The nature of informal pain questioning by nurses – a barrier to post-operative pain management?
- 160 Downloads
Objective: The aim of this study was to explore the nature of nurses' informal pain-related questioning.
Methods: Non-participant observations were performed on one vascular and one urology surgery ward, involving 26 nurses in 402 patient contacts on eight days (total observation time: 39 hours). A questionnaire survey of 180 (of 335=53.7% response rate) nurses working on the same two types of surgery wards in 14 UK hospitals was also undertaken. Instruments (observation sheet & questionnaire) were based on initial qualitative work and developed alongside each other to enable complementation of data.
Results: Both methods identified routine drug administration rounds as the predominant time for informal pain questioning. Observed nurses asked about one third of patients at those times. The majority of pain questions were closed, and interactions were generally brief and task-orientated, often involving one question.
Conclusion: This study has shown the need for a more systematic way to assess patients' pain in routine practice. Suggestions are made about how pain questioning could be improved even if it continues to take place during drug rounds. These may provide a good opportunity for efficient pain questioning within a work environment acknowledging pressures of time and workload. Furthermore, within the current climate of increased multidisciplinary collaboration, the relevance of this study to medicines management and pharmacy are discussed.
Unable to display preview. Download preview PDF.
- 1.McGinty MK, Chase SL, Mercer ME. Pharmacy-nursing discharge counseling program for cardiac patients. Am J Hosp Pharm 1988; 45: 1545–8.Google Scholar
- 2.Stewart S, Pearson S, Luke CG, Horowitz JD. Effects of home-based intervention on unplanned readmissions and out-of-hospital deaths. J Am Geriatr Soc 1998; 46: 174–80.Google Scholar
- 3.Semple JS, Morgan JE, Garner ST, Sutherland K, Milligan M. The effect of self-administration and reuse of patients' own drugs on a hospital pharmacy. Pharm J 1995; 255: 124–6.Google Scholar
- 4.Sutherland K, Morgan J, Semple S. Self-administration of drugs: an introduction. Nurs Times 1995; 91(23): 29–33.Google Scholar
- 5.Royal College of Surgeons. Report of the Working Party on Pain after Surgery. London: Royal College of Surgeons of England and College of Anaesthetists — Commission on the Provision of Surgical Services, 1990.Google Scholar
- 6.Audit Commission. Anaesthesia under Examination, the Efficiency and Effectiveness of Anaesthesia and Pain Relief Services in England and Wales. London: Audit Commission, 1997.Google Scholar
- 7.Oden RV. Acute postoperative pain: incidence, severity, and the etiology of inadequate treatment. Anesth Clin North Am 1989; 7(1): 1–15.Google Scholar
- 8.Mac Lellan K. A chart audit reviewing the prescription and administration trends of analgesia and the documentation of pain, after surgery. J Adv Nurs 1997; 26: 345–50.Google Scholar
- 9.Marks RM, Sachar EJ. Undertreatment of medical inpatients with narcotic analgesics. Ann Intern Med 1973; 78: 173–81.Google Scholar
- 10.Cohen FL. Postsurgical pain relief: patients' status and nurses' medication choices. Pain 1980; 9: 265–74.Google Scholar
- 11.Saxey S. The nurse's response to postoperative pain. Nursing 1986; 3: 377–81.Google Scholar
- 12.Donovan M, Dillon P, McGuire L. Incidence and characteristics of pain in a sample of medical-surgical inpatients. Pain 1987; 30: 69–78.Google Scholar
