Effective Management Of Post-Operative Pain - Literature review Example

?Introduction Patients often have poor understanding of pain and as a result, often develop low expectations for pain relief and their level of satisfaction with the pain management efforts by the healthcare professionals. An effective management of pain can help patients to relieve their pain and achieve early mobilization thus helping patients to recover and return to normality as soon as possible. Effective pain management not only reduces the stay of patients at the hospital but also reduces the cost involved. Pain management is considered as the second most common nursing intervention. It is however still a consistent problem faced and has not been adequately addressed yet. The recurrence and higher probability of pain after surgery indicates the overall significance of the problem faced by the medical professionals. Since last many decades, various studies have critically highlighted the inadequate nature of the post-operative pain management by the physicians as well as by the nurses. These studies not only highlight the inadequate knowledge of the medical professionals but also provide a critical insight into the attitude of nurses and medical professionals towards post-operative pain management. Since it is also the second most common cause of nursing intervention therefore it directly affects the way nurses perform their job. What is critical to note however is the fact that medical professionals including nurses lack the knowledge, education and face other barriers to manage the post-operative pain. This literature review will present a critical review of 10 articles on this topic using Critical Appraisal Skill Programme tool to critically evaluate the articles under study. Methodological Overview of Articles Rajeh et.al (2008) used a qualitative approach to understand and explore the perceptions and experience of nurses regarding post-operative pain management. By using semi-structured interviews from 26 nurses in Iranian educational hospitals, this study utilized constant comparative method to analyze the data. It has been suggested that there are widespread knowledge gaps which need to be addressed in order to effectively tackle post-operative pain management issues. Same approach has been undertaken by Blondal & Halldorsdottir (2009) also where through 20 dialogues with 10 experienced nurses were conducted to understand as to how nurses care patients suffering post-operative pain. This was a phenomenological study with focus on understanding the motivations of nurses in pain management and what actually restricts them to achieve the objective of relieving patient sufferings. A similar type of study was carried out by Subramian et. al (2011) by using semi-structured interviews of 21 nurses working in the critical care of the acute teaching healthcare trusts in UK. This study was qualitative and exploratory in nature and a framework analysis was performed. This study however, highlighted various challenges faced by the nurses in terms of their ability to provide pain management support to patients under critical care. Wilson (2007) aimed at understanding as to whether education actually results into better pain management capabilities of nurses or not. Wilson (2007) focused on understanding the influence of post-registration education and clinical experience could actually result into better management of pain. 100 questionnaires were circulated by the researcher out of which 86 were returned. However, a sample of 72 was taken out of which 35 nurses were from hospice/oncology and 37 were from district hospitals (general). It has been argued that working environment tend to have relative greater influence on the ability of nurse to administer pain as compared to their knowledge and education suggesting that overall influences on nurses in terms of their ability to manage pain are complex in nature. Richards (2007) conducted a qualitative study to understand the influence of experience on the nurses’ ability to actually manage post-operative pain. With a phenomenological study, three expert nurses were interviewed and author has outlined 4 important themes which expert and experienced nurses consider in terms of managing the overall post-operative pain. Al-Shaer, Hill & Anderson (2011) developed a non-experimental descriptive design study with a convenience sample of 129 nurses was taken. This study also focused on exploring the knowledge and other related factors in terms of managing post-operative pain of the patients. This study is significant in the sense that it provides a further explanation of other related factors with knowledge to evaluate the preparedness of nurses in managing post-operative pain. Mathews & Malcolm (2007) used a prospective comparative study and use convenience sampling of two groups of nurses to understand pain management knowledge and attitude of both the groups of nurses. The two groups were divided as such one group was comprised of the nurses who completed the training and competency programme on pain management whereas the other group just attended the workshop on the pain management. Leegaard .et.al (2011) conducted a focus group study with total participants of 22 who were asked regarding the overall