Pain management after cardiac surgery: experience with a nurse-driven pain protocol

Valen, Richard van; Vuuren, Henriette van; Domburg, Ron T. van; Woerd, Dries Van Der; Hofland, Jan; Bogers, Ad J.J.C.

doi:10.1177/1474515111430879

Cited by 21 publications

(21 citation statements)

References 29 publications

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“…One possible explanation is that not receiving additional pain medication (only 10% of patients still receive pain medication) accounts for the poorer quality of sleep. However, earlier studies in our centre show a decreased need for pain medication at this time [18].…”

Section: Discussionmentioning

confidence: 46%

“…The department has a nurse driven protocol which has been shown to result in lower pain scores (according to VAS) [18]. The efficacy of pain medication and low VAS scores on the quality of sleep need further investigation.…”

Section: Discussionmentioning

confidence: 99%

“…This is shown in Table 4. Since pain medication is often used in this patient group, scores were divided into scores with and without pain medication [18]. This study also investigated the effect of pain medication and hypnotics on the quality of sleep.…”

Section: Vshmentioning

confidence: 99%

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Quality of Sleep at the Ward after Cardiothoracic Surgery

Pröpper¹,

Valen²,

Domburg³

et al. 2015

OJN

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Objective: Sleeping problems are among the issues most mentioned by patients after cardiothoracic surgery. These problems can have a negative effect on duration of the hospital stay and recovery. In the ward of our cardiothoracic surgery department, a study was initiated to assess the quality of sleep after cardiothoracic surgery. The primary objective was to investigate the effect of cardiothoracic surgery on the quality of sleep. The secondary objective was to investigate the quality of sleep. Correlations with perioperative factors and related issues such as the type of surgery and medication were sought. Methods: A consecutive prospective cohort study was initiated (N = 72). The study used validated questionnaires to assess sleep: the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS), the Verran Snyder-Halpern Sleep Scale (VSH) and the Factors Influencing Sleep Quality (FISQ). Results: The PSQI showed that the quality of sleep one month after surgery was inferior to the quality of sleep before surgery (p-value: 0.03). The efficiency of sleep (time spent in bed) was higher after surgery then before surgery (p-value: 0.01). The VSH showed increased impaired sleep on the third night after surgery. The most disruptive factors were not being comfortable in a hospital bed, pain and the noise of medical devices. Conclusions: The quality of sleep after cardiothoracic surgery is worse when compared with the preoperative situation. The chief influencing factors are discomfort in bed, pain and disturbance from medical devices. The use of pain medication does not improve the quality of sleep.

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Section: Discussionmentioning

confidence: 46%

Section: Discussionmentioning

confidence: 99%

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Quality of Sleep at the Ward after Cardiothoracic Surgery

Pröpper¹,

Valen²,

Domburg³

et al. 2015

OJN

Self Cite

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“…Subjects were assessed by visual analogue scale (VAS) and medicated through the use of a pain protocol guided by nurses; others received medica ons conforming to the usual pain protocol. The results showed that pa ents medicated according to the rou ne of the ins tu on presented higher pain scale scores when compared to those treated with the nurse-guided protocol, who had a signifi cant reducon in pain, with greater comfort and safety (14) .…”

Section: Rev Esc Enfermmentioning

confidence: 82%

“…In another study conducted with a similar popula on, pa ents were evaluated for pain intensity and managed according to the protocol associated with a visual analogue scale (7) . The results showed be er management of pain intensity when protocols used were guided by nurses (8) .…”

Section: Introductionmentioning

confidence: 96%

Escala da dor: implantação para pacientes em pós-operatório imediato de cirurgia cardíaca

