Författare: Warrén Stomberg, Margareta
Titel: Postoperative pain management. Nurse perspectives on acute pain
services
Utgivningsår: 2004
ISBN: 91-628-6013-5
Ämnesord: Postoperative pain management, -assessment, -documentation;
VAS; nurse anaesthetist, acute pain services.
Institution: Department of Anaesthesiology and Intensive Care ;
Avdelningen för anestesiologi och intensivvård
Fakultet: MF
Disputationsdatum: 2004-05-11
Lokal: Aulan, Sahlgrenska Universitetssjukhuset/Sahlgrenska, Göteborg,
kl. 09.00
Abstract: Postoperative pain management (POPM) has remained an area of
concern despite major efforts to improve pain assessment and management by the
introduction of specified guidelines, advanced techniques for pain alleviation,
and education of staff members. Different nurse specialists are involved in the
perioperative care of surgical patients. It is still not known to what extent
the specific information noted by the nurses about the individual surgical
patient at the different steps of the perioperative management is taken into
consideration so that a potentially more optimal, individualised POPM as part of
acute pain services (APS) can be provided.
The aims of the present study were to assess if information of
potential value for the POPM is noted by nurse anaesthetists involved in the
perioperative management of surgical patients and to what extent such
information could be of value for an individualised POPM of surgical patients
and if nurse involvement is of importance for the adequacy and efficacy of POPM
routines in a nurse-based, anaesthesiologist-supervised acute pain service (APS)
model on surgical wards.
Semistructured interviews of nurse anaesthetists (n=40),
questionnaire responses of staff members (n=375)/surgical patients (n=110) and
assessment of medical records (n=135)/database data (n=222) were included for
evaluation of factors of importance in the perioperative care and POPM of
surgical patients. Descriptive statistics, non-parametric and parametric tests
were used for the analysis of the data.
It was found that nurse anaesthetists continuously monitor
different stress evoked physiological signs induced by surgical interventions
during general anaesthesia. Nurses considered the signs indicative of pain
evoked stimuli and/or insufficient depth of anaesthesia. The intraoperative
information of the response pattern and anaesthetic drug requirements of the
individual patient noted by the nurse anaesthetist was considered at present not
to be routinely taken into consideration but could be a successful strategy in
an optimal multi-professional approach to postoperative pain management. The
introduction of APS, using a nurse-based anaesthesiologist-supervised model,
resulted in more adequate pain management routines, better patient satisfaction
with information about POPM, and increased confidence in pain management among
nurses on the surgical wards than was noted for the outcome data for the
hospital not having introduced such an APS model. Database documentation of
outcome measures of POPM for patients receiving postoperative epidural analgesia
was found to provide valuable information about the adequacy of the POPM. The
feedback of information from the anaesthesia services to the surgical ward
nurses was found not to be efficient enough to make ward nurses properly aware
of the importance of their own direct involvement in the documentation process
of POPM and that such involvement could further optimise POPM outcome.
Conclusions: The present study stresses the importance of creating
proper, better functioning, feedback channels between all staff members involved
in the perioperative care of surgical patients. The specific information noted
by nurses about the individual surgical patient at the different steps of
perioperative management was not considered by the nurses to be optimally
utilised. The data indicates that POPM could benefit from increased involvement
of nurses having specific training in the APS model of POPM.