Vital signs and nurses’ choices of titrated dosages of intravenous morphine for relieving pain following cardiac surgery

Abstract

Postoperative pain, if unrelieved, will impede patients' recovery. A theoretical model of factors which influence nurses' choices of titrated dosages of intravenous (IV) morphine was constructed for this study. This study aimed to examine whether or not a patient's vital signs would influence nurses' choices of titrated dosages of IV morphine for relieving pain following cardiac surgery. A survey design with a vignette and questionnaire method was used to collect data. The vignette developed by McCaffery & Ferrell was modified and adapted for this study. It described the pain reports and vital signs of two patients on postoperative day 1 following cardiac surgery. Convenience sampling was used to seek voluntary participation from 29 registered nurses working in the cardio-thoracic intensive care unit of a private hospital in Sydney, Australia. A protocol of the unit allowed nurses to titrate IV morphine against the pain of patients following cardiac surgery. The results showed that the pain assessment of the two patients in the vignette documented by the nurses were not consistent. The titrated dosages (a bolus dosage and a maintenance dosage) chosen by the nurses for the patient with slightly elevated vital signs differed significantly from the titrated dosages chosen by the same group of nurses for another patient with vital signs at the lower end of the stable range (t=3. 33, d.f.=25, P < 0.01 for a bolus dosage and t=3.73, d.f.=25, P < 0. 01 for a maintenance dosage). Different risk factors were stated by the nurses in titrating the bolus and maintenance dosages of IV morphine. The importance of accepting patients' verbal reports of pain as well as the provision of optimal dosages of IV morphine for pain relief is highlighted. A disadvantage of using a vignette and questions method is that the patients' clinical status is somewhat unreal. Further studies, however, were also recommended.

Patients' perceptions of pain management after cardiac surgery in an australian critical care unit

“…6 It has also been hypothesized that in an environment where the speedy hemodynamic stabilization and reversal of anesthesia is paramount, pain control can become a secondary consideration. 2,7 Despite the common belief expressed by many nurses that cardiac surgery is not very painful 8 studies have shown that operations that necessitate a sternal incision do cause substantial pain. 9,10 Specifically, studies describe the intensity of cardiac surgical pain as fluctuating mainly between moderate to severe.…”

Self‐reported Pain Scores in the Emergency Department: Lack of Association with Vital Signs

“…43 Despite published guidelines and research listed previously, health care providers often use clinical data, including vital signs, when assessing pain and deciding whether to administer analgesic agents. 35,[44][45][46][47][48] According to these study results, assumptions about pain (or lack thereof), in light of normal vital signs, should not be made. Judgments regarding the need for analgesia remain subjective determinations for both patient and provider.…”

Smärtbedömning hos äldre personer med kommunikationssvårigheter — en utvärdering av den svenska versionen av Doloplus-2

“…Smärtutvärdering är en viktig grund för en effektiv smärtlindring. Dock har studier visat att sjukvårdspersonal ofta undervärderar patienternas smärta (15,16,17,18). Denna underskattning kan bero på att vårdpersonalen inte på ett acceptabelt sätt har metoder och rutiner för en giltig smärtbedömning.…”