Amanda Lee Williford and Dr. Renea Beckstrand, Nursing

It is estimated that less than 50% of postoperative patients experience adequate pain management (Cater et al., 1999). Pain management is an important topic of study because patients tend to get well faster with the absence of pain. Pain is more than a physical discomfort or a physiological nuisance, as it affects a person in every aspect of his or her life. The mind-body connection theory explained by health psychologist Chino reasonably states that any disruption of the mental state of a patient influences him or her physically, and vice versa. Chino further explains that when patients are distressed by pain, their nervous systems produce stress hormones that cause muscle contraction and subsequent stress on the skeleton. This leads to more pain and decreased blood flow. Biochemically, unrelenting pain can deplete neurotransmitters, and the patient may experience subsequent depression and insomnia due to this imbalance (Whitley, 2000). Jairath and Kowal (1999) note that inadequate short-term pain management correlates with delayed wound healing, longer hospital stays, and long-term pain syndromes.

In order to prevent these side-effects of inadequate pain management, health care providers need to know how effective their current treatments are so their methods can be improved if necessary. My research deals with assessing patients’ perception of their postoperative pain management so that health care providers can be informed.

My research subjects consisted of a convenience sample of 21 post-surgical patients at the Utah Valley Regional Medical Center during their first 24 hours on the step-down unit on the 5th floor. The sample included 13 males and 8 females who had either undergone a coronary artery bypass graft (14), heart valve surgery (6), or cardiac tamponade (1). All of my subjects were Caucasian, with ages ranging from 44 to 80. It took me an average of 4 minutes to survey the subjects with the 6-item multiple choice questionnaire I had developed.

Upon completion of the surveys, I had ordinal data to analyze which documents 21 patients’ perception of pain management after open-heart surgery. My goals in conducting this research were (a) to discover if management of post-operative pain has improved in comparison to Cater’s (1999) report of widespread deficiencies in pain control and (b) to identify possible barriers to pain management.

My survey used a scale of 0 to 10, 0 being no pain and 10 being the worst pain imaginable. When asked what level of pain the patient felt right after surgery, most patients stated they were at a 0, with the mean response being 3.52. When asked what level of pain they felt presently, most patients reported a level of 2, with the mean of all responses being 2.95.

Another question addressed the level of pain patients feel is reasonable or acceptable after open-heart surgery. Most patients answered that a level 6 would be acceptable, with the mean response totaling 5.43. Patients said things like, “I could have endured a lot more,” or “A reasonable amount of pain is a lot more than I’ve got.” Only five of the 21 patients reported pain levels higher than a level they believed to be acceptable or reasonable. Four of the 5 said they didn’t know what could have been done to better manage their pain. One patient said that, although he didn’t like being drugged, perhaps more medications would have prevented the pain.

Although 76.2% of patients stated their pain levels fell below the level of pain they believed to be acceptable after heart surgery, the remainder reported a level of pain they felt to be unreasonable. In order to search for barriers to adequate pain management, I asked patients how often nurses in the intensive care unit (ICU) assessed their pain. Most patients remembered being asking about their pain every half-hour, with a mean response of every 1.95 hours.

Another question I asked to assess for pain management barriers was the patients’ understanding regarding people taking pain medications and their risk for addiction to that medication. In response, 8 subjects said they believed there was no risk, 2 responded there was a low risk, 7 believed there was a moderate risk, and 4 replied that there was a high risk.

Of the 5 patients who reported above “reasonable” pain levels, 2 believed that there was a high risk for pain medication addiction while another reported there was a moderate risk. Three of those same patients reported that their pain was assessed less frequently than the average of every 1.95 hours (2 hours, 4-6 hours, and never).

Thus, my data would suggest that, although post-operative pain management is improving when compared to national surveys from three years ago, barriers still exist that impede adequate management of pain for all patients. These barriers include both patients’ need for education on pain medications and the need for nurses to perform more frequent assessments on postoperative patients in order to stay on top of their pain.

One frustration I encountered is that patients were transferred from the ICU at different times. So although I interviewed every patient within 24 hours of their admission to the step-down unit on the 5th floor, the subjects ranged from 1 to 21 postoperative days.

This was an interesting study for me, as I graduated in April and procured a job at the Utah Valley Regional Medical Center. Now I am a nurse and can do more to decrease the deficits in pain management that have been reported. I’ve already begun to apply my research findings by educating patients and their families as well as assessing their pain frequently. As I share this research with my co-workers, I hope they will be motivated to do the same.

References

• Cater, K., Chatham, C., Coyne, C. L., Dubuisson, W., Parker, M. M., Reinert, Bonita, & Smith, J. F. H. (1999). Nurses’ knowledge of pain assessment, pharmacologic and nonpharmacologic interventions. Clinical Nursing Research, 8, 153-165.
• Jairath, N., & Kowal, N. (1999). Patient expectations and anticipated responses to postsurgical pain. Journal of Holistic Nursing, 17, 184-196.
• Whitely, J. (2000). New outlook: Shattering pain [Review of the book Validate your pain! Exposing the chronic pain cover-up]. Las Vegas Review – Journal, 6, 1E-1G.