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1
McConaghy, Paul M. "Secondary hyperalgesia and postoperative pain". Thesis, Queen's University Belfast, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.387878.
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Ng, Alexander. "Advances in postoperative pain management". Thesis, University of Leicester, 2003. http://hdl.handle.net/2381/29438.
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Management of postoperative pain still depends on the administration of opioids and these drugs are associated with adverse effects eg sedation, nausea and vomiting. Local anaesthetics and NSAIDs are not associated with these adverse effects. Five RCTs have been undertaken: three on the administration of local anaesthetics, and two on NSAIDs. Two models of surgery have been used. As an example of an invasive standardised surgical procedure associated with severe pain, I have studied patients undergoing total abdominal hysterectomy (TAH). I also studied patients undergoing laparoscopy as an example of a minimally invasive technique that is associated with moderate pain. In patients who had TAH, I found that a combination of intraperiotoneal and incisional bupivacaine with epinephrine was associated with significant morphine sparing analgesia. Patients experienced significantly less pain on movement with this technique compared with placebo. Furthermore, in patients having laparoscopic cholecystectomy, I found that intraperitoneal administration of levobupivacine with epinephrine was associated with significantly lower total abdominal pain on inspiration, compared with placebo. However, I was not able to demonstrate significant differences in rescue morphine consumption or adverse effects between the two treatment groups. In another RCT, I did not find that administration of local anaesthetics via the transcervical route during laparoscopic sterilisation was useful for analgesia. I also examined how NSAIDs may be useful for postoperative analgesia. After TAH, rectal diclofenac was found to reduce morphine consumption, improve postoperative analgesia and was associated with reduced sedation and nausea. In another RCT of similar design, I found that iv parecoxib was associated with significant reductions in morphine consumption and pain scores on sitting, compared with placebo. The results of the investigations described in this thesis show that local anaesthetics and NSAIDs are useful as analgesic adjuncts after major and minimally invasive surgery.
3
Herman, Julie L. "Nurses' pain management knowledge and patient outcomes related to pain". Muncie, Ind. : Ball State University, 2009. http://cardinalscholar.bsu.edu/464.
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Bennett-Branson, Susan Marie. "Postoperative pain and coping in children and adolescents". Thesis, University of British Columbia, 1990. http://hdl.handle.net/2429/30925.
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The present study examined psychological factors associated with individual variation in children's adjustment following minor surgery, and focused specifically on the process of coping with postoperative pain. Sixty children and adolescents (7 to 16 yrs) were interviewed on the day following surgery. They provided ratings and descriptions of their postoperative pain experience, perceived capacity for pain control, spontaneous coping strategies, and emotional distress. Parents also provided information about their efforts (both historical and present) to facilitate their child's coping, their own emotional distress, and perceptions of their child's distress following surgery. Thirdly, nurses rated children's pain behaviours displayed on the ward. Finally, information about analgesic medications and physical complications following surgery was recorded from children's medical charts.
Qualitative data concerning the process of coping with postoperative pain and specific parental influences on children's coping were presented within a conceptual model adapted from the adult stress and coping literature. The data were also analyzed for age/developmental differences between older children (10 to 16 yrs) and younger children (7 to 9 yrs). Finally the predictive role of demographic, child coping process, and parental influence variables, in accounting for variations in child coping outcome, was analyzed.
Results indicated that children and adolescents experienced moderate to severe pain following minor surgery. They reportedly tried a number of different cognitive and behavioural methods to deal with postoperative pain. Also, parents took an active role in facilitating children's coping. Age group differences were revealed in children's descriptions of postoperative pain, their reported ways of coping with pain, and their perceptions of control over pain and recovery. Age effects were interpreted with caution, however, since age and sex were confounded in this sample.
Children who reported the most pain and emotional distress following surgery also reported more catastrophizing cognitions, felt less in control of their recovery, and reported having tried a greater number of behavioral coping strategies to manage pain. These results emphasize the role of children's appraisal processes in predicting coping effectiveness, and demonstrate that more coping does not imply better outcome.
Future research directions and potential clinical appplications that follow from these findings were discussed.Arts, Faculty of
Psychology, Department of
Graduate
5
Hussain, M. "Acute pain for postoperative patients in Kuwait : a study of how surgical nurses assess postoperative pain". Thesis, University of Salford, 2015. http://usir.salford.ac.uk/36123/.
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Background Proper management of pain is necessary to help patients recover quickly during postoperative care. Failure to promptly assess and manage pain could lead to complications in postoperative situations and can also increase the length of required hospital stays, create or add to elements of chronic post-surgical pain and overall poor health outcomes for the patients. Nurses play crucial roles in assessing postoperative pain, however despite advances in nursing care, there is evidence from a range of research which suggests that patients still suffer considerable levels of postoperative pain. In Kuwait’s healthcare setting, there is a paucity of literature on how nurses perform pain assessment and whether this leads to significant pain relief amongst patients. This research addressed this apparent vacuum in current research literature by exploring the experiences of nurses and patients in Kuwait in postoperative scenarios – focusing in particular on postoperative pain. This work also utilised the findings to help to provide a suggested framework through which the quality of care received by patients in surgical wards in Kuwait could be improved. Aims and Objectives This study aimed to explore how Kuwaiti nurses assess pain in postoperative patients in hospital settings in Kuwait and also to examine postoperative patients’ self-reported experiences of pain. Specifically, this study aimed to address the following objectives: - To explore the roles and responsibilities of surgical nurses in postoperative pain assessment; - To determine the knowledge and perceptions of nurses working in Kuwait on pain assessment; - To investigate the postoperative pain experiences of patients in surgical wards; and identify potential factors that could affect how patients respond to postoperative pain. This was intended to help to provide a framework for dealing with the main aim of this thesis which was to look at how nurses assess postoperative pain in Kuwait, and whether the current methods for doing so represented best practice when compared to other regions or institutions. Methodology This study utilises a qualitative methodology based on a Grounded Theory (GT) approach to social research. This encourages theory building throughout the work and is used to explore concepts relating to pain and how this is influenced by a range of socio-economic and cultural factors. In addressing these issues the experiences of nurses and patients in a hospital ward in a Kuwaiti hospital was established as the research case study. Ten nurses and ten patients were invited to take part in the study through purposive sampling techniques outlined within a grounded theory approach. Inclusion and exclusion criteria were established to ensure that only adult patients aged 18 years old and above who will give their informed consent to participate in the study would be included. Nurses who have at least one-year experience in a surgical ward were also invited to take part in the study. Data Analysis Data was analysed through a grounded theory approach based on key elements of the models espoused by Strauss and Corbin (2008) and Charmaz (2006). This began with a process of data familiarisation once the interviews had taken place, followed by processes of axial and open coding, selective coding, and the generation of categories and themes. In accordance with the grounded theory methodology data analysis and collection of data occurred simultaneously. The main aim of the data analysis was to help generate theories that explain the nurses and patients’ experiences in pain assessment during postoperative care in Kuwait’s healthcare setting. Results and Recommendations The research found evidence to suggest that many patients in the Kuwaiti healthcare system in postoperative scenarios are experiencing difficulties in addressing issues relating to postoperative pain. This was evidenced by patient participants in the study who felt de-legitimised and an undercurrent of distrust between the nurses and the patients. This was mirrored in the responses of some nurses, who also expressed concern that some patients were exaggerating their pain - determining their own opinions and perhaps devaluing the direct experiences of the patients themselves. In addition the research suggests that there are ongoing social power issues in Kuwait and an apparent lack of autonomy which is creating a culture of blame. Although there are clear resource issues, it is apparent that this lack of autonomy and the levels of distrust between patients, nurses and doctors need to be addressed urgently to ensure that postoperative pain care in Kuwaiti hospitals is improved. In Kuwait these issues of a lack of autonomy and an apparent lack of focus on the subjective nature of pain in relation to robust assessment methods has manifested as a cultural norm. As a result there is a need to begin to address formal education of nurses, the level of power and autonomy given to nurses and the establishment of standardised pain assessment procedures more rigorously and definitively. This can be achieved by ensuring that the nurse-doctor professional relationship is improved through better communication structures, more effective training programmes in treating pain, and by challenging a culture where patient’s opinions and feelings on pain are not addressed by medical professionals. This study has provided evidence based data sets which can be utilised in further developing the nursing curricula in Kuwait across both undergraduate and postgraduate nursing programmes and also across many aspects of in-service education within the hospital units themselves.
6
Miller, Lori-Mae. "Children's pain on the first post-operative day". Thesis, University of British Columbia, 1990. http://hdl.handle.net/2429/28794.
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A review of the literature identified that few research studies have been published which examined the post-operative pain of children, particularly those between the ages of 4 and 7 years. As a result, theoretical literature has been the major contributor to the understanding of the concept of children's post-operative pain. Therefore, the purpose of this study was to describe the post-operative pain of hospitalized children aged 4 to 7 years on the first postoperative
day, through a self-reported measure of pain intensity levels as well as descriptions of the children's overt behaviours used to express pain.
