To describe the analgesic use in hip fracture patients with dementia during the first two postoperative days as reported by nurses.
Nurses play a pivotal role in treating postoperative pain in patients with dementia and monitoring the effects of administered analgesics.
Cross-sectional descriptive questionnaire study in seven university hospitals and 10 central hospitals in Finland.
The study was conducted from March until May in 2011 in Finland. For this analysis, the focus was on the sample of nurses (n = 269) who were working in orthopaedic units. Analgesics were classified according to the Anatomical Therapeutic Chemical Classification System. Nonparametric tests were applied to find out the significant differences between analgesic use and different hospitals.
Paracetamol and strong opioids administered orally or parenterally seemed to be the most typical of postoperatively used types of analgesics in patients with dementia. Nonsteroidal anti-inflammatory analgesics and weak opioids were also commonly reported to be in use. There were no statistically significant differences between hospitals in typical daily doses. The majority of the nurses reported that the primary aim of postoperative pain management in hip fracture patients with dementia was 'slight pain, which does not prevent normal functioning' (72%).
The pharmacological postoperative pain treatment in acute care was commonly based on the use of strong opioids and paracetamol in hip fracture patients with dementia. The reported use of transdermal opioids and codeine combination warrants further examination. Further studies are also needed to find out whether the pain is appropriately and adequately treated.
Transdermal opioids and codeine combination may not be relevant analgesics for acute pain management in older adults. It is important to create a balance between sufficient pain relief and adverse effects of analgesics to allow early mobilisation and functional recovery.
To understand how nurses contribute to postoperative pain management in a surgical setting and to identify barriers to achieving optimal postoperative pain alleviation.
Postoperative pain is inadequately managed. Nurses play an important role in assessment, treatment and evaluation of postoperative pain in surgical wards, but combined observational and interview studies about how they approach these activities have rarely been undertaken.
The study design is descriptive. Observations and in-depth interviews were conducted with nine nurses on three surgical wards at two hospitals. Each nurse was observed during five shifts, day and night, and interviewed after the final observation. The collection and analysis of data followed principles of qualitative research.
One main theme emerged about the nurses' approach to postoperative pain management: a discrepancy between what the nurses said they did and what they actually did.
The study revealed a gap between what nurses said and did in postoperative pain management, and this gap was smaller when the nurses took an active approach. An active approach towards patients about postoperative pain seemed to enhance pain alleviation.
Nursing education and practice both need to promote knowledge of pain and pain management, as well as empathy and empathic communication in relation to pain. They need to collaborate in guiding nurses to act in accord with theoretical knowledge and so enhance competence in nursing actions related to postoperative pain management.
This study describes how assessment and documentation of children's acute postoperative pain is managed by nurses in university hospitals in Finland. A survey was conducted of 303 nurses working in children's wards of university-affiliated hospitals, and at the same time a retrospective chart review of 50 consecutive cases of operation of acute appendicitis was carried out. Charts were analyzed by content analysis, and the results of the survey are reported with percentage distribution and nonparametric statistical calculations. The results indicate that nurses assess pain mainly by observing the child's behavior and changes in physiology. Pain measurement instruments are rarely used, and nurses do not recognize them. The documentation of pain care is unsystematic and does not support the continuity of care. There is a clear need for development of assessment and documentation practices in the studied hospitals. Future research should look at the postoperative care of pain at home as well as care in non-university-affiliated hospitals.
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.
This study examined the intensity of pain children experience following surgical procedures, the relationship between analgesic administration patterns and perceived level of pain, and children's affective, cognitive, and sensory interpretation of their experiences with pain. The sample included 24 children between 7 and 11 years of age who were hospitalized after abdominal, orthopedic, or urologic surgery. Children rated the intensity of their pain on a visual analog scale three times on the day after surgery. A chart review examined analgesic administration. On the third day after surgery, children were interviewed about their experiences with pain. The findings provide insight into the content of children's fears and concerns when they have postoperative pain, and how they interpret their responses and the responses of others in the management of their pain experience.