This study examines the influence of an educational program on the nursing assessment and management of post-operative pain. A problem-based retrospective audit was implemented to initially determine the nursing assessment and management of post-operative pain. Based on the results of the audit, educational strategies were implemented and a re-audit was carried out to evaluate the changes in nursing practice. There was evidence in the study to support the notion that nurses do not assess or manage post-operative pain effectively. The study suggested that an educational program based on the results of the problem-based audit may improve the frequency and accuracy of documentation of the assessment of pain and the documentation of the utilization of a variety of alternate approaches to relieve post-operative pain. However, the results also indicated that an educational program may not increase the frequency and dosage of analgesic administration and that nurses' perception of their nursing practice may be inconsistent with their actual practice. The study also indicated that nurses will attend educational programs if given the opportunity to participate in the development of these programs. Further studies should be carried out to examine the relationship between written documentation of assessment and management of pain and the actual assessment and management of pain by nurses, between nurses' perceptions of their clinical practice and their actual practice, and among variables environment which may affect nurses' clinical performance. Further studies should also be undertaken to determine if practice-based education programs can influence nurses' clinical practice. / Thesis / Master of Science (Teaching)

Purpose: The purpose of this pilot study was to determine if there is a difference in post-operative pain experience for children following dental restorations and/or extractions under general anesthesia (GA), with and without local anesthetic (LA). The alternative hypothesis is that children will experience less post-operative discomfort and soft tissue trauma when using intra-ligamental local anesthetic during the intra-operative time period. Methods: Patients were recruited for this single blind, randomized, prospective cohort study with the following inclusion criteria, children age 2-6 years requiring general anesthesia for dental treatment. Patients were randomized into categories of either receiving a standardized local anesthetic or no local anesthetic for the dental procedure. A Wong-Baker Faces Pain Scale (Figure 1) was utilized to evaluate pre-operative and post-operative pain. Data were compared using a pooled t-test and two way mixed model ANOVA controlling for sex, ethnicity, and intra-op meds given. Results: Currently, 33 patients have been enrolled in the study. No difference was found in the LA versus the no LA groups, and significantly more pain was reported in the extraction versus non-extraction groups. With the limited sample size, current trends indicate that pain scores do depend on whether or not treatment included the extraction of a tooth. Conclusion: When adequately powered (n=100), this study could assist clinicians providing dental surgeries under general anesthesia care by providing evidence based criteria for the provision of local anesthetic during general anesthesia to reduce need for intra-operative pain medication to relieve post-operative pain.

Background: Pain management is a major issue in post-operative care. Little is known about the pain management experiences of parents and adolescents following discharge from inpatient surgery. Studies examining pain outcomes following day surgery suggest that children often experience severe pain and parents are challenged in providing pain care. Objective: To explore the pain management experiences of parents and adolescents following discharge from hospital after inpatient surgery. Results: Thematic analysis found that parents and adolescents were challenged in providing pain care. School return was more difficult than anticipated yet parents and adolescents were unsure how to navigate pain at school. Discharge education focused on analgesic management, leaving participants to discover non-pharmacological strategies on their own. Conclusions: Recovery from post-operative pain following inpatient surgery is challenging; nurses and healthcare professionals need to better prepare parents and adolescents to meet pain care needs following discharge.

Objectives: The objectives of study were to (i) examine the regional differences in methods of performing cataract surgery across different jurisdictions in Australia and New Zealand (ii) identify risk factors for post-operative endophthalmitis and (iii) explore the implication of changes in surgical practice on the number of cases of post-operative endophthalmitis and resultant net cost to health system. Methods: Cataract surgeons across Australia and New Zealand were surveyed about their demographics, surgical techniques, use of pre- and post-operative antibiotics and antiseptics and cases of post-operative endophthalmitis. Statistical analysis was conducted to determine the regional variations in the use of methods of chemoprophylaxis and surgical practices. Multivariate Poisson regression was performed to identify factors associated with the incidence of post-operative endophthalmitis. A cost analysis was conducted to determine the impact of an increased use of chemoprophylatic treatment on the number of cases of post-operative endophthalmitis and net cost savings to the health system from its use. In addition, the results of the current survey of surgical practices of cataract surgeons was compared with those from an earlier survey conducted approximately 10 years ago. Result: The response to the survey of ophthalmologists was 82%, but after excluding ophthalmologists who did little or no cataract surgery, the study sample comprised 540 participants of the 896 who were initially sent the survey. Participating cataract surgeons reported 162,120 cataract surgeries and 92 cases of post-operative endophthalmitis, an incidence rate of 0.056%. Regional variations were found in the methods of chemoprophylaxis and surgical techniques. / Chloramphenicol was the most frequently used topical antibiotic in Australia, while neomycin was used by majority of cataract surgeons in New Zealand. The only notable change found over the past decade was a sharp fall in use of subconjunctival antibiotics from 75% to 45% in the current survey. A slight increase in use of post-operative topical antibiotics was noticed. Subconjunctival injection of antibiotics was the only form of chemoprophylaxis associated with a reduction in incidence of endophthalmitis. Results from this survey indicated that cataract surgeons routinely using corneal or limbal incisions had an incidence of endophthalmitis considerably higher than those surgeons routinely using scleral wounds, whilst surgeons routinely using temporally sited wounds had almost half the incidence of endophthalmitis compared to surgeons using superior wounds. The cost implications of subconjunctival gentamycin injection for chemoprophylaxis were examined. Additional costs of subconjunctival antibiotics were subtracted from the reduced cost of treating fewer cases endophthalmitis. There would potentially be a net saving to the Australian health system of $ 110,354 if all cataract surgeons used subconjunctival chemoprophylaxis. Conclusion: Regional variation in chemoprophylaxis and surgical techniques did not entirely explain differences in post-operative endophthalmitis incidence. Subconjunctival antibiotics would only need to reduce the incidence of endophthalmitis by 15% for it to be cost-effective.

<p>Patients that have been undergoing surgery often experience pain and anxiety. Pain relief can be problematic because of the side effects and complications that may occur. This leads to a prolonged recovery phase. Music therapy has long been used as an alternative treatment, it is useful from an economic point of view and no side effects have emerged. However, few studies conducted to evaluate its clinical efficacy. The purpose of this literature study was to describe if music as a complementary treatment method can alleviate post-operative pain, anxiety and if any physiological effects occur in the patient. Literature search was performed in the databases Cinahl, Pubmed, Psychinfo and the search base Elin@Kalmar. The main result showed that the postoperative pain decreased in eight scientific articles and anxiety in four of the scientific articles. In two articles, results showed that there were no improvement in pain and cause for anxiety on the scale of patients. Some of the articles also examined whether the alternative treatment had any effect on the patient's vital signs such as heart rate and respiratory values. The results were varied, indicating that further research is needed for an efficient evaluation. The authors believe that music therapy is an appropriate alternative treatment which can relieve post-operative pain and anxiety. Music therapy is also seen as a simple, contact-building and cost-effective method in daily nursing work.</p>

Patients that have been undergoing surgery often experience pain and anxiety. Pain relief can be problematic because of the side effects and complications that may occur. This leads to a prolonged recovery phase. Music therapy has long been used as an alternative treatment, it is useful from an economic point of view and no side effects have emerged. However, few studies conducted to evaluate its clinical efficacy. The purpose of this literature study was to describe if music as a complementary treatment method can alleviate post-operative pain, anxiety and if any physiological effects occur in the patient. Literature search was performed in the databases Cinahl, Pubmed, Psychinfo and the search base Elin@Kalmar. The main result showed that the postoperative pain decreased in eight scientific articles and anxiety in four of the scientific articles. In two articles, results showed that there were no improvement in pain and cause for anxiety on the scale of patients. Some of the articles also examined whether the alternative treatment had any effect on the patient's vital signs such as heart rate and respiratory values. The results were varied, indicating that further research is needed for an efficient evaluation. The authors believe that music therapy is an appropriate alternative treatment which can relieve post-operative pain and anxiety. Music therapy is also seen as a simple, contact-building and cost-effective method in daily nursing work.

SAMMANFATTNING Bakgrund Postoperativt illamående och kräkningar (PONV) är de vanligaste komplikationerna efter kirurgi och anestesi. Många patienter kan uppleva illamående och kräkningar som ett större problem än postoperativ smärta i samband med kirurgiska ingrepp. Faktorer som kön, ålder och åksjuka kan öka risken att drabbas av PONV. Syfte Studiens syfte var att undersöka förekomsten av illamående efter hjärtkirurgi. Vi ville även kartlägga om det fanns skillnad mellan kvinnor och män, i ålder samt samband mellan åksjuka och tid med respiratorbehandling och illamående.    Metod Studiens design var kvantitativ. Data samlades in med hjälp av ett frågeformulär bland patienter som genomgått hjärtkirurgi. Resultatet bearbetades och analyserades i Excel och statistikprogrammet SPSS. Resultat Tjugoåtta patienter av totalt 36 tillfrågade tackade ja att medverka i studien. Resultatet visar att 75 % (21) av deltagande patienter upplevde illamående postoperativt. Merparten av patienterna drabbades av illamående under operationsdagen eller dagen efter. Inget samband mellan illamående och kön, ålder och åksjuka kunde ses. Slutsats Denna studie visar att många patienter drabbades av illamående och att illamåendet debuterade tidigt i det postoperativa förloppet, medan litteraturen visar att tre av tio patienter drabbas av illamående och att illamåendet kan ha sin kulmen upp till 2-3 dygn efter operationen. Undersökningsgruppen var för liten för att några säkra slutsatser kunde dras. / ABSTRACT Background Post-operative nausea and vomiting (PONV) are the most common complications after surgery and anaesthesia. Many patients experience nausea and vomiting as a bigger problem than post-operative pain following a surgical procedure. Factors such as gender, age and motion sickness could increase the risk of suffering from PONV. Purpose The aim of this study was to examine the presence of nausea after cardiac surgery. Another aim was to map out variation in experiences between male and female patients, age related susceptibility, connection to motion sickness and if respiratory treatment could increase the likelihood of nauseousness. Method This study was designed to be quantitative. Data was collected by using a questionnaire that was filled out by patients who had experienced cardiac surgery. All data were processed and analysed in Excel and with the statistical program SPSS. Result 28 patients out of 36 patients, gave their consent to taking part in this study. Seventifive procent (21) of the participated patients experienced post-operative nausea. The majority of patients experienced nausea during the day of operation or the following 24 hours. There was no difference between genders and nausea neither ageor, motion sickness seemed to have any direct influence in cases where nausea was experienced. Conclusion This study shows that many patients are affected by nausea and that nauseousness appears during the early stages of the procedure. Literature demonstrates that 30% patients are affected by nausea, and that it will peak 2 to 3 days post-operatively. The study group was too small to draw significant conclusions.