Data were gathered on the pain intensity levels (using the PCT) and overt behaviours of 11 children between the ages of 4 and 8 years on the first post-operative day between the hours of 0800 and 2000. In addition, data regarding parental presence and the administration of analgesics were also collected for these children.
Findings related to pain intensity scores provided the basis for three important conclusions. First, all of the children were able to place a value on their pain using the PCT. Second, all of the children were experiencing some degree of post-operative pain possibly related to the lack of consistent administration of analgesia. Third, parental presence did not influence the pain intensity scores reported by the children.
Findings related to the overt behaviours exhibited by children also provided the basis for three important conclusions. First, the most frequent behaviours identified were not those normally associated with feelings of pain. The researcher believed that this lack of expected response was as a result of the children's ability to adapt and cope with the pain. Second, behavioural measurement of pain may not be a reliable and valid measure of post-operative pain. Third, parental presence or absence did not influence the overt behaviours exhibited.Applied Science, Faculty of
Nursing, School of
Graduate
7
Duedahl, Tina Hoff. "Anti-hyperalgesic drugs in postoperative pain /". Cph. : The Danish University of Pharmaceutical Sciences, Department of Pharmaceutics, 2005. http://www.dfuni.dk/index.php/Tina_Hoff_Duedahl/1732/0/.
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Jylli, Leena. "Acute pain in pediatric patients : aspects of pain management and pain assessment /". Stockholm, 2004. http://diss.kib.ki.se/2004/91-7140-135-0/.
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Kianifar, Arash. "Case-based reasoning in postoperative pain treatment". Thesis, Mälardalens högskola, Akademin för innovation, design och teknik, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:mdh:diva-12169.
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Even today, with modern medicine and technology, post-operative pain still exists as anmajor issue in modern treatment. A lot of research efforts have been made, in order toimprove pain outcome for patients that has undergone surgery[18][15].Even though physician's and doctors are well educated, the success rate is aboutapproximately 70 %, still there are patients that experience severe pain, after they haveundergone surgery. There could be several reasons to this, for example, lack of methods orsupport should be amongst other things, factors to consider[18].The problem has been to initiate a case-library and eventually create a tool, that could aidphycisians or doctors in their decision making, which hopefully would help in improvingpain outcome. The chosen method to do this, is a modified version of the CBR-algorithm,which is an artificial intelligence algorithm. The CBR-algorithm makes use of features,solution and outcome, and is implemented with a simple prototype, as a similarity function.The are several reasons for why this method was chosen, but using this method makes itpossible to easily create a web-based tool, so it can easily be accessed from anywhere, butstill be effective and work as a support tool.The algorithm works as a self learning mechanism, and is easy to implement, and theinterface has been constructed, allowing the phycisian or doctor to retrieve informationabout patients and run CBR. The desired results are as expected, it's possible to run theCBR, retrieve and compare cases, and get suggestion of solution or action that should beperformed.The conclusion that can be made, is that, although this is a very basic working medicalapplication, still an overall improvement is needed in order to be used as a medicalapplication. It's anyhow a start. For more details and information, check the appendicesplease.The PainOut Project
10
Hamers, Johan Peter Herman. "Postoperative pain in children assessment and intervention /". [Maastricht : Maastricht : Rijksuniversiteit Limburg] ; University Library, Maastricht University [Host], 1995. http://arno.unimaas.nl/show.cgi?fid=5790.
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Briggs, Emma Victoria. "Postoperative pain : nursing management and organisational commitment". Thesis, University of Hull, 2003. http://hydra.hull.ac.uk/resources/hull:5830.
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Postoperative pain management has been the subject of several national reports (Royal College of Surgeons of England and College of Anaesthetists, 1990; Audit Commission, 1997; Clinical Standards Advisory Group, 2000) that have each made recommendations for practice at ward level and Trust-wide strategies to improve pain management within an organisation. These two areas represent the foci of the work undertaken in this thesis. The research consisted of two studies; the first surveyed hospital Trusts in the Northern and Yorkshire region (n=35) and the second explored nursing care of 120 patients admitted to four English hospitals (two with an acute pain service) through nonparticipant observation, patient interviews and examination of nursing documentation. The questionnaire results highlighted increases in funding for pain management, staff education, audit practices and written guidelines compared to previous work by the Audit Commission (1998) but wide variations in the nature of these activities. In the second study, hospital two (without a pain service) achieved the lowest pain scores at rest (p=0.018) and on movement (p=0.013) but also had one of the lowest rates of analgesic administration and morphine equivalent doses. This ward had the highest number of pain-related interactions (p=0.004), entries onto pain assessment charts (p=0.03) and documented evaluations in nursing care plans. Data also illustrate the differences between observed and documented care in all hospitals and the low use of pain assessment tools in practice to inform analgesic decision-making. This study provides an insight into hospital activities aimed at improving pain management and surgical nursing practice across Trusts. Recommendations are made to further enhance pain relief in hospital including the promotion of pain as a quality of care indicator and increasing accountability within organisations.
12
Akhtar-Danesh, Noori. "Statistical aspects of studies measuring postoperative pain". Thesis, University of Newcastle Upon Tyne, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.360737.
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Gregory, Sabrina. "Managing Acute Pain in Postoperative Surgical Patients". ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/3030.
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Every year, millions of Americans suffer from either chronic or acute pain that results in tremendous healthcare cost, rehabilitation, and loss of work productivity. Pain is an unpleasant sensation associated with sensory and emotional experiences that can cause potential or actual tissue damage. One plausible solution to managing pain is the use of nonpharmacological modalities such as guided imagery. The purpose of this project was to determine if there was a difference in pain scores following pharmacological interventions and the use of guided imagery among postoperative same day surgical patients. Guided imagery is a nonpharmacological modality that uses pictures, music, and imaginary scenes to help heal the body in addition to using relaxation techniques and mental images for the management of pain. This project included the translation of evidence into practice using guided imagery on a 25-bed same day surgery unit (N = 34 patients), guided by Kolcaba's comfort theory. The findings of this project included using guided imagery for same day surgery patients who rated their pain greater than 4 on the traditional pain scale of one to ten, with one equaling no pain and ten equaling worst pain. The results of the evaluation showed a significant decrease in pain scores between premedication to postmedication (p < 0.001), premedication and postguided imagery (p < 0.001), and postmedication and postguided imaginary (p < 0.001). Guided imagery has been demonstrated to be efficient and cost effective methods to reducing pain. This project indicated that use of nonpharmacological and pharmacological interventions working together could be more effective for pain management in same day surgical patients.
14
Reina, Alysia Deborah y Alysia Deborah Reina. "Intraoperative Esmolol Administration in Managing Postoperative Pain". Diss., The University of Arizona, 2017. http://hdl.handle.net/10150/625580.
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Background: Managing perioperative pain is an essential goal for all anesthesia providers. The utilization of multimodal methods for analgesia is common. Administration of opioids has traditionally been the primary method to control pain. However, opioids have additional side effects such as nausea, vomiting, respiratory depression and potential for long term misuse, all of which can lead to adverse patient outcomes. Research studies suggest perioperative administration of esmolol, a beta-blocker normally used to control heart rate and blood pressure, can decrease opioid requirements. The purpose of this quality improvement study was to assess anesthesia provider’s knowledge of using esmolol for the purpose as an alternative or adjunct to perioperative opioid administration.
Methods: A non-experimental descriptive quantitative methodology was employed to evaluate knowledge of esmolol as a perioperative pain management method. A convenience sample of four anesthesia providers working in the main operating suite at a 530-bed acute care facility in a southern Texas town participated in this DNP project. Collection and analysis of data was accomplished through use of a pre and post educational intervention survey. A pre and post survey was used to identify provider knowledge and influence on practice after an education intervention. The pre and post surveys contained the same nine questions, two of which were open ended, to assess achieved learning and/or changes in practice.
Results: A total of four anesthesia providers completed the pre survey, educational PowerPoint and post survey. Upon completion of both surveys, the data gathered was entered into SPSS for analysis using a Wilcoxan Signed Rank Test for comparison. No significant changes indicating enhanced knowledge of esmolol use for perioperative pain management was noted post educational PowerPoint. Commonalities regarding patient characteristics and barriers to esmolol use, such as cost and access were reported in the open-ended question.
Conclusion: Results suggest anesthesia providers are knowledgeable about use of esmolol as a perioperative pain management method. Barriers surrounding the use of esmolol, such as cost, ease of access and assessment of pain, exist, limiting its use in pain management. Future educational opportunities to increase provider participation and response may provide additional insight to selection and incorporation of different pain management modalities.
15
Allred, Kelly Dixon. "The Impact of Music on Postoperative Pain and Anxiety". Doctoral diss., University of Central Florida, 2007. http://digital.library.ucf.edu/cdm/ref/collection/ETD/id/3764.
