypothermia for re-implantation of lost digits or limbs. There are slight variations in the definitions of hypothermia, but the author has clearly referenced and defined what they mean by mild (32.2-35~ moderate (28-32. I~ and severe (<28~ hypothermia. There is an explanation of the differences between the temperature sites used: oral, axillary, rectal, tympanic and oesophageal. The implication of gaining accurate readings at each site is discussed along with the different thermometers that can be used (glass, chemical, electronic and tympanic membrane). The physiological changes that occur with hypothermia are explained and the need for an accurate physical examination. The re-warming methods of passive external re-warming, active external re-warming and active internal re-warming, are each described. The need for controlled use of warmed intravenous fluids during re-warming is discussed along with the appropriate observations that are needed.
Professional Nurse 1999; 14(4): 253-258
The Controversy Over Traction for Neck and Lower-Back Pain Saunders HD This review of research articles raises many valid points about the use of randomized controlled trials (RCT) in researching the treatments for neck and low back pain. This evaluative review uses a questioning and critical approach to the reviewing of research reports. The author demonstrates the flaws