Thesis (M.A.)--York University, 2004. Graduate Programme in Kinesiology and Health Science. / Typescript. Includes bibliographical references (leaves 85-101). Also available on the Internet. MODE OF ACCESS via web browser by entering the following URL: http://gateway.proquest.com/openurl?url%5Fver=Z39.88-2004&res%5Fdat=xri:pqdiss&rft%5Fval%5Ffmt=info:ofi/fmt:kev:mtx:dissertation&rft%5Fdat=xri:pqdiss:MQ99325

published_or_final_version / Nursing Studies / Master / Master of Nursing

Postoperative pain management is a major responsibility of nurses who provide care for patients recovering from surgery. In the postsurgical environment, the nurse has a pivotal role in assessing the patient with pain, implementing both doctor and nurseinitiated pain interventions and evaluating the patient's response to pain control treatments. Apart from its humanitarian utility, effective relief of postoperative pain is a critical element of a patient's postoperative recovery. Failure to manage pain effectively in the immediate postoperative period can produce undesirable immediate and longterm physical and psychological consequences that can severely disrupt an individual's quality of life. Despite the availability of multidimensional assessment measures, sophisticated pharmacological therapies and a greater range of complementary pain therapies, postoperative pain remains treated ineffectively by those professionally responsible for its management. In particular, evidence indicates that nurses are poor managers of their patients' postoperative pain. This thesis reports research that was conducted in two stages to explore, describe and analyse how nurses managed their patients' postoperative pain and their perceptions of factors that influenced this practice. A predominantly descriptive design was utilised in Stage 1 of the study to collect data from patients' hospital records and with a demographic questionnaire administered to nurses. This was complemented with interview data from nurses in Stage 2. / Previous studies offer limited views of the clinical realities of nursing practice in postoperative pain management. From this perspective, there is a need for research that incorporates these realities to permit analysis of clinical practice and greater understanding therefore of the problem of poor postoperative pain management. The purpose of this study was to provide an illuminative and authentic account of nursing practice in postoperative pain management. For the first part of Stage 1, data were collected retrospectively from nurses' documented accounts of pain assessment and intervention over the first three postoperative days for 100 patients in a major adult acute care teaching hospital. Analysis of nurses' documented responses to patients' reports of postoperative pain revealed that less than one-third of all responses could be considered appropriate for pain management. In particular, nurses failed to provide any pharmacological relief for 53% of patients' reports or severe and excruciating pain. Exploration of the influence of nurses' professional characteristics of education and experience on pain management practice was then undertaken in part 2 of Stage 1 with the use of a demographic questionnaire distributed to 106 nurses who were identified as signatories to the documented responses identified in part 1. Results indicated that length of professional experience accounted for most variations in practice, with older, more experienced nurses managing pain more appropriately than their younger and less experienced colleagues. Irrespective of education or experience, however, nurses failed to respond appropriately to patients reporting excruciating pain. / In Stage 2, in-depth interviews were conducted with 8 nurses caring for postoperative patients at the research site. Thematic content analysis revealed four major themes from nurses' perceptions of their practice of postoperative pain management that served to elucidate and enrich the findings of Stage 1 of the research. These were finding out about the patient's pain, making decisions about pain and pain management, individual factors affecting pain management, and interpersonal and organisational factors affecting pain management. This thesis provides an authentic account of nursing practice in postoperative pain management, and contributes understanding and insight into factors that provoke ineffective management of pain after surgery. It has implications for the development of intervention strategies aimed at improving nursing practice, at both individual and organisational levels, and suggests new directions for nursing education and research toward achieving optimum care and eliminating unnecessary pain for patients recovering from surgery.

Ph.D.

Thesis (M. Nurs.)--University of Hong Kong, 2009. / Includes bibliographical references (p. 151-162).

Thesis (M. Nurs.)--University of Hong Kong, 2009. / Includes bibliographical references (p. 73-78).