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Objective: The objective of this study was to add to the body of knowledge about the impact of music on postoperative pain and anxiety. The specific purpose of this research study was to determine if listening to music and/or having a quiet rest period just prior to and just after the first ambulation on postoperative day 1 can reduce pain and/or anxiety, or impact mean arterial pressure, heart rate, respiratory rate, and/or oxygen saturation in patients following a total knee arthroplasty. Methods: An experimental repeated measures design was used. Setting: A postoperative orthopedic unit in a 300-bed community hospital in the southeastern United States. Sample: Fifty-six patients having a total knee arthroplasty, randomly assigned to either a music intervention group or a quiet rest group. Measures: A visual analog scale was used to measure pain and anxiety. Physiological measures, including blood pressure, heart rate, oxygen saturation, and respiratory rate, were also obtained. Results: A repeated measures analysis of variance between and within groups was conducted for pain and anxiety. Statistical findings between groups indicated the music group's decrease in pain or anxiety was not significantly different from the comparison rest group's decrease in pain (F = 1.120, p = .337) or anxiety (F = 1.566, p = .206) at any measurement point. However, statistical findings within groups indicated that when the groups were combined, the sample had a statistically significant decrease in pain (F = 6.699, p = .001) and anxiety (F = 4.08, p = .013) over time. Post hoc analyses showed the significant decrease in pain was from time 1 (just prior to the initiation of music or rest) to time 2 (just after 20 minutes of music or rest) (t(55) = 4.751, p = .000). Post hoc analyses showed the significant decrease in anxiety was from time 1 (just prior to the initiation of music or rest) to time 2 (just after 20 minutes of music or rest) (t(55) = 2.86, p = .006). Additionally, anxiety decreased significantly from time 3 (just after physical therapy) and time 4 (after second period of 20 minutes of music or rest period) (t(55) = 2.222, p = .030). Implications: Results of this research provides evidence to support the use of music and/or a quiet rest period to decrease pain and anxiety when initiated just before and just after ambulation on postoperative day 1 following a total joint arthroplasty of the knee. The interventions pose no risks, and have the benefits of improved pain reports and decreased anxiety. It potentially could be opioid sparing in some individuals, limiting the negative effects from opioids. Nurses can offer music as an intervention to decrease pain and anxiety in this patient population with confidence, knowing there is evidence to support its efficacy.Ph.D.
School of Nursing
Health and Public Affairs
Nursing PhD
16
Ahlgren, Eva y Malin Isacsson. "Anestesisjuksköterskors strategier för att förebygga postoperativ smärta". Thesis, Högskolan i Halmstad, Sektionen för hälsa och samhälle (HOS), 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:hh:diva-24366.
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Sammanfattning Postoperativ smärtbehandling är otillräcklig trots ökad kunskap i smärtfysiologi och utvecklandet av nya farmakologiska riktlinjer. Obehandlad postoperativ smärta kan leda till komplikationer som fördröjd mobilisering, djup ventrombos, lungemboli, hjärtinfarkt, stroke och lunginflammation, vilka leder till ett ökat lidande för patienten både fysiskt och psykiskt samt ökade kostnader för samhället. Anestesisjuksköterskan lägger grunden för den postoperativa smärtbehandlingen före och under anestesin och ska arbeta preventivt för att patientens smärtbehandling ska vara tillräcklig. Syftet med studien var att belysa anestesisjuksköterskans strategier för att förebygga patientens postoperativa smärta efter generell anestesi. Semistrukturerade intervjuer genomfördes med fyra anestesisjuksköterskor på ett västsvenskt sjukhus och analyserades med kvalitativ innehållsanalys. Anestesisjuksköterskorna strävade efter att ge en individuell smärtbehandling till patienterna. Känslan som skapades vid det preoperativa mötet med patienten, typen av ingrepp, samt användandet av andra smärtbehandlingsmetoder påverkade planeringen av de intravenösa analgetikadoserna peroperativt. Genom att använda multimodal smärtbehandlingsmetod till patienter som opereras i generell anestesi skulle postoperativ smärta kunna förebyggas och bidra till minskat lidande för patienterna samt snabbare postoperativ återhämtning. Även vårdtiderna kan förkortas vilket kan leda till en samhällsekonomisk vinst.Abstract The management of postoperative pain is insufficient despite increased knowledge of the physiology of pain and the development of new pharmacological guidelines. Postoperative pain left untreated can lead to delayed mobilization and secondary complications such as deep venous thrombosis, pulmonary embolism, cardiac infarction, stroke and pneumonia. The outcome is increased mental and physical disability for the patient and increased costs for the society. The nurse anesthesist has a crucial role in postoperative pain management before and during anesthesia and needs to work preventively to secure sufficient analgesia for the patient. The aim of this study was to enlighten the nurse anesthesist’s strategies to prevent postoperative pain after general anesthesia. Semi-structured interviews with four nurse anesthetists at a hospital in the Southwest of Sweden were analyzed with qualitative content analysis. The nurse anesthesists strived to individualize pain management. The effect of the atmosphere created at the preoperative meeting with the patient, the character of the planned procedure and the usage of other methods of pain management all affected peroperative planning of dosage of intravenous analgesics. By using multimodality analgesia in patients who have surgery under general anesthesia postoperative pain could be prevented and hence contribute to reduced patient disability and faster postoperative recovery. Furthermore, the in-hospital care time can be reduced which could mean socioeconomic benefits.
17
Wasylak, Tracy J. "The impact of pain on postoperative physical functioning /". Thesis, McGill University, 1988. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=61726.
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Larsson, Björn A. "Procedural and postoperative pain-reducing methods in newborns /". Stockholm, 1998. http://diss.kib.ki.se/1998/91-630-6548-7/.
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Cheung, Chi-wai y 張志偉. "Role of dexmedetomidine on acute postoperative pain management". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2011. http://hub.hku.hk/bib/B4684868X.
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Green, Kemble L. y L. Lee Glenn. "Blinding and Controls in Postoperative Percutaneous Pain Management". Digital Commons @ East Tennessee State University, 2013. https://dc.etsu.edu/etsu-works/7475.
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Excerpt: Gavronsky, Koeniger-Donohue, Steller, and Hawkins (2012) concluded that, 48 hours after major pelvic surgeries for cancer, the women in their study experienced equivalent pain relief from either manual acupuncture or percutaneous electrical nerve stimulation. This statement was not supported by the study data because of the lack of blinding and insufficient controls. Despite the numerous strengths of the study, due to weaknesses in the study design with regard to blinding and control groups, the addition of acupuncture to percutaneous electrical nerve stimulation should not yet be ruled out as a method of obtaining enhanced pain relief.
21
Kless, Jack Robert. "FACTORS ASSOCIATED WITH MODERATE AND SEVERE POSTOPERATIVE PAIN". Case Western Reserve University School of Graduate Studies / OhioLINK, 2010. http://rave.ohiolink.edu/etdc/view?acc_num=case1264081658.
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Seers, Catherine Jean. "Pain, anxiety and recovery in patients undergoing surgery". Thesis, King's College London (University of London), 1987. https://kclpure.kcl.ac.uk/portal/en/theses/pain-anxiety-and-recovery-in-patients-undergoing-surgery(434c9cf7-2186-4084-b9c3-1c485d9f1192).html.
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Tsui, Siu-lun y 徐兆麟. "Postoperative analgesia in Chinese patients: an in depth analysis of postoperative pain management in the QueenMary Hospital of Hong Kong". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 1996. http://hub.hku.hk/bib/B3198163X.
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Tsui, Siu-lun. "Postoperative analgesia in Chinese patients : an in depth analysis of postoperative pain management in the Queen Mary Hospital of Hong Kong /". Hong Kong : University of Hong Kong, 1996. http://sunzi.lib.hku.hk/hkuto/record.jsp?B18597774.
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Magnusson, Niklas. "Postoperative aspects of inguinal hernia surgery : pain and recurrences". Doctoral thesis, Örebro universitet, Institutionen för hälsovetenskap och medicin, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-26054.
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Approximately one in four men will have surgery for ingunial hernia in their lifetime. In Sweden, 16 000 procedures are performed each year. To investigate the possible link between handling of nerves and sensory disturbance, 97 groins in 92 patients were examined one year after inguinal hernia surgery. Sensory disturbances were found to be common after open surgery (29 %), but were not seen after the laparoscopic procedures. No significant relationship between sensory disturbance and handling of nerves or pain was seen. The risk for recurrence has been significantly reduced due to the use of prosthetic meshes, but continued surveillance of this important outcome will always be necessary. In that context, the time frame in which recurrence develops in relation to possible risk factors can help our understanding of the underlying mechanisms. To explore such temporal relationships, 142,578 patients were included in a register study. A relative over-risk for early recurrence was seen after suture repair, laparoscopic repair, after postoperative complications, and after surgery for previous recurrence. Corticosteroids are known to decrease pain and nausea after several surgical procedures. In a randomised trial on open hernia surgery, 398 patients were randomised to treatment with 12 mg of betamethasone or placebo. Decreased levels of pain were seen on the day of surgery, the next day and after one month. No difference was seen on days 2-7 and after one year. Nausea was not common and did not differ between the groups. Reoperation is sometimes performed to correct a presumed structural defect thought to cause the long-term pain. In order to evaluate the result of such treatment, 111 cases were analysed based on register data, questionnaires and medical records. Sixty-two per-cent of the patients reported an improvement compared to before the reoperation, but a high level of pain remaining (42 %), and impaired quality of life was seen. There was no clear advantage for any surgical intervention over the other.
