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  • 1.
    Kim, Hesook Suzie
    et al.
    College of Nursing, University of Rhode Island, 2 Heathman Road, White Hall, Kingston, RI 02881-2021, United States / Buskerud University College, Drammen, Norway.
    Schwartz-Barcott, Donna
    College of Nursing, University of Rhode Island, 2 Heathman Road, White Hall, Kingston, RI 02881-2021, United States.
    Tracy, Susanne M.
    College of Nursing, University of Rhode Island, 2 Heathman Road, White Hall, Kingston, RI 02881-2021, United States.
    Fortin, Jacqueline D.
    College of Nursing, University of Rhode Island, 2 Heathman Road, White Hall, Kingston, RI 02881-2021, United States.
    Sjöström, Björn
    University of Skövde, School of Life Sciences.
    Strategies of pain assessment used by nurses on surgical units2005In: Pain Management Nursing, ISSN 1524-9042, E-ISSN 1532-8635, Vol. 6, no 1, p. 3-9Article in journal (Refereed)
    Abstract [en]

    The purpose of this study was to identify the criteria nurses actually used to assess postoperative pain and the kind of knowledge they drew on from past experience. A series of semistructured interviews were performed with 10 nurses while they conducted pain assessments with 30 postsurgical patients. Data were analyzed on the basis of Dahlgren and Fallsberg’s (1991) analytic approach called phenomenography. Findings were compared with Sjöström’s 1995 study of nurses in Sweden. Nurses in this study, much like the group in Sweden, used three categories of criteria (i.e., how the patient looked, what the patient said, and experience with similar circumstances) and drew on their past experiences in four different ways (i.e., in terms of a typology of patients, a focus on listening to patients, what to look for, and what to do for patients) when assessing postoperative pain. In the most frequently reported strategy, nurses relied on criteria related to the patient’s appearance and drew on their past experience in terms of what physical signs to look for (e.g., facial expressions, bodily movement, and heart rate). The variety of strategies used by nurses in this study opens an avenue for further investigating the linkage between underlying conceptions of pain (as essentially subjective vs. objective phenomenon) and the quality and effectiveness of nurses’ assessments of pain and its management in postoