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The clinical applicability of a daily summary of patients’ self-reported postoperative pain - a repeated measure analysis
Jönköping University, School of Health and Welfare, HHJ. ADULT.
Jönköping University, School of Health and Welfare.
Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
Futurum - Academy for Health and Care, Region Jönköping County, Sweden.
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2017 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702Article in journal (Refereed) Epub ahead of print
Abstract [en]

AIM AND OBJECTIVES:

(I) to determine if a central tendency, median, based on patients' self-rated pain is a clinically applicable daily measure to show patients' postoperative pain on the first day after major surgery (II) and to determine the number of self-ratings required for the calculation of this measure.

BACKGROUND:

Perioperative pain traits in medical records are difficult to overview. The clinical applicability of a daily documented summarising measure of patients' self-rated pain scores is little explored.

DESIGN:

A repeated measure design was carried out at three Swedish country hospitals.

METHODS:

Associations between the measures were analysed with non-parametric statistical methods; systematic and individual group changes were analysed separately. Measure I: pain scores at rest and activity postoperative day 1; measure II: retrospective average pain from postoperative day 1.

RESULTS:

The sample, 190 general- and 289 orthopaedic surgery patients with a mean age of 65; 56% were men. 44% had a pre-operative daily intake of analgesia, and 77% used postoperative opioids. A range of 4-9 pain scores seem to be eligible for the calculation of the daily measures of pain. Rank correlations for individual median scores, based on four ratings, versus retrospective self-rated average pain, were moderate and strengthened with increased numbers of ratings. A systematic group change towards a higher level of reported retrospective pain was significant.

CONCLUSIONS:

The median values were clinically applicable daily measures. The risk of obtaining a higher value than was recalled by patients seemed to be low. Applicability increased with increased frequency of self-rated pain scores and with high-quality pain assessments.

RELEVANCE TO CLINICAL PRACTICE:

The documenting of daily median pain scores at rest and during activity could constitute the basis for obtaining patients' experiences by showing their pain severity trajectories. The measures could also be an important key to predicting postoperative health-related consequences.

Place, publisher, year, edition, pages
John Wiley & Sons, 2017.
Keyword [en]
documentation; numerical rating scale; pain; repeated measures; self-rated
National Category
Nursing
Identifiers
URN: urn:nbn:se:hj:diva-35350DOI: 10.1111/jocn.13818PubMedID: 28334471Scopus ID: 2-s2.0-85019551916OAI: oai:DiVA.org:hj-35350DiVA: diva2:1088124
Available from: 2017-04-11 Created: 2017-04-11 Last updated: 2017-06-14
In thesis
1. The clinical utility of patients’ self-rated postoperative pain after major surgery – the perspective of healthcare professionals'
Open this publication in new window or tab >>The clinical utility of patients’ self-rated postoperative pain after major surgery – the perspective of healthcare professionals'
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The Numeric Rating Scale (NRS) is suitable in postoperative settings, yet, the implementation has shown varying results. This has raised issues about the pain scales contribution to the identifying and understanding of pain. The aim of this thesis was to describe the clinical utility of patients’ self-rated postoperative pain after major surgery from a healthcare professional perspective.

The aim of study I and II was to describe healthcare professionals’ perceptions of the use of pain scales, and to through considering critical incidents describe care experiences and actions taken by healthcare professionals’ when assessing pain. Participants in study I (N=25) and II (N=24) were enrolled- registered nurses and physicians with clinical experiences of pain scales. The aims of study III and IV were to determine the clinical applicability of NRS mode- and maximum- measures, and the NRS mode- and median measures at rest and during activity based on patients self-rated pain. The aim in study IV was additionally to determine the number of NRS ratings needed for the calculation of these measures. The number of surgical and orthopedic patients who completed study III were: n=157 and study IV: n=479.

Study I and II confirmed earlier findings of patients’ self-reported pain scores as a facilitator in the understanding of their postoperative pain. Organizational routines, documentation devices, clinical competence, continuity in care, collaborative actions, time, and individual routines were healthcare related factors affecting the use of pain scales (I, II). Patient-related facilitating factors were patients’ ability and willingness to communicate pain, while disability and unwillingness to communicate or inconsistency in verbal communication with observed behaviors were barriers (II). Time and multidimensional communication approaches could bridge these barriers (I, II).

Study III and IV showed acceptable reliability for the mode, median and maximum measures. Rank correlations for individual median scores, based on four ratings, versus patients’ retrospective self-rated average pain, were moderate and strengthened with increased numbers of ratings. The Svensson method showed an individual variation within the expected outcome and a significant systematic group change towards a higher level of reported retrospective pain. The calculated pain measures, particularly concerning pain at rest, generally were lower than patients’ recall of pain.

The findings described beneficial effects of patient self-reported pain, however present healthcare did not fully support the utilization of pain scales. Because of the simple measurement characteristics, the use of daily NRS average pain measures, patients’ pain can be followed until resolved. The measures could additionally become important patient reported outcome measures and thus constitute new motivators to increase the utilization of pain scales.

Place, publisher, year, edition, pages
Jönköping: Jönköping University, School of Health and Welfare, 2017. 84 p.
Series
Hälsohögskolans avhandlingsserie, ISSN 1654-3602 ; 081
Keyword
healthcare professionals, pain scales, postoperative pain assessment, collaboration, communication, routines, habits
National Category
Nursing
Identifiers
urn:nbn:se:hj:diva-35361 (URN)978-91-85835-80-5 (ISBN)
Public defence
2017-05-11, Forum Humanum, School of Health and Welfare, Jönköping, 13:00 (English)
Opponent
Supervisors
Available from: 2017-04-20 Created: 2017-04-12 Last updated: 2017-04-24Bibliographically approved

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