26
Yang, Xiaojie. "UI design for PAIN-OUT Online System". Thesis, Mälardalens högskola, Akademin för innovation, design och teknik, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:mdh:diva-25949.
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How to achieve a quality improvement for individual post-operative pain treatment is an important issue. PAIN-OUT is a multinational research project and its aim is to build functional software for clinicians with post-operative pain management. This paper presents a specification for a UI that is intended for physicians to intuitively access the database and to help them in decision making for the postoperative pain treatment. The interface design is tailored for PAIN-OUT data and combines the UI design knowledge and the physicians’ need. In order to meet the needs, and to implement the design into current PAIN-OUT computer aided system, the mockup design is developed as a HTML’s prototype. To verify the design’s performance, we connect the case library and the interface design in Matlab to see the work out. We also made a small demonstration video for the design and asked the expert from PAIN-OUT to offer some professional opinions.
27
Nordin, Anna y Caroline Ragnarsson. "Postoperativ smärta och illamående vid behandling med Dolcontin/Depolan/Morfin och Oxycontin/Oxynorm : En jämförande studie". Thesis, Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-165329.
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Syfte: Syftet med denna studie var att jämföra graden av smärta och illamående hos två patientgrupper inom ortopedi som smärtlindrades med tablett Dolcontin/Depolan/Morfin eller tablett Oxycontin/Oxynorm postoperativt dag 0, 1 och 2. Syftet var även att undersöka vilka riskfaktorer enligt Apfel Risk Score som kan påverka grad av illamående samt att undersöka om en korrelation fanns mellan preoperativ information och incidensen av postoperativt illamående och kräkning (PONV). Metod: En komparativ studie med kvantitativ ansats. Data samlades in genom två olika enkäter, varav en enkät fylldes i av patienterna och en enkät av sjuksköterskorna. 48 patienter inkluderades i studien, 24 per substans. Både kvinnor och män som genomgått elektiva knä- eller höftarteroplastikoperationer deltog i studien och de var mellan 31-77 år. Mätinstrumentet som sjuksköterskorna använde sig av för att skatta smärta och illamående var visuell analog skala (VAS). Data analyserades i Statistic Package for the Social Science (SPSS) 10.1 med x2-test, oberoende t-test samt Mann-Whitney U-test. Resultat: Resultatet i studien visade att inte fanns någon signifikant skillnad gällande smärta och de två substanserna. Det fanns en signifikant skillnad gällande illamående och de två substanserna. Inget signifikant samband påvisades mellan illamående och riskfaktorerna i Apfel Risk Score. Det fanns heller inget signifikant samband mellan incidensen av PONV och patientens upplevelse av att ha fått noggrann information preoperativt. Slutsats: Då dokumentationen av smärta och illamående enligt VAS på sjuksköterskeenkäterna var bristfällig, kan inga säkra slutsatser dras. Mer forsknings krävs således inom detta område.Aim: The aim of this study was to compare the rating of pain and nausea in two groups of patients in orthopedics that was pain relieved with tablet Dolcontin/Depolan/Morphine or tablet Oxycontin/Oxynorm postoperative day 0, 1 and 2. The aim was also to investigate the risk factors according to Apfel Risk Score that may affect the degree of nausea and to investigate whether a correlation existed between preoperative information and the incidence of postoperative nausea and vomiting (PONV). Method: A comparative study with quantitative approach. Data were collected through two different questionnaires, one that was filled out by the patients and the other questionnaire by the nurses. The study included 48 patients, 24 per substance. Both men and women, between 31-77 years old, who would undergo elective knee or hip replacement surgery, participated in the study. The measuring instrument that the nurses used to estimate the pain and nausea were visual analogue scale (VAS). Data were analyzed in the Statistic Package for the Social Science (SPSS) 10.1 with the x2-test, independent t-test and Mann-Whitney U-test. Results: The results of the study showed that there was no significant difference regarding pain and the two compounds. There was a significant difference regarding nausea and the two compounds. No significant correlation was found between nausea and the risk factors in the Apfel Risk Score. There was no significant correlation between the incidence of PONV and patient experience of receiving accurate information preoperatively. Conclusion: As the documentation of pain and nausea according to VAS on the nursing surveys were poor, no firm conclusions can be drawn. Further studies are necessary to confirm the results of this study.
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Helmersson, Anna y Olga Hermansson. "Barns erfarenheter av postoperativ smärtskattning och smärtlindring : En kvantitativ enkätstudie". Thesis, Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-353442.
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Bakgrund: Studier visar att barns smärta underskattas av sjuksköterskor samtidigt som smärtskattningsskalor används i för liten utsträckning inom barnsjukvården.Syfte: Att undersöka hur smärtbedömning skedde på en postoperativ barnavdelning och hur smärtskattningsskalor användes samt barnens erfarenheter av smärtlindringen. Utöver det var syftet att undersöka hur barnens ålder påverkade dessa faktorer. Metod: Studien är en kvantitativ tvärsnittsstudie baserad på ett enkätunderlag och ett konsekutivt urval. Enkäter delades ut postoperativt till 30 barn i åldrarna 5-17 år som genomgått olika typer av operationer. Barnen svarade på enkäterna själva eller med stöd av sina vårdnadshavare. Resultat: Smärtskattningsskalorna Visuell Analog Skala (VAS) och Faces Pain Scale-revised (FPS-r) användes i mycket liten utsträckning (3% vardera) medan Numerisk Skala (NRS) användes i hög utsträckning (78%). Endast 20% av barnen fick information om någon smärtskattningsskala preoperativt. Barnen var generellt nöjda med hur ofta de hade blivit tillfrågade om sin smärta (73%) och majoriteten (80%) tyckte att de alltid (43%) eller oftast (37%) fått tillräckligt med hjälp mot smärtan. Inga signifikanta skillnader kunde ses utifrån ålder. Slutsats: Studiens resultat visar att NRS användes i hög utsträckning samt att barnen generellt var nöjda med hur ofta de blivit tillfrågade om sin smärta och med hjälpen de fått mot smärtan. Resultatet visar också områden där förbättringar kan göras såsom den preoperativa informationen. Studien belyser det viktiga ämnet barns smärta ur barns perspektiv och kan fungera som ett underlag för att förbättra bedömning och behandling av barns smärta.Background: Studies show that in pediatric care, nurses underestimate children's pain and perform pain assessments too seldom.Aim: To investigate how pain measurements were performed in a postoperative pediatric care unit, how pain assessment scales were employed, and how children experienced the pain relief. Furthermore the study aimed to investigate how children's age influenced the above mentioned factors. Method: A quantitative cross-sectional study based on a survey and a consecutive sample. 30 children, undergoing surgery, aged 5-17 answered questionnaires postoperatively. The children answered the questionnaires themselves or with support from their caretakers. Results: The pain assessment scales Visual Analoge Scale (VAS) and Faces Pain Scale-revised (FPS-r) were rarely used (3% each), while Numeric Rate Scale (NRS) was frequently used (78%). Only 20% of the children received preoperative information about pain assessment scales. In general the children were pleased with how often they were asked about their pain (73%) and the majority (80%) thought they always (43%) or often (37%) received enough help with their pain. No significant difference was found regarding age. Conclusion: The study shows that NRS was frequently used, and that the children felt content with how often personnel asked about their pain and the help they received. Preoperative information about pain assessment scales was an area for improvement. The study highlights the important subject of children’s pain from a child's perspective and could be used to make improvements in children's pain measurement and treatment.
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Gustafsson, Tomas y Benjamin Erkstam. "Patienters upplevelse av postoperativ smärtbehandling : En litteraturstudie". Thesis, Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-398046.
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Bakgrund: Smärta är en subjektiv känsla där varje individ lär sig betydelsen av ordet genom egna erfarenheter. Smärta är något nästan alla upplever efter ett kirurgiskt ingrepp och där otillräcklig smärtlindring i den akuta fasen kan leda till svåra komplikationer vilket skapar lidande för patienten samt stora samhällsekonomiska kostnader. Syfte: Att beskriva patienters upplevelse av postoperativ smärtbehandling. Metod: Litteraturstudie med deskriptiv design av 11 kvalitativa originalartiklar från databaserna PubMed, CINAHL och PsycINFO vars innehåll analyserades i fem steg. Resultat: Patienter var överlag tillfredsställda trots smärta. Det fanns delade åsikter om nyttan av NRS (numerisk skala). Patienter hade en rad föreställningar om läkemedel som ledde dem till att undvika analgetika. Information ansågs vara huvudsakligen hjälpsamt, framför allt skriftlig, dock upplevde patienter att informationen var bristfällig. Attityd, tillit och kommunikation spelade en viktig roll för relationen mellan personal och patient. Patienter som genomgått dagkirurgi och behandlade sin smärta ensamma i hemmet med mycket begränsad kontakt med vårdpersonal, upplevde svårigheter att ta beslut och följa sin smärtbehandlingsplan. Patienter uppskattade att bli inkluderade och delaktiga i sin vård, även om det kunde upplevas som en börda, och tog många egna initiativ och egna strategier under sin behandling, ofta för att slippa använda analgetika. Tidigare erfarenheter var också något som ofta hjälpte patienter i deras smärtbehandling. Slutsats: Patienter var ofta nöjda med sin smärtbehandling trots att de fortfarande upplevde smärta, viktigast för att uppnå detta var en känsla av trygghet. Viktiga faktorer för detta var utförlig skriftlig och upprepad information om smärta, smärtbehandling och analgetika samt ett gott, professionellt, inkluderande och individanpassat bemötande från vårdpersonalen. Brister inom dessa områden ledde till oro och rädsla för det okända, vilket försvårade smärtupplevelsen. Patienter upplevde sällan fullgod smärtlindring.Background: Pain is a subjective feeling where each individual learns the meaning of the word through their own experiences. Pain is something almost everyone experiences after a surgical procedure and where insufficient pain relief in the acute phase can lead to severe complications, which creates suffering for the patient and large socio-economic costs. Aim: To describe patients' experience of postoperative pain management. Method: Literature review with descriptive design of 11 qualitative original articles from the databases PubMed, CINAHL and PsycINFO whose contents were analyzed in five steps. Result: Patients were generally satisfied despite pain. There were different opinions about the benefits of the NRS (numeric rating scale). Patients had a number of conceptions about drugs that led them to avoid analgesics. Information was considered to be mainly helpful, especially written, however patients felt that the information was deficient. Attitude, trust and communication played an important role in the relationship between staff and patient. Patients who underwent day surgery and treated their pain alone in the home with very limited contact with health care professionals experienced difficulties in making decisions and following their pain management plan. Patients appreciated being included and involved in their care, although it could be perceived as a burden, and took many own initiatives and strategies during their treatment, often to avoid using analgesics. Previous experience was also something that often helped patients in their pain management. Conclusion: Patients were often satisfied with their pain management even though they were still experiencing pain, most important to achieve this was a peace of mind. Important factors for this were detailed written and repeated information about pain, pain treatment and analgesics as well as a good, professional, inclusive and individualized response from the care staff. Deficiencies in these areas led to worrying and fear of the unknown, which made the pain experience more difficult. Patients rarely experienced adequate pain relief.
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Nilsson, Stefan. "Procedural and postoperative pain management in children : experiences, assessments and possibilities to reduce pain, distress and anxiety". Doctoral thesis, Hälsohögskolan, Högskolan i Jönköping, HHJ. CHILD, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-13811.
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Introduction Children’s visits to hospital are often connected with painfulexaminations and treatments. If these situations are associated withunsuccessful alleviation of pain, the children may develop distress, anxiety and even pain sensitization. Effective pain management including pharmacological treatment and coping methods that support the children when undergoing examinations or treatments could reduce these harmful effects. Distraction methods such as serious games and music medicine are techniques to deviate attention away from procedural or postoperative pain, and these may help children create positive experiences. There is a need to examine these interventions among children in hospital. Aim The overall purpose of this thesis was to investigate procedural and postoperative pain management among children in hospital. The specific aims were to describe a group of children’s experiences of pain in conjunction with procedural pain to validate an observational behavioural scale for procedural pain assessment in children aged 5-16 years to study pain intensity and distress among children using serious games and music medicine to describe children’s experiences of the use of serious games and music medicine. Methods Two hundred and twelve children who underwent a medical or surgical procedure at the Queen Silvia Children’s hospital in Gothenburg participated in one or two studies, and data were collected with assessment scales, vital signs and interviews. All the data were analyzed using approved methods of analysis. Results The results showed that the children emphasized nurses who were clinically competent and that they wanted to participate in decision making concerning distraction techniques as a complement to pharmacological treatment. An observational assessment scale, the Face, Legs, Activity, Cry and Consolability (FLACC) scale, was avaluable tool for assessing procedural pain and complementing retrospective self-reported pain and distress. Distraction techniques were helpful coping strategies for the children, who also needed to feel secure in the pain management. In children undergoing needle related procedures, serious games reduced pain intensity, but only for those who liked the game, and the interviews showed increased wellbeing. Music medicine reduced morphine consumption and decreased the children’s distress when they underwent day surgery. Conclusions The conclusions of this thesis are that procedural pain can be evaluated using the FLACC scale, the children want to participate in decision-making on distraction techniques such as serious games or music medicine and these self-selected distraction techniques are also helpful coping strategies for the children.All articles have been reprinted with kind permission of the respective journals.
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Al-Tawafsheh, Atef M. M. "The influence of an Acute Pain Service on postoperative pain management in Jordan : a comparative case study". Thesis, University of Nottingham, 2016. http://eprints.nottingham.ac.uk/37586/.
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Background and Aims: Acute pain services (APSs) have developed worldwide to improve the quality of postoperative pain management (POPM). Although there is evidence that APSs can reduce pain and side effects after surgery and improve nurses’ knowledge regarding pain management, the processes through which APSs influence these outcomes remains unclear. Previous studies regarding the influence of APSs on these outcomes have reported conflicting findings and there has been little research exploring clinicians’ perceptions of the APS, and POPM practice. The development of a nurse-based, anaesthetist-supervised APS in one of Jordan’s hospitals in February 2010 provided an interesting and timely opportunity to investigate the influence of an APS on POPM in Jordan, as compared to a similar hospital that has yet to develop this service. This study seeks to address the gap in our knowledge concerning the impact of an APS on the quality of POPM, the knowledge and attitudes of clinicians relating to pain, and to explore clinicians’ views and perceptions of the APS, and current POPM practice. Methods: A comparative multiple-case (embedded) study was conducted between July 2011 and October 2011 at two hospitals in Jordan (Hospital-A has APS, Hospital-B without APS). The case study utilised a combination of quantitative and qualitative methods. Adult patients who underwent elective major surgery (50 from each hospital) completed the Strategic and Clinical Quality Indicators in Postoperative Pain Management (SCQIPP) questionnaire 24 hours after surgery to examine the quality of POPM in both hospitals. A representative sample of nurses and junior doctors at the two hospitals (89 from hospital-A and 100 from hospital-B) completed the knowledge and attitudes regarding pain (KAP) questionnaire. Documentary evidence including hospital policies and notes of meetings was gathered to illuminate the findings derived from other sources. Finally, a purposeful sample of 25 clinicians (mixture of nurses, anaesthetists & surgeons; 12 from hospital-A and 13 from hospital-B) was interviewed to explore clinicians’ views on the APS and current POPM practice. Results: The total mean SCQIPP scores for hospital-A (57.28) and hospital-B (51.88) did not reach the ‘high quality of care’ threshold of 63 in either hospital. The findings from clinicians’ interviews suggest that the lack of patient involvement, the lack of regular pain assessment, and organisational challenges in both hospitals have prevented the total quality scores from reaching the international standard for ‘high quality of care’. Patients in hospital-A reported a significantly higher total SCQIPP scores, and in the subscales of communication and action, (P < 0.001) than hospital-B. There was no significant difference in the subscales of trust (P=0.927) and environment (P=0.344) or in the patient satisfaction scores (P=0.059). Patients in hospital-A also reported significantly lower pain intensity scores (P < 0.001). Patients in hospital-A used significantly more PCA (P=0.013) and epidural analgesia (P<0.001) whereas patients in hospital-B used significantly more IM analgesia (P < 0.001). The findings suggest that the provision of patient education and the more robust approach to pain assessment in hospital-A have positively influenced the achievement of higher total quality scores when compared to Hospital-B. The qualitative findings indicate that the availability of the APS staff 24 hours in hospital-A, the APS’s ‘round’, the specialist pain nurses’ ‘rapid interventions’ and coordination role, and the introduction of PCA and epidural analgesia, were the main activities of the APS that had an impact on the quality of care and patients’ experience of pain in hospital-A. The median total KAP scores for hospital-A (61.6%) and hospital-B (51.5%) did not reach the internationally recognised scores of 80%. A possible explanation is that the short duration of in-service pain education, lack of education sessions, and the reliance of clinicians on their experience, learning from other colleagues or undergraduate courses to learn about pain management are potential explanations for this shortfall. Clinicians in hospital-A had significantly higher KAP scores than hospital-B (P<0.001). Ongoing education and training provided by the APS; the quality and content of training on different aspects of pain management, and the development of pain policies were the main activities of the APS that had an impact on the knowledge of clinicians in hospital-A. However, clinicians in both hospitals were found to have misconceptions about the side effects of PCA and epidural analgesia, and the use of placebo and behavioural clues in pain assessment. Moreover, clinicians’ interviews indicate that patients refuse to take narcotics because they believe it is Haraam (prohibited) or due to fear of opioid addiction. They also speculate that the presence of relatives (escorts) may lead patients to pretend to be in pain and show Dala’ [spoiled] in front of their relatives. Conclusions: The total quality scores did not reach the internationally recognised standard for high quality pain management in either hospital. The findings suggest that the presence of an APS is associated with better managed pain experience, a higher quality of patient care, an increase in the provision of patient education and an increase in compliance with performing regular pain assessment. To improve the quality of pain management practice, clinicians in hospitals with an APS need to continue their work to promote patient education, regular pain assessment, and pay more attention to interventions promoting patient involvement. Hospitals without access to an APS need to find innovative ways to integrate regular pain assessment, patient involvement, and the provision of patient education into routine clinical practice. They may also need to invest in establishing APSs to introduce advanced pain management modalities into their hospitals effectively and safely. The findings suggest that the presence of an APS is associated with a higher knowledge and a positive attitude of clinicians regarding pain management. Despite hospital-A outperforming hospital-B on a number of measures, the total knowledge and attitudes scores did not reach the internationally acceptable scores of 80% in either hospital. To improve the knowledge and attitude of clinicians, it is necessary to improve the content, quality and duration of pain education offered at both the undergraduate and professional levels. It should be noted that this study was carried out in Jordan, a middle-income and an Arabic Muslim country and the internationally recognised thresholds could be too high benchmarks to achieve. In terms of further research, it would be helpful to validate the suggested ‘high quality of care’ threshold on the SCQIPP questionnaire and explore an adjusted ‘high quality of care’ threshold for low/middle-income countries that are struggling with limited resources. There is also a need for further research to develop a contemporary questionnaire to assess clinicians’ knowledge and attitudes regarding POPM including the use of advanced pain management techniques. In addition, a further qualitative study with patients and relatives is recommended to understand their religious beliefs concerning the use of opioids, and the role of the religious practices in pain management.
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Kjellin, Isabella y Jenny Lindfors. "Postoperativ smärta hos barn på en kirurgavdelning : En kvantitativ studie baserad på ett enkätunderlag". Thesis, Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-215989.
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Bakgrund: Studier har visat sig att barns postoperativa smärta i många fall är otillräckligt behandlad och barnen upplever ofta smärta som något obehagligt och skrämmande. Barn kan påverkas negativt av smärta och de kan utveckla skadliga beteendeförändringar efter en operation på grund av otillräckligt behandlad postoperativ smärta. Syfte: Syftet med den här studien är att undersöka hur barnen, på en specifik kirurgavdelning, mår under det första dygnet efter en operation då de blivit sövda, avseende deras postoperativa smärta. Om möjligt ska grupper som har ökad risk för otillräcklig postoperativ smärtlindring försöka identifieras. Metod: En kvantitativ tvärsnittsstudie baserad på ett konsekutivt urval. Deltagarna består av barn på en kirurgavdelning i åldrarna 4-16 år som alla har genomgått en operation där de blivit sövda. De har fått besvara en enkät om sin smärta ett dygn efter operation. Resultat: I studien deltog 32 barn med en medelålder på 9,25 år. Medelvärdet av smärta just nu var 2,59. Medelvärdet av smärta som mest var 7,56. Medelvärdet av minsta smärtan var 1,03. De äldre barnen skattade sin smärta högre än de yngre. Pojkarna skattade sin smärta högre än flickorna. Allmän kirurgi skattade sin smärta högre än de andra kirurgityperna vid två av tillfällena. Urologi skattade sin smärta högst vid ett av tillfällena. Alla deltagande barn uppgav att den ordinerade smärtlindringen hjälpte. Inga signifikanta skillnader kunde ses mellan könen, åldrarna eller de olika kirurgityperna. Slutsats: En större studie, med fler tillfrågade barn, hade gett ett tydligare resultat. Mer forskning behövs inom området. Sjuksköterskorna måste bli bättre på att använda sig av smärtskattningsskalor.Background: It has been shown that children's postoperative pain, in many cases, is inadequately treated. The children often experience pain as something unpleasant and frightening. Children might be affected in destructive ways by the pain and they can develop adverse behavioral changes because of inadequately treated postoperative pain. Aim: The aim of this study is to investigate how the children, at a specific surgical ward, are feeling during the first day after a surgery where they have been anesthetized, regarding their postoperative pain. Groups with increased risk of inadequate postoperative pain treatment are Method: A quantitative cross-sectional study based on a consecutive sample. The participants consist of children on a surgical ward aged 4-16 years who all had surgery where they were anesthetized. They have answered a questionnaire one day after the surgery. Results: 32 children participated in the study. Their mean age was 9.25 years. The mean of pain right now was 2.59. The mean of the worst pain was 7.56. The mean of the minimum pain was 1.03. The older kids rated their pain higher than the younger ones. The boys rated their pain higher than the girls. General surgery rated their pain higher than the other surgery types at two occasions. Urology rated their pain highest at one of the occasions. All participating children reported that the prescribed pain relief helped. No significant differences were seen between the sexes, ages or different surgery types. Conclusion: A larger study with more responding children, would have given a clearer result. More research is needed in this area. The nurses have to improve their usage of pain measurement instruments.
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Rees, Nancy Wylie. "Nursing Management of Postoperative Pain: Perceived Care and Actual Practice". Curtin University of Technology, Faculty of Education, 2000. http://espace.library.curtin.edu.au:80/R/?func=dbin-jump-full&object_id=12334.
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Postoperative pain management is a major responsibility of nurses who provide care for patients recovering from surgery. In the postsurgical environment, the nurse has a pivotal role in assessing the patient with pain, implementing both doctor and nurseinitiated pain interventions and evaluating the patient's response to pain control treatments. Apart from its humanitarian utility, effective relief of postoperative pain is a critical element of a patient's postoperative recovery. Failure to manage pain effectively in the immediate postoperative period can produce undesirable immediate and longterm physical and psychological consequences that can severely disrupt an individual's quality of life. Despite the availability of multidimensional assessment measures, sophisticated pharmacological therapies and a greater range of complementary pain therapies, postoperative pain remains treated ineffectively by those professionally responsible for its management. In particular, evidence indicates that nurses are poor managers of their patients' postoperative pain. This thesis reports research that was conducted in two stages to explore, describe and analyse how nurses managed their patients' postoperative pain and their perceptions of factors that influenced this practice. A predominantly descriptive design was utilised in Stage 1 of the study to collect data from patients' hospital records and with a demographic questionnaire administered to nurses. This was complemented with interview data from nurses in Stage 2.Previous studies offer limited views of the clinical realities of nursing practice in postoperative pain management. From this perspective, there is a need for research that incorporates these realities to permit analysis of clinical practice and greater understanding therefore of the problem of poor postoperative pain management. The purpose of this study was to provide an illuminative and authentic account of nursing practice in postoperative pain management. For the first part of Stage 1, data were collected retrospectively from nurses' documented accounts of pain assessment and intervention over the first three postoperative days for 100 patients in a major adult acute care teaching hospital. Analysis of nurses' documented responses to patients' reports of postoperative pain revealed that less than one-third of all responses could be considered appropriate for pain management. In particular, nurses failed to provide any pharmacological relief for 53% of patients' reports or severe and excruciating pain. Exploration of the influence of nurses' professional characteristics of education and experience on pain management practice was then undertaken in part 2 of Stage 1 with the use of a demographic questionnaire distributed to 106 nurses who were identified as signatories to the documented responses identified in part 1. Results indicated that length of professional experience accounted for most variations in practice, with older, more experienced nurses managing pain more appropriately than their younger and less experienced colleagues. Irrespective of education or experience, however, nurses failed to respond appropriately to patients reporting excruciating pain.
In Stage 2, in-depth interviews were conducted with 8 nurses caring for postoperative patients at the research site. Thematic content analysis revealed four major themes from nurses' perceptions of their practice of postoperative pain management that served to elucidate and enrich the findings of Stage 1 of the research. These were finding out about the patient's pain, making decisions about pain and pain management, individual factors affecting pain management, and interpersonal and organisational factors affecting pain management. This thesis provides an authentic account of nursing practice in postoperative pain management, and contributes understanding and insight into factors that provoke ineffective management of pain after surgery. It has implications for the development of intervention strategies aimed at improving nursing practice, at both individual and organisational levels, and suggests new directions for nursing education and research toward achieving optimum care and eliminating unnecessary pain for patients recovering from surgery.
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Shimizu, Michael S. "Benzodiazepines as an adjunct in the management of postoperative pain". Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape8/PQDD_0016/MQ49443.pdf.
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Yong, Sin Leong. "Protective analgesia using bupivacaine and ibuprofen for postoperative dental pain". Thesis, University of Manchester, 2010. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.529939.
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Myers, Elizabeth C. "Evaluation of a patient-controlled approach to postoperative pain relief". Thesis, Glasgow Caledonian University, 1993. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.335359.
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Washington, Angela. "Management of Postoperative Pain in the Total Joint Replacement Patient". ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5594.
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Managing postoperative pain continues to be a challenging public health problem. The organization under study was experiencing a prolonged length of hospital stay (LOS) in the post-total knee and hip replacement surgery population that was causing system-wide patient flow issues. The purpose of this quality improvement project was to educate patients through an established education class on pain expectations, strategies on managing pain, discharge planning, and physical therapy expectations with a goal of reducing pain and LOS. The health belief model was used as a guide to incorporate new content into the educational program that addressed patient knowledge on pain, concerns, fears, and misconceptions related to surgery. New content was added to the class on strategies to improve postoperative pain to help the organizational need to meet 2- to 3-day LOS. The project compared differences in pain levels and LOS in participants who completed the preoperative education and those who did not. The project methodology was a retrospective nonexperimental pretest and posttest design, and a quantitative analysis was used to compare pain levels measured by visual analog scale in documented charts during hospital stay. LOS was measured from data collected from chart review. The findings revealed lower pain levels during the hospital stay of those who completed the educational program. The patients who did not attend the class had an average mean LOS of 5 days as compared to 3 days LOS for those who attended the preoperative class. The project impacts social change on an organizational level by demonstrating that patients undergoing joint replacement surgery benefit from the revised educational plan, which results in early mobility, better pain control, and decreased LOS.
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Agu, Blessing. "Patients and Nurses Attitudes to Hysterectomy and Postoperative Pain Management". ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/4265.
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Over 500,000 hysterectomies are performed yearly in the United States, and they often result in a moderate to severe amount of pain. Nurses play a significant role in postoperative pain management. However, studies have shown that despite technological advances and nurses' theoretical knowledge of pain, postoperative pain management remains a challenge among healthcare providers. The purpose of this study was to examine how nurses' and patients' attitude towards abdominal hysterectomy can impact postoperative pain management and hospital length of stay after a hysterectomy. Informed by the theory of reasoned action, the study examined the differences in the nurses' and patients' attitudes to abdominal hysterectomy and postoperative pain management. It also examined the correlation between attitudes toward postoperative pain management and hospital length of stay after a hysterectomy. A convenience sample of 147 participants were recruited from a self-administered online survey. Using the SPSS software, data was analyzed by an independent t test, Pearson correlation, and multiple regression. No statistical difference was found between patients and nurses' attitudes toward abdominal hysterectomy. However, a significant difference was found between the attitudes of each group toward postoperative pain management. There was also a strong negative correlation between attitudes to postoperative pain management and hospital length of stay. This study may aide nurses on ongoing pain management education for both new and seasoned nurses in practice. It will also help hospitals with pre- and postoperative patient education, which will lead to better collaboration with their nurse caregivers. Finally, this study will add to the existing body of research.
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Campbell, Belinda. "Effect of Local Anesthesia on Postoperative Pain with General Anesthesia". VCU Scholars Compass, 2012. http://scholarscompass.vcu.edu/etd/2699.
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Purpose: The aim of this study was to determine if the use of local anesthesia with general anesthesia results in less postoperative pain. The alternative hypothesis is that children will experience less postoperative discomfort when utilizing intraligamental local anesthetic during the intra-operative time period. Methods: Patients were recruited for this single blind, randomized, prospective cohort study with the following inclusion criteria: English speaking children age 3-6 years, ASA I/II requiring general anesthesia for dental treatment. Randomization was done to place patients in groups of no local anesthetic vs. local anesthetic administration. A Wong-Baker Faces Pain Scale was utilized to evaluate pre-operative and postoperative pain. Data were compared using a two way mixed model ANCOVA controlling for sex, ethnicity, pre-op pain, and intra-op meds given. Results: Data was collected and evaluated on 90 patients. There was a statistically significant difference in postoperative pain for patients who received extractions without local anesthesia vs. those with local anesthetic. There was no statistically significant difference in pain outcomes based solely on whether local anesthetic was administered regardless of treatment type. Conclusions: The outcome of this study shows evidence for provision of local anesthetic during general anesthesia in patients receiving extractions to reduce postoperative pain.
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Maglanque, Maria Jannette. "Cardiac nurses' knowledge, assessment practices and management of postoperative pain". Thesis, University of British Columbia, 2017. http://hdl.handle.net/2429/63761.
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Background: Pain is an important stressor for postoperative patients and remains an issue this present day. Postoperative patients continue to report moderate to severe postoperative pain following cardiac surgery. Acute postoperative pain that is not treated appropriately could potentially progress into postsurgical chronic pain which would significantly impact an individual’s overall quality of life. Nurses are at the frontlines providing direct patient care and play a major role in pain assessment and pain management, however, barriers exist that prevent postoperative patients from receiving effective pain relief. Purpose: To understand cardiac nurse’ postoperative pain knowledge, pain assessment practices and pain management in the context of cardiac surgical patients. Sample/Methods: This was a mixed methods design that was conducted on two cardiac surgical units in a tertiary hospital located in British Columbia. There were 63 nurses who accessed the online survey. Results: The findings revealed nurses have moderate pain knowledge with scores ranging from 56.1% to 91.1%. Nurses education level, experience level and age had no impact on their knowledge scores. Conclusions: A majority of nurses reported adequate pain knowledge in assessment and management, however, knowledge gaps exist in terms of pain assessment, neuropathic pain and chronic pain.Applied Science, Faculty of
Nursing, School of
Graduate
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Thomas, Veronica J. "Personality characteristics of patients and the effectiveness of patient controlled analgesia". Thesis, University of London, 1991. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.261202.
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One of the most exciting developments within postoperative pain research in recent years has been the introduction of Patient Controlled Analgesia (PCA). PCA is a technique in which patients self-administer small doses of opioids intravenously and it has been shown to be more effective than the conventional intramuscular injection method (IMI). However, PCA requires costly equipment and this necessarily places constraints on its availability. Therefore it is vital to ensure that the PCA facilities which are available are used as efficiently as possible. Essential to this is an understanding of the categories of patients for whom it will be most effective. At present the basis of selection of patients for PCA is often unclear. Frequently anaesthetists use the extent of trauma as a guide, although there is no evidence that this is the most effective strategy. Moreover, it ignores numerous factors which empirical research has shown to influence the experience of postoperative pain. These include state and trait anxiety, neuroticism and coping style. Until now their importance has only been investigated within the IMI analgesic regime. The present thesis remedies this omission by investigating pain/personality relationships under both PCA and IMI regimes. A particular interest was the identification of ways of detecting the patients who would benefit most from the use of PCA in terms of personality profiles. This study investigated whether knowledge of the patient characteristics of state anxiety and trait anxiety, neuroticism and coping style can be used to predict which patients will benefit the most from PCA. This research involved two main studies, in which a sample of 164 adult female and male patients undergoing major elective surgery were preoperatively assessed in terms of anxiety, neuroticism and coping style. Postoperatively they were allocated to either PCA or IMI analgesic regimes and their pain experience was assessed at 6,18 and 24 hours after surgery. The data were analyzed using Pearson's Correlations, T tests, Analysis of Variance and Multiple Regression. The findings revealed that state anxiety and coping style were significant predictors of postoperative pain for PCA as well as IMI regimes. Patients using PCA experienced significantly better pain relief than did their IMI counterparts. However, it was the patients with high levels of state anxiety using PCA who benefited the most. The superior pain control of PCA was not found to be related to the presence of the technically sophisticated PCA machine. PCA was also associated with a reduction in the length of hospital stay and a saving of nursing time on the ward. Patients had positive reactions about being in control of their pain relief, whilst staff felt that patient control was beneficial. They were also impressed by the time saving element of PCA. The implications for the management of post operative pain and the financial saving are considered.
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Thompson, Dale Leslie 1953. "THE USE OF GUIDED IMAGERY TO REDUCE ACUTE POSTOPERATIVE PAIN (EMOTIVE, RELAXATION)". Thesis, The University of Arizona, 1986. http://hdl.handle.net/10150/276726.
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Daibes, Mayada. ""A pain that ruins mountains" : a case study of factors influencing postoperative pain management in two Jordanian hospitals". Thesis, University of Warwick, 2011. http://wrap.warwick.ac.uk/47360/.
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Postoperative pain is still poorly managed among surgical patients despite evidence-based approaches to its treatment being well established. Prompted by the persistence of this problem, many researchers have studied factors influencing postoperative pain management. Empirical clinical research has dominated this area and has presented a set of factors which, albeit important, have not taken into account the influence of contextual factors on the individual’s practices in pain management. This study is designed to examine the role of context on the practices and interactions of professionals and patients during postoperative pain management. Informed by the insights of post-structuralism, it uses nonparticipant observation, informal and semi-structured interviews with participants of both genders (29 staff nurses, 13 surgeons, 38 patients, and 20 patients’ family members), and a document review to construct a case study of four surgical patients’ wards in two Jordanian hospitals. Also included is a descriptive analysis of pain and distress scores, and a thematic analysis of the raw data The findings reveal both a significant problem with pain among Jordanian surgical patients, and limited engagement by nurses in postoperative pain management. It is found that a series of socio-cultural and organizational factors limit participants’ practices in respect of pain management. Influential socio-cultural factors include: sexual surveillance, an inferior public view of nurses, patriarchal ideas, and use of personal influence (wasta). Organisational factors include: hierarchical observations, fear of punishment, the subordination of nursing staff, perceptions of low staffing and high workload, and social hierarchies, such as rank. In combination these contextual factors operate as a set of disciplinary and power mechanisms that limit the ability of nurses to become involved in patients’ pain management; impede nursing professionalism by restricting autonomy and self-regulation; reduce some of the patients’ willingness to communicate pain and lead to a reluctance to be cared for by professionals of a different gender. It is concluded that in this area organisational policies are subservient to nurses’ culturally constructed approaches to pain management. As such, socio-cultural factors appeared to have a greater effect than organizational factors. Recommendations are made to address the situation and provide for appropriate pain relief after surgery.