Keller

Paixão

Moraes

et al. 2013

Rev. esc. enferm. USP

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RESUMOEstudo de intervenção em serviço desenvolvido em um hospital especializado em cardiologia de Porto Alegre, RS, com o obje vo de avaliar a implementação da escala de dor para pacientes de pós-operatório de cirurgia cardíaca. Foi desenvolvido em quatro etapas: pré-teste sobre dor, treinamento com aula exposi va para a equipe de enfermagem, reaplicação do pré-teste em 30 e 60 dias. O teste con nha dez questões com peso um para cada questão. Escores ≥7 foram determinantes para considerar o conhecimento sa sfatório para uso da escala de dor. A amostra foi cons tuída por 57 profi ssionais de enfermagem. Os escores variaram de 6,12±1,65 no pré-teste para 7,73±1,05 e 8,18±0,99 após 30 e 60 dias, respec vamente (p<0,005). A intensidade da dor foi correlacionada à medicação padronizada pelo protocolo. O conhecimento da equipe melhorou após a capacitação, assim como o po de analgesia administrada em relação à intensidade da dor. DESCRITORES RESUMENEstudio de intervención realizada en hospital especializado en cardiología, Porto Alegre, RS, Brasil, para evaluar la aplicación de escala de dolor en pacientes some dos a cirugía cardíaca. Se ha hecho en cuatro etapas: pre-test sobre dolor, formación de conferencias para el personal de enfermería, una nueva aplicación del pre-test de treinta y sesenta días. La prueba con ene diez preguntas valiendo un punto cada. Aciertos con una puntuación ≥7 se consideraran crucial para conocimiento adecuado para la escala de usodel dolor. Muestra estuvo conformada por 57 enfermeras. La puntuación de 30 y 60 días osciló entre 6,12±1,65 a 7,73±1,05 y 8,18±0,99, respec vamente (p<0,005). La intensidad del dolor se correlacionó con el medicamento por vía protocolo estandarizado. Un mejor conocimiento del equipo después de capacitación, así como po de analgesia administrada en relación con intensidad del dolor.

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Standardising analgesic administration for nurses: a prospective intervention study

et al. 2016

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Background Uncontrolled pain reduces quality of life, delays recovery from surgery and can potentially contribute to the development of chronic pain. Strategies to improve pain management are desirable in view of these detrimental outcomes, yet frequently they are predominately medically based despite nurses playing key roles in pain assessment and analgesic administration. Objective To develop an algorithm-based guidance addressing nurses' pain assessment and analgesic administration and investigating its impact on quality of pain management. Setting Two orthopaedic units in a university hospital. Method An interdisciplinary expert panel consisting of physicians, nurses and clinical pharmacists developed an algorithm-based guidance in analgesic administration for nurses. The guidance was based on current guidelines addressing the appropriate use of analgesics. In a prospective intervention study, clinical pharmacists acted as independent monitors who assessed nurses' pain assessment and analgesic administration before (control period: usual care without any further support) and after implementation of the algorithm-based guidance (intervention period). We evaluated patient-nurse contacts for guideline adherence. We predefined guideline adherence (main outcome) as fulfilling all three of the following criteria: (A) nurses' pain intensity assessment, (B) their assessment of the patients' need for analgesics, and (C) analgesic administration depending on patients' individual pain intensity (including choice of prescribed analgesics). Main outcome measure Adherence to pain management guidelines. Results We analysed 706 patient-nurse contacts with 162 patients in the control and 748 contacts with 168 patients in the intervention period. Without support, guidelines were followed in 6 % of the patient contacts. We achieved an increase to 54 % (p < 0.001) after guidance implementation (main outcome). Guideline adherence decreased with rising pain intensity (slope coefficient -0.763, p < 0.001). Conclusion Especially in patients suffering from severe pain, current guidelines were not strictly followed by nurses when administering analgesics. Guideline adherence improved eightfold by implementing an algorithm-based guidance.

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Pain management after cardiac surgery: experience with a nurse-driven pain protocol

Abstract: This study shows that in post-cardiac surgery patients a significant reduction in VAS scores can be safely realized by a nurse-driven protocol. Furthermore, a reduction in time to achieve an acceptable pain score (VAS < 4) was realized.

Cited by 21 publications

References 29 publications

Quality of Sleep at the Ward after Cardiothoracic Surgery

Quality of Sleep at the Ward after Cardiothoracic Surgery

Escala da dor: implantação para pacientes em pós-operatório imediato de cirurgia cardíaca

Standardising analgesic administration for nurses: a prospective intervention study

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