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Healthcare professionals’ descriptions of care experiences and actions when assessing postoperative pain – a critical incident technique analysis
Jönköping University, School of Health and Welfare. Department of Anaesthesia and Intensive Care, Ryhov County Hospital, Jönköping, Sweden.
Jönköping University, School of Health and Welfare. Department of Anaesthesia and Intensive Care, Ryhov County Hospital, Jönköping, Sweden.
Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
School of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden.
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2016 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 30, no 4, 802-812 p.Article in journal (Refereed) Published
Abstract [en]

Background

Pain is a common postoperative symptom, and length of hospital stay after surgery is short which highlights the importance of pain assessments. Experiences of assessing pain are mainly described from the perspective of nurses. In postoperative care, enrolled nurses and physicians also assess pain. It is therefore important to take note of their experiences to improve postoperative pain assessments.

Objectives

The aim of this study was, through considering critical incidents, to describe care experiences and actions taken by healthcare professionals when assessing postoperative pain.

Methods

An explorative design employing critical incidents technique analysis was used. A total of 24 strategically selected enrolled nurses, nurses and physicians employed at orthopaedic or general surgery wards in four Swedish hospitals were interviewed. The intention was to reach variation in age, sex, profession and professional experience.

Findings

In pain assessments, patient-related facilitators were patients’ verbal and emotional expressions including pain ratings, while lack of consistency with observed behaviours was a barrier. Clinical competence, continuity in care and time were healthcare-related facilitators. The actions healthcare professionals took were gathering facts about patients’ pain manifestations and adapting to patients’ communication abilities. Patient observations, either passive or active were used to confirm or detect pain. Collaboration between healthcare professionals, including consultations with pain experts, social workers and relatives, strengthened understanding of pain.

Conclusions

Communication skills and working conditions have an impact on performance of pain assessment. Patient comfort without compromising safety is reached by including healthcare professionals’ dissimilar responsibilities when collecting patients’ and relatives’ perspectives on current pain.

Place, publisher, year, edition, pages
2016. Vol. 30, no 4, 802-812 p.
Keyword [en]
collaboration; critical incident technique; healthcare professionals; postoperative pain assessment
National Category
Nursing
Identifiers
URN: urn:nbn:se:hj:diva-28942DOI: 10.1111/scs.12308PubMedID: 26709955Scopus ID: 2-s2.0-84952837637OAI: oai:DiVA.org:hj-28942DiVA: diva2:892532
Funder
Medical Research Council of Southeast Sweden (FORSS)
Available from: 2016-01-11 Created: 2016-01-11 Last updated: 2017-12-01Bibliographically approved
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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Wikström, LottaEriksson, KerstinFridlund, BengtBroström, Anders

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