One of the most exciting developments within postoperative pain research in recent years has been the introduction of Patient Controlled Analgesia (PCA). PCA is a technique in which patients self-administer small doses of opioids intravenously and it has been shown to be more effective than the conventional intramuscular injection method (IMI). However, PCA requires costly equipment and this necessarily places constraints on its availability. Therefore it is vital to ensure that the PCA facilities which are available are used as efficiently as possible. Essential to this is an understanding of the categories of patients for whom it will be most effective. At present the basis of selection of patients for PCA is often unclear. Frequently anaesthetists use the extent of trauma as a guide, although there is no evidence that this is the most effective strategy. Moreover, it ignores numerous factors which empirical research has shown to influence the experience of postoperative pain. These include state and trait anxiety, neuroticism and coping style. Until now their importance has only been investigated within the IMI analgesic regime. The present thesis remedies this omission by investigating pain/personality relationships under both PCA and IMI regimes. A particular interest was the identification of ways of detecting the patients who would benefit most from the use of PCA in terms of personality profiles. This study investigated whether knowledge of the patient characteristics of state anxiety and trait anxiety, neuroticism and coping style can be used to predict which patients will benefit the most from PCA. This research involved two main studies, in which a sample of 164 adult female and male patients undergoing major elective surgery were preoperatively assessed in terms of anxiety, neuroticism and coping style. Postoperatively they were allocated to either PCA or IMI analgesic regimes and their pain experience was assessed at 6,18 and 24 hours after surgery. The data were analyzed using Pearson's Correlations, T tests, Analysis of Variance and Multiple Regression. The findings revealed that state anxiety and coping style were significant predictors of postoperative pain for PCA as well as IMI regimes. Patients using PCA experienced significantly better pain relief than did their IMI counterparts. However, it was the patients with high levels of state anxiety using PCA who benefited the most. The superior pain control of PCA was not found to be related to the presence of the technically sophisticated PCA machine. PCA was also associated with a reduction in the length of hospital stay and a saving of nursing time on the ward. Patients had positive reactions about being in control of their pain relief, whilst staff felt that patient control was beneficial. They were also impressed by the time saving element of PCA. The implications for the management of post operative pain and the financial saving are considered.

published_or_final_version / Public Health / Master / Master of Public Health

The purpose of this study was to elucidate relationships among habitual physical activity level, endogenous opioid level, postoperative opioid analgesic, and experiences of acute pain in response to the noxious stimulation of a subsequent orthopedic surgical procedure. Specifically, the study examined (1) the relationship between habitual activity and preoperative level of endogenous opioids in peripheral blood, and (2) whether habitual activity predicts perception of pain intensity or distress in response to a subsequent noxious stimulus. The study utilized a descriptive correlational design with causal modeling methodology to assess a five-stage theory. The convenience sample was comprised of 36 English-speaking adult subjects hospitalized for orthopedic surgeries. The theoretical concepts, acute pain intensity and distress, were indexed three times for each subject by visual analogue scales. Reliability and validity of the scales were assessed by correlation with concurrent pain measurements using randomized verbal descriptor lists. Multiple regression statistical techniques were used to estimate the theory; violations of causal modeling and statistical assumptions were assessed by residual analysis. For this sample, the strongest predictors of postoperative pain were the immediately preceding comparable indices of pain intensity or pain distress. Approximately 31% of the variance on postoperative analgesic was predicted by the combined effects of immediate postoperative pain and habitual activity. Although activity was not significantly related to endogenous opioid level in peripheral plasma, activity directly and positively influenced immediate postoperative pain intensity (Beta = .37), 24-hour pain distress (B = .27), and total opioid analgesic received in the initial 24 postoperative hours (Intensity B = .40; Distress B = .50). Endogenous opioid was significantly related only to immediate postoperative pain distress (B = -.26). More physically active patients reported greater immediate postoperative pain intensity and greater 24-hour pain distress; they received more postoperative exogenous analgesic. Incorporation of information about activity as a potential determinant of operative pain experiences would increase validity of nursing assessments on which pain interventions are based. Patients in acute pain would benefit from this improved scientific basis for pain assessment.

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