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Jacobson, Eva. "Pain management in outpatient knee arthroscopy /". Stockholm, 2006. http://diss.kib.ki.se/2006/91-7140-642-5/.
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Good, Marion Patricia Long. "Comparison of the effects of relaxation and music on postoperative pain". Case Western Reserve University School of Graduate Studies / OhioLINK, 1992. http://rave.ohiolink.edu/etdc/view?acc_num=case1059751996.
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Simonsson, Katarina y Karin Bergman. "Patientens upplevelse av postoperativ smärta". Thesis, Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-352676.
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Bakgrund: Postoperativ smärta uppkommer efter operation. En obehandlad akut smärta kan utvecklas till långvarig smärta och detta är den vanligaste orsaken till att patienter söker läkarvård. Sjuksköterskans ansvar är att lindra, bedöma och skatta smärta hos patienter. Ett ömsesidigt förtroende kan underlätta arbetet, emellertid blir enbart hälften av patienterna på en avdelning delaktiga i sin smärtbehandling. Patientens egna uppfattningar, tidigare erfarenheter och beskrivning av smärta bör tas på allvar. Studiens teoretiska referensram är Joyce Travelbees teori där huvudkomponenten innefattar förståelse för vad som händer i interaktionen mellan patienten och sjuksköterskan. Vårdlidande kan uppstå om patienten förlorar kontroll, vilket är vanligt förekommande inom vården. Smärta är ett exempel på en situation när patienten tappar kontroll över situationen. Syfte: Syftet var att beskriva patienters upplevelse av postoperativ smärta. Metod: Litteraturstudie av kvalitativa artiklar genomförd i databaserna Pubmed, CINAHL, PsycINFO. Totalt inkluderades 10 stycken vetenskapliga artiklar. Resultat: Generellt upplevde patienter postoperativ smärta fysiskt. Kroppsliga förnimmelser var kopplade till smärtans karaktär, intensitet och varaktighet. Patienterna upplevde att smärtan begränsade vardagliga livet genom svårigheter att utföra aktivitet och sämre sömn. Patientens psykiska upplevelse präglades av rädsla och oro. Patienter upplevde att vårdpersonalens bemötande hade en inverkan på förtroendet. Tidigare erfarenhet och kunskap av smärta påverkade hur patienter hanterade smärta. Den farmakologiska och icke- farmakologiska smärtlindringen upplevdes positivt och negativt. Slutsats:Patienter upplever smärtans karaktär, varaktighet, intensitet och lokalisation individuellt. Förtroendet för vårdpersonal, deras bemötande och attityd har en betydelsefull inverkan på patienternas postoperativa smärtupplevelse. Tidigare erfarenheter av smärtlindring och relationen till vårdpersonal påverkar patienters inställning gentemot analgetika. Nyckelord: lidande, postoperativ smärta, smärtbedömning, smärtlindring, upplevelse.Background: Postoperative pain emerge after surgery. Untreated acute pain can develop into chronic pain. It’s the most common cause for patients to seek medical treatment. It’s the nurse's responsibility to ease and evaluate pain among patients. Mutual trust can help make these responsibilities easier, though only half of the patient in a caring unit gets to be involved in their pain-treatment. Patients opinions, earlier experiences and descriptions of pain must be taken seriously. The theoretical reference frame of this study is Joyce Travelbee’s theory, where the main component includes the understanding of the interaction between patients and nurses. Suffering in healthcare can develop if the patient loses control, which is common in health care. Pain is an example of a situation when a patient loses control over of the situation. Aim: To describe patients experiences of postoperative pain. Method: A literature study of 10 qualitative articles, found in Pubmed, CINAHL and PsycINFO. Results: Patients generally experienced their postoperative pain physically. The experience related to the pains character, intensity and durability. The pain was often perceived to restrict everyday-life by bringing difficulties performing exercises and resulted in deficient sleep. The physical experience where tinged by fear and anxiety. The healthcare professional’s treatment towards patients had an impact on the relationships trust-status. Earlier experiences and knowledge about pain affected how patients handled their pain. Pharmacological and nonpharmacological pain treatment were experienced as both positive and negative. Conclusion: Patients experiences the character of the pain, as well as the intensity and durability, individually varying. Trust towards healthcare staff, their treatment and attitude, had an impact on the postoperative pain experience. Earlier experiences of pharmacological treatments and the relationship with staff impacted patients attitude towards analgesics. Keywords: Experience, painassessment, pain relief, postoperative pain, suffering.
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Everett, Bronwyn L., University of Western Sydney y of Nursing Family and Community Health School. "The impact of linguistic diversity on postoperative opioid consumption". THESIS_CSHS_NFC_Everett_B.xml, 2000. http://handle.uws.edu.au:8081/1959.7/465.
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Pain management is a critical part of the care of the surgical patient. This study sought to investigate the impact of cultural and linguistic diversity on analgesic administration practices and opioid consumption during postoperative period. A retrospective medical record audit of 278 English-speaking and non-English speaking surgical patients was carried out at four hospitals in Sydney's South West. No differences were found in the type of analgesia prescribed, the mode of analgesia, or the commencement of oral analgesia between the two groups. However, non-English speaking patients consumed less analgesia during the initial postoperative period than their English speaking counterparts. The importance of this difference was further examined within the context of a range of factors known to influence analgesia consumption. A model including sociodemographic and clinical factors - mode of administration of analgesia, gender, and language spoken -predicted 37% of total opioid consumption. Although mode of administration was the most important factor, being of non-English speaking background also contributed substantially. Pain assessment, inclusive of gender and cultural nuances is recommended. The need for further research into pain interpretation in specific linguistic and cultural groups is highlightedMaster of Science (Hons) (Health)
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Idvall, Ewa. "Development of strategic and clinical quality indicators in postoperative pain management /". Doctoral thesis, Linköping : Univ, 2001. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-5158.
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Carr, Eloise C. J. "Exploring the effect of postoperative pain on patient outcomes following surgery". Thesis, King's College London (University of London), 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.393116.
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Chatila, Nadwa. "Postoperative oral surgical pain : Incidence, clinical characteristics and risk factors Jury". Thesis, Clermont-Ferrand 1, 2015. http://www.theses.fr/2015CLF1DD03.
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Les objectifs de cette thèse étaient de1/ carctériser la douleur post-opératoire chez des patients ayant reçu un implant dentaire mandibulaire. 2/examiner la relation entre facteurs individuels, facteurs chirurgicaux et douleurs post-operatoire chez patients ayant reçuun implant dentaire mandibulaire. 3/déterminer les incidences de la douleur neuropathique chez des patients ayant reçu un implant dentaire mandibulaire.Cette thèse a montré que la douleur post-opératoire aigüe après un implant dentaire allait d'une intensité douce à modérée((inférieur à 3 sur l'échelle visuelle analogique) et de courte durée. Une anlyse univariée a montré que l' intensité de la douleur post-operatoire était en lien avec l'âge, le souvenir de la douleur ayant fait suite à une précédente chirurgie orale, le nombre d'implants et la distance entre la fraise et le canal neurologique alvéolaire inférieur(IAN). En revanche aucun lien n'a été démontré avec le sexe, des facteurs psychologiques ou le procédé chirurgical. Une analyse multivariée a montré une association significative entre une douleur post-opératoie aigüe et la distance entre l'implant et le canal neurologique alvéolaire inférieur mémoire de la douleur après une précédente chirurgie oraleThis prospective study investigates the clinical characteristics and time course of postoperative pain after placement of dental implants in the mandible over a 6-month period. We also examined the influence of preoperative physical and psychological factors, as well as surgical factors, on acute postoperative pain. Postal questionnaires built to assess the existence neuropathic features of pain at the site of surgery (with the Douleur Neuropathique 4 Questions [DN4]) were sent two weeks, and one, three and six months after surgery.Acute postoperative pain was of mild-to-moderate intensity and had a short duration. Univariate analyses showed that the intensity of postoperative pain was related to age, remembrance of pain after a previous oral surgery, the number of implants, and the distance between the drill and the inferior alveolar nerve (IAN) canal. But, there was no relationship with gender, psychological factors, or surgical procedure (buccal flap). Besides the number of implants (P=0.013), and the distance between the end of the drill and the IAN canal (P=0.004), multivariate analyses showed a significant interaction between the acute postoperative pain and: i) the distance between the implant and the IAN canal (P=0.0005), ii) remembrance of pain after a previous oral surgery (P=0.003), iii) previous oral surgical pain (P=0.005). Among the patients who completed follow-up, only 0.7% (n = 1) scored positive on neuropathic symptoms (DN4 ≥ 3).This prospective observational study provides the characteristics of acute postoperative pain after placement of dental implants in the mandible and the risk factors for developing severe oral postoperative pain. It also provides the incidence rate of neuropathic pain occurring within the 6 months after dental implant surgery