Pain and anxiety management in the postoperative gastro-surgical setting

BACKGROUND: Despite increasing knowledge and technological advances, patients continue to experience pain and anxiety in the postoperative setting. AIM OF THE STUDY: The aim of this study was to examine how nurses managed patients' pain and anxiety within the gastro-surgical hospital setting. METHODS: An observational design was selected to examine nurses' management of postoperative patients' pain and anxiety. Six nurses who were involved in direct patient care in one of two gastro-surgical wards in a public teaching hospital in Melbourne, Australia, were randomly selected to participate. The observation period comprised a fixed 2-hour segment, and each nurse was observed on three different occasions. FINDINGS: Patient assessment was a major concern for participants, which was influenced by the modes of assessment used, patients' medical condition and operation procedure, and their self-reports of pain or anxiety. Communication with health care professionals and policy and protocol concerns also affected nurses' pain and anxiety management decisions. Formal communication through the multidisciplinary ward round tended to be somewhat fragmented, as the medical consultant did not seek out the bedside nurse. Nurses had good knowledge of unit policies and protocols and, while attempting to enforce them, spent considerable time encouraging medical colleagues to abide by these guidelines. Finally, nurses made complex clinical judgements which extended beyond the administration of analgesics or antianxiety drugs. STUDY LIMITATIONS: It is possible that nurses demonstrated a raised awareness of how they managed patients' pain and anxiety during observation periods. CONCLUSIONS: The study confirmed the importance of examining the complexities of the clinical context in determining how nurses manage pain and anxiety in the postoperative setting.     

Postoperative pain management: study of patients' level of pain and satisfaction with health care providers' responsiveness to their reports of pain

The present prospective survey was conducted in a 1200-bed hospital to examine postoperative patients' current pain intensity, most intense pain experienced, satisfaction with postoperative pain management, and differences regarding pain and satisfaction levels. All adult patients admitted to a hospital in Hong Kong for surgery, except those receiving local anesthesia, were eligible to enter this study. The patient outcome questionnaire developed by the American Pain Society was used to solicit data about patients' pain and satisfaction with pain relief. The subjects were 294 postoperative patients. Approximately 85% complained about varying degrees of pain during the 24 h prior to the assessment of their pain. When interviewed, most patients complained of mild to moderate pain (median = 2 on a 10-point scale), while the median for 'worst pain intensity' was 5. Approximately 80% of the subjects indicated that both the nurses and physicians reminded them to report pain when it occurred. Only 143 (48.6%) agreed that the nurses and physicians sufficiently emphasized the importance of pain relief. Those who received acute pain services, provided by anesthetists, reported lower levels of current pain intensity. Over 65% of the subjects were satisfied with all levels of health care providers, regarding their postoperative pain management.     

Patients' evaluation of pain and nurses' management of analgesics after surgery. The effect of a study day on the subject of pain for nurses working at the thorax surgery department

The effect of a study day on the subject of pain for nurses working at the thorax surgery department The aims of this investigation were: to describe patients' evaluation of pain and the treatment of pain after thorax surgery via sternotomy; to repeat the evaluation with another group of patients following a study day for nurses, featuring pain and pain treatment; and to examine whether the study day influenced the nurses in their treatment of pain. The investigation included daily evaluation of pain using a visual analogue scale (VAS), and an interview with the patients before discharge, where they were asked to review their experience of pain and its treatment. The nurses on the thorax surgery ward and on the intensive care unit (ICU) completed a questionnaire before and after the study day. Finally, a retrospective study of the case notes of the patients taking part was carried out. The results of the investigation showed a low assessment of pain by most patients during the daily evaluation. Asked to recall their pain when interviewed, the rating was higher. A small group of patients had more evident pain than others. When administering opiates the ICU nurses often chose a lower dose than the standing order prescribed. After the study day the nurses gave larger doses of intravenous opioids and the patients experienced less pain.     

The ethics of postoperative pain management: Mapping nurses' views

Aim: We explored the positions of nurses working in hospitals regarding the acceptability of refusing to give a repeat dose of painkiller to a postoperative patient who requested it. These positions were compared with that of lay people, physicians, and other health professionals. Design and Methods: Factorial design was used to assess the impact of 6 situational factors: the patient's age, the current level of pain as assessed by the nurse, the number of requests, the level of risk associated with the administration of a repeat dose, the outcome of surgery, and the giving of alternative mild analgesics. We implemented a combination of scenario technique and of cluster analysis. Data were collected from April 2013 to December 2015. Participants: 138 registered nurses, 32 nurse's aides, 33 physicians, 23 psychologists, and 169 lay people participated in the study. Results: We found 4 qualitatively different meaningful positions. A plurality of participants (57% of nurses) considered that refusing was not acceptable, irrespective of circumstances. A substantial minority of participants (but 52% of physicians) considered that refusing was acceptable only if the level of pain was low and the risk was high. Other participants (mostly lay people) considered that refusing was always acceptable each time a risk of side effects, either serious or simply mild, was present.     

