Journal of nursing management
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Randomized Controlled Trial Clinical Trial
Evidence-based postoperative pain management in nursing: is a randomized-controlled trial the most appropriate design?
There is an increasing drive to make nursing care evidence-based. High quality evidence from systematic reviews relevant to postoperative pain relief exists, yet pain after surgery remains poorly controlled for many patients. This study aimed to assess whether implementing evidence-based pain management improved postoperative pain outcomes. ⋯ No effects were found on pain in the intervention wards. Pain ratings at rest since surgery, on movement since surgery and worst pain on movement were significantly reduced compared with baseline in the control wards. Although there are many pressures to utilize a randomized-controlled trial study design in the culture of evidence-based health care, there will be times, especially when implementing complex changes in practice that other types of design should be considered.
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It has long been acknowledged that pain is a subjective, multifaceted phenomenon which is influenced by many factors such as past experience and culture. However there are other symptoms that can be distressing such as dyspnea and nausea. In Ottawa, Canada there was recognition that inconsistencies existed in pain and symptom assessment methods and documentation in the different institutions and agencies when patients with cancer moved from one setting to another as their illness progressed. ⋯ Although various tools have been developed for pain assessment such as visual analogue or numeric rating scales, there has been limited attention focused on the sustainability of these tools in the practice setting. This paper will focus on the importance of the use of tools for pain and symptom management, issues around implementing them, and sustaining their use in the clinical setting. The Ottawa Pain and Symptom Assessment Record will be used as an exemplar.
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(1) To determine the acceptability of the Royal College of General Practitioner Guidelines to small samples of nurses, General Practitioners and acute back pain patients, (2) to determine what additional roles for nurses in the management of acute back pain in primary care might be acceptable to these samples, (3) to evaluate the responses of General Practitioners, nurses and patients to a suggested service model based on the RCGP Guidelines, (4) to identify opportunities for and barriers to the further development of such models and to obtain the appraisal of the above by an external group of assessors. ⋯ Barriers to implementation of the RCGP Guideline and to a nurse-led acute back pain service in general practice, were illustrated. These mainly relate to grossly inadequate capacity to deal with multidimensional patient needs, allowing progression to chronic pain states and much higher health care costs. There was a strong desire to include a different group of professionals in primary care. We recommend a local needs assessment and consideration of a national strategy for the implementation of the RCGP Guideline in primary care.
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The incidence of chronic pain amongst elderly people in nursing homes is very high, making pain in this population a serious problem for aged care facilities. Research studies reveal a pattern of poor pain management in this setting despite the high incidence of pain suggesting that the management of pain in nursing homes is limited in scope and only partially effective. What is not fully appreciated by health professionals is the impact pain has on the lives of elderly people who live in nursing homes. ⋯ The discussion focuses on some of the themes drawn from the study with an emphasis on a key theme 'being constantly pained'. The findings of the study highlight what it is like to experience pain and how this impacts on everyday lives of elderly people. The paper concludes with some suggestions for health professional for improving care in this area.
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Comparative Study
Quality of care in postoperative pain management: what is realistic in clinical practice?
This paper presents a study describing nurses' assessment of whether it was realistic to carry out good quality of care in postoperative pain management. Further, the study compared their assessment with the quality of care actually performed in clinical practice as assessed by both patients and nurses. Three questionnaires were used; one for patients (n = 198) and two for nurses (n = 63). ⋯ The nurses also responded to questions concerning whether the different aspects of good quality of care were realistic to carry out in practice. The results show that in several important aspects of postoperative pain management, both patients and nurses assessed the quality of care to be lower than the nurses' assessment of what was actually possible to effectuate in clinical practice, e.g. pain assessment and information. This finding highlights the problem of applying evidence-based care in actual clinical practice.