Even today, with modern medicine and technology, post-operative pain still exists as anmajor issue in modern treatment. A lot of research efforts have been made, in order toimprove pain outcome for patients that has undergone surgery[18][15].Even though physician's and doctors are well educated, the success rate is aboutapproximately 70 %, still there are patients that experience severe pain, after they haveundergone surgery. There could be several reasons to this, for example, lack of methods orsupport should be amongst other things, factors to consider[18].The problem has been to initiate a case-library and eventually create a tool, that could aidphycisians or doctors in their decision making, which hopefully would help in improvingpain outcome. The chosen method to do this, is a modified version of the CBR-algorithm,which is an artificial intelligence algorithm. The CBR-algorithm makes use of features,solution and outcome, and is implemented with a simple prototype, as a similarity function.The are several reasons for why this method was chosen, but using this method makes itpossible to easily create a web-based tool, so it can easily be accessed from anywhere, butstill be effective and work as a support tool.The algorithm works as a self learning mechanism, and is easy to implement, and theinterface has been constructed, allowing the phycisian or doctor to retrieve informationabout patients and run CBR. The desired results are as expected, it's possible to run theCBR, retrieve and compare cases, and get suggestion of solution or action that should beperformed.The conclusion that can be made, is that, although this is a very basic working medicalapplication, still an overall improvement is needed in order to be used as a medicalapplication. It's anyhow a start. For more details and information, check the appendicesplease. / The PainOut Project

Det finns idag ingen konsensus om den optimala rehabiliteringen efter en främre korsbandsrekonstruktion, vi vet heller inte idag huruvida rehabiliteringen ska specificeras efter parametrar som kön och ålder. Studien var en korrelerande tvärsnittsstudie med syfte att ta reda på om det förelåg någon skillnad i postoperativ lårmuskelstyrka 4-7 månader efter en korsbandsrekonstruktion med avseende på kön, ålder, skada och typ av operativt ingrepp. Av de 330 aktuella försökspersonerna var det endast 74 personer som godkänt deltagande och uppfyllde kraven för inklusionskriterierna. Försökspersonerna testades i en isokinetisk dynamometer(Biodex) för maximal styrka(60gr/s) och uthållig styrka(180gr/s). Resultaten presenterades genom ett Limb Symmetry Index. Studien fann inga signifikanta skillnader i de undersökta parametrarna mellan försökspersonerna i uppmätt lårmuskelstyrka mellan opererade och icke opererade benet. Detta tyder på att ålder och kön inte är avgörande vid initial rehabilitering avseende post operativ lårmuskelstyrka.

Social support and resilience have been shown to reduce recovery times after major operations, as well as predict levels of post-operative pain. This study aims to determine whether social support and resilience modulate medical outcomes parameters and perceptions of recovery after a surgical intervention. Post-operative patients were recruited from an inner-city, safety net, level 1 trauma center prior to discharge. They completed questionnaires on social support (Medical Outcomes Study - Social Support Survey MOS-SSS), resilience (Brief Resilience Scale BRS), and overall health (Medical Outcomes Study – Short Form 36 MOS-SF36). Patients then completed the MOS-SF36 questionnaire approximately six and twelve weeks after surgical treatment. Preliminary results from recruited patients offer no conclusion regarding social support and outcome measures, but a significant positive relationship between resilience and patient-reported quality of life was seen (Spearman's Rho = 0.606). Resilience was also highest among patients in the surgical oncology service, relative to the other two surgical cohorts.