- 13.Carr ECJ. Postoperative pain: patients' expectations and experiences. J Adv Nurs 1990; 15: 89–100.Google Scholar
- 14.Sriwatanakul K, Weis OF, Alloza JL, Kelvie W, Weintraub M, Lasagna L. Analysis of narcotic analgesic usage in the treatment of postoperative pain. JAMA 1983; 250: 926–9.Google Scholar
- 15.Gillies ML, Smith LN, Parry-Jones WLI. Postoperative pain assessment and management in adolescents. Pain 1999; 79: 207–15.Google Scholar
- 16.Hamilton J, Edgar L. A survey examining nurses' knowledge of pain control. J Pain Symptom Manage 1992; 7(1): 18–26.Google Scholar
- 17.Clarke EB, French B, Bilodeau ML, Capasso VC, Edwards A, Empoliti J. Pain management knowledge, attitudes and clinical practice: the impact of nurses' characteristics and education. J Pain Symptom Manage 1996; 11(1): 18–31.Google Scholar
- 18.Furstenberg CT, Ahles TA, Whedon MB, Pierce KL, Dolan M et al. Knowledge and attitudes of health-care providers toward cancer pain management: a comparison of physicians, nurses, and pharmacists in the state of New Hampshire. J Pain Symptom Manage 1998; 15: 335–49.Google Scholar
- 19.Evans J. The nursing management of postoperative pain: policies, politics and strategies. J Clin Nurs 1992; 1: 226.Google Scholar
- 20.James N. Care = organisation + physical labour + emotional labour. Soc Health Illness 1992; 14: 488–509.Google Scholar
- 21.Field L. Are nurses still underestimating patients' pain postoperatively? Br J Nurs 1996; 5: 778–84.Google Scholar
- 22.Seers K. Perceptions of pain. Nurs Times 1987; 83(48): 37–9.Google Scholar
- 23.Zalon ML. Nurses' assessment of postoperative patients' pain. Pain 1993; 54: 329–34.Google Scholar
- 24.Harrison A. Assessing patients' pain: identifying reasons for error. J Adv Nurs 1991; 16: 1018–25.Google Scholar
- 25.Lavies N, Hart L, Rounsefell B, Runciman W. Identification of patient, medical and nursing staff attitudes to postoperative opioid analgesia: stage 1 of a longitudinal study of postoperative analgesia. Pain 1992; 48: 313–9.Google Scholar
- 26.Kitson A. Post-operative pain management: a literature review. J Clin Nurs 1994; 3: 7–18.Google Scholar
- 27.Roberts DE. Treatment of postoperative pain. Hosp Pharmacist 1997; 4: 181–4.Google Scholar
- 28.Schafheutle EI. Post-operative Pain Management: Patient Behaviour and Professional Practice. PhD Thesis, University of Manchester, Manchester, UK, 1999.Google Scholar
- 29.Ridge KW, Jenkins DB, Noyce PR, Barber ND. Medication errors during hospital drug rounds. Qual Health Care 1995; 4: 240–3.Google Scholar
- 30.Ho CYW, Dean BS, Barber ND. When do medication administration errors happen to hospital inpatients? Int J Pharm Pract 1997; 5: 91–6.Google Scholar
- 31.Mays N, Pope C. Qualitative research: observational methods in health care settings. BMJ 1995; 311: 182–4.Google Scholar
- 32.Macleod Clark J. Communication in nursing. Nurs Times 1981; 77(1): 12–8.Google Scholar
- 33.Willson H. Factors affecting the administration of analgesia to patients following repair of a fractured hip. J Adv Nurs 2000; 31: 1145–54.Google Scholar
- 34.Walsh M, Ford P. Nursing Rituals. Research and Rational Actions. Oxford: Heinemann Nursing, 1989.Google Scholar
- 35.Carr E. Overcoming barriers to effective pain control. Prof Nurse 1997; 12: 412–6.Google Scholar
- 36.Nolan M, Brown J, Naughton M, Nolan J. Developing nursing's future role 2: nurses' job satisfaction and morale. Br J Nurs 1998; 7: 1044–8.Google Scholar
- 37.Adams A, Bond S, Hale CA. Nursing organizational practice and its relationship with other features of ward organization and job satisfaction. J Adv Nurs 1998; 27: 1212–22.Google Scholar