perception of the nurses regarding education needs of the patients after cardiac surgery. A pain belief scale was used to actually measure the disbeliefs of the nurses about pain. This study outlined as to what nurses considered as the important education needs of the patients. Common Themes 1. Knowledge of Nurses 2. Organizational Environment 3. Personal Experience and Attitudes Theme 1- Knowledge and Education of Nurses Rajeh et.al (2009) in their study outlined that despite decades of research on the topic of pain management there is still greater prevalence of patients suffering the pain. 26 Iranian Nurses from large educational hospitals were interviewed in this study based upon content analysis. It has been argued that there is a greater need to put more focus and emphasis on understanding the role of nurses and their knowledge and education in helping patients to successfully deal with the pain. This study was exploratory in nature therefore qualitative design was developed to complete this study. This study was important to understand the perceptions and knowledge of nurses to understand their overall motivations. This study outlined that the nurses strongly feel that the inability to cope and manage the post-operative pain is often restricted due to the lack of knowledge and education of the nurses. The lack of preparedness of nurses in terms of their education, places a highest bar on the effective pain management. Wilson (2007) however argued that specialist nurses have better knowledge of managing pain as compared to the general nurses. The author has actually took the research one step ahead to analyze as to whether the knowledge prevalence in nurses is equal or whether the specialty of nurses can actually reduce the knowledge deficit to manage post-operative pain. Wilson (2007) however also argued that the knowledge of the special nurses does not correspond with their experience and there may exist a gap between translating knowledge effectively in terms of better manage the pain in real life situation. Richard and Hubbert (2007) while exploring the theme of knowledge and experience attempted to segregate what distinguishes nurses who are successful in managing pain as compared to the nurses who are unable to do so. It has been suggested that the expert nurses actually rely on their ability to assess their patients as the whole persons. While treating and managing post-operative pain, it is critical to use a holistic approach for pain assessment. Another important theme which has emerged during this research was the ability of nurses to actually apply their own independent judgment. Knowledge and experience tend to provide nurses sufficient tools to actually formulate their own responses when they know that their patient is in pain. Nurses with adequate knowledge and experience also tend to understand and act on what patient says. This study therefore suggested that if applied correctly, knowledge and experience can provide certain advantages to nurses to better manager post-operative pain. Subramanian et.al (2011) however further suggested that the lack of nursing guidelines as well as proper structured pain assessment tools may be some of the reasons nurses actually fail to apply their knowledge in managing pain. Similar conclusion was also made by Al-Shaer, Hill & Anderson (2011) suggesting that the inadequate knowledge of nurses is one of the leading causes of nurses not being able to actually manage post-operative pain. Matthews & Malcolm (2007) highlighted the knowledge and perceptions of two groups of nurse i.e. one which was trained and other just attended a pain management conferences. This study comprised of 113 nurses and used The Nurses Knowledge and Attitude Survey regarding Pain to explore the attitudes of nurses towards the pain management. It highlighted that the overall knowledge of the pain management does not reflect into the attitudes of the nurses. Theme 2: Organizational Environment Another barrier in overcoming the inability of nurses to deal with the post-operative pain is the lack of organizational support and organizational structures. Rajeh et.al. (2009) outlined the limited authority given to nurses is one of the common organizational barrier resulting into alleviation of pain rather than its management. Secondly, disturbances in pain management intervention have also been recognized as one of the key organizational barriers for nurses to manage post-operative pain. Leegard et.al (2011) through a focus group study of 22 participants also suggested the lack of organizational interest in improving the knowledge and education of the nurses is one of the causes. Participants critically highlighted the lack of opportunity for having hands-on experience as well as no dedicated educational days as some of the organizational barriers which, if removed, can improve the response of nurses to deal with the post-operative pain easily. Al-Shaer, Hill & Anderson (2011) using a non-experimental descriptive design with a convenience sample of 129 nurses from 10 separate nursing units. It outlined that experience of nurses in particular nursing units plays an important role in improving the skills and capabilities of the nurses to manage the pain. Hospitals therefore need to provide a team