术后疼痛管理新进展

术后疼痛管理的新理念包括多模式镇痛、超前镇痛和个体化镇痛,目前国外的术后疼痛管理完成了从以麻醉医生为主体到以护士为主体的转变,术后疼痛评估常态化、常规化,同时将个人数字助理（PDA)用于术后镇痛随访,使用无线远程镇痛监控系统进行术后疼痛管理。这些措施有效地提高了术后镇痛的效果,并实现了个体化的术后疼痛管理,提高了患者对术后镇痛的满意度,减少了医护人员的工作量,提高了工作效率。     

Effects of patients’ anxiety,previous pain experience and non‐drug interventions on the pain experience during colonoscopy

Aims. This paper is a report of a study evaluating anxiety in patients prior to colonoscopy and identifying correlations between that anxiety, previous pain experience, non‐drug interventions and pain intensity during colonoscopy. Background. Waiting for forthcoming procedures, such as colonoscopy, is stressful. However, a few studies have evaluated the influence of patients’ anxiety, previous pain experience and non‐drug interventions during colonoscopy. Design. A quantitative cross‐sectional survey design was used. The data were collected from colonoscopy patients by using the Spielberger State Trait Anxiety Inventory and a questionnaire developed for the study. Methods. We assigned one hundred and thirty patients scheduled for diagnostic colonoscopy in a Finnish university hospital during 2006. Patients completed the State Trait Anxiety Inventory before and a questionnaire developed for the study after colonoscopy. Results. Most of the patients suffered from pain but they considered it to be tolerable. Women were more anxious before colonoscopy and experienced more pain and discomfort than men. Previous pain experiences and high state anxiety level decreased patients’ perceptions of colonoscopy. Non‐drug interventions, such as peaceful talk, explanation of the reason for pain and guidance helped both anxious and non‐anxious patients to ease the pain. Conclusion. Awareness and understanding of previous pain experiences and anxiety levels in patients are essential and must be taken into account. Relevance to clinical practice. Colonoscopy patients’ clinical education should be developed so as to be more individual. Furthermore, nurses should be better aware of the positive effects of non‐drug interventions and should use them as an element of pain management for colonoscopy patients.     

疼痛规范管理对开胸术患者术后早期疼痛控制的效果观察

目的探讨疼痛规范管理对开胸术患者术后早期疼痛的控制效果。方法将本院2011年1月—2012年8月收治的200例开胸患者随机分为对照组和观察组,每组100例。观察组予以疼痛规范管理,对照组给予传统的疼痛护理管理,对比2组的疼痛控制效果并总结分析。结果经过疼痛规范管理后,观察组将术后24 h伤口疼痛分数>3分患者的疼痛分值均小于对照组;观察组重度以上疼痛患者明显少于对照组。结论疼痛规范管理可以提高开胸患者术后的疼痛控制效果,有利于患者术后的早期康复。     

Educating nurses about pain management: the way forward

Nurse education does not appear to be preparing nurses to manage pain in the clinical area. A number of studies have demonstrated that nurses continue to have educational deficits in this context. Several studies have found no change in knowledge or behaviours following education about pain management. Others have found that changes in behaviour do occur. It is possible that innovative teaching strategies need to be used. The literature in this area is reviewed and recommendations made.     

Pathophysiology of acute pain: Implications for clinical management

To effectively treat acute pain, emergency medicine practitioners must have a thorough understanding of both the pathophysiology and terminology of the pain experience. The pathophysiology of pain is discussed with an emphasis on the mechanisms of acute, inflammatory pain. The various types of pain receptors, pathways and neurotransmitters are also discussed. See Commentary, page 271.     

规范化疼痛管理在肝胆外科术后患者疼痛控制中的应用

目的探讨规范化疼痛管理在肝胆外科术后患后疼痛控制中的应用效果。方法选取2017年11月—2018年4月住院行肝胆外科手术治疗的患者547例,分为对照组369例和观察组178例。对照组采用常规疼痛管理,观察组采取规范化疼痛管理。比较2组患者中重度静息疼痛的发生率、活动性疼痛评分等指标。结果观察组患者术后3天内中重度静息痛的发生率为20.22%,低于对照组的23.31%,差异有统计学意义(P<0.05)。术后6、12、24、48 h时观察组活动性疼痛评分低于对照组,差异有统计学意义(P<0.01)。结论规范化疼痛管理能有效控制肝胆外手术患者术后疼痛程度,有利于患者的快速康复。