based environment to nurses in order to strengthen their ability to better under pain and develop their individual responses to deal with it. Subramanian et.al (2011), in a study performed by conducting semi-structured interviews with 21 nurses, also highlighted the limited authority given to nurses by the healthcare centers in managing pain. The reliance of nurses on other healthcare professionals therefore restricts the ability of nurses to exercise their own independent judgment. These findings are specially correlated with the work of Richard and Hubbert (2007) highlighting that the successful nurses in managing pain are those who, to some degree, are able to apply their own personal judgment which is different from the overall professional judgment of the physicians. Independence of nurses in exercising their professional judgment therefore is dependent upon the degree of organizational autonomy to the nurses. Theme-3 Personal Attitude and Experiences Another important theme underlying the barriers to successfully manage post-operative pain is the attitude and experience of the nurses. Matthews and Malcolm (2007) outlined that despite imparting training to improve the competency of the nurses to better manage the pain, there was little difference in the attitude of two groups involved in the study. The group without training also showed same level of competency and attitudes as compared to the group which was trained to improve its level of competency. Al-Shaer, Hill & Anderson (2011) suggested the individual nursing experience is also an important barrier. Nurses with more experience tend to better knowledge of managing pain as compared to the nurses with relatively low level of experience. Especially nurses having more than 16 years of experience tend to show higher degree of knowledge. Richard and Hubbert (2007) also highlighted the same issue and outlined that nurses with better attitude towards patients tend to face low barriers as compared to the nurses who are relatively less motivated. The experienced nurses with the experience and attitude to assume a holistic approach to manage pain tend to have better chances to manage pain. Wilson (2007) however came up with a relatively different explanation suggesting that the nurses with the better knowledge are unable to translate the same into their experience. This is therefore related with the overall attitude of the nurses in deciding how to actually use their knowledge to relieve patients of pain. Blondal & Halldorsdottir (2009) however do suggest that the nurses have strong conviction and moral obligation to ease the pain. This attitude often translates into higher level of motivation, sense of greater moral obligation as well as conviction and personal experience to better manage the pain. This study indicates that with right attitude, nurses can play an effective role in easing pain and contribute towards overall well-being of the patients. Summary & Conclusion The above literature review highlighted three important common themes which restricts the nurses from effective management of post-operative pain. The level of knowledge of nurses is number one barrier with nurses lack the required knowledge to effectively manage pain. This is also critical in terms of inability of nurses to develop holistic approach for pain management. Nurses are also not given the authority to formulate their own judgment to understand and manage pain. Reliance on physicians as well as the organizational restrictions often compels nurses not to develop the independent art of nursing. Experienced nurses develop their own ability to exercise their own judgment in administrating pain. The overall attitude and experience of nurse is also another common barrier because despite having the knowledge and experience, nurses fail to develop required attitude which can translate into better practice. Attitude of the nurses can effectively translated into better pain management if nurses find right level of motivation as well as moral obligations to relieve the pain experienced by patients as a result of surgery. References Blondal, K. and Halldorsdottir, S. (2009) The challenge of caring for patients in pain: from the nurse’s perspective. Journal of Clinical Nursing, 18 p.2897–2906. Deborah , A. et al. (2011) Nurses’ Knowledge and Attitudes Regarding Pain Assessment and Intervention. MED Nursing, 20 (1), p.8-11. Leegaard, M. et al. (2011) Nurses’ Educational Needs for Pain Management of Post–Cardiac Surgery Patients A Qualitative Study. Journal of Cardiovascular Nursing, 26 (4), p.312-320. Matthews, E. and Malcolm, C. (2007) Nurses' knowledge and attitudes in pain management practice. British Journal of Nursing,, 16 (3), p.174-179. Rejeh, N. et.al (2009) Nurses’ experiences and perceptions of in?uencing barriers to postoperative pain management. Scandinavian Journal of Caring Sciences, p.274-281. Richard, J. and Hubbert, A. (2007) Experiences of Expert Nurses in Caring for Patients with Postoperative Pain. Pain Management Nursing,, 8 (1), p.17-24. Subramanian, P. et al. (2011) Challenges faced by nurses in managing pain in a critical care setting. Journal of Clinical Nursing, 21 p.1254–1262,. Wilson, B. (2007) Nurses’ knowledge of pain. Journal of Clinical Nursing, 16 p.1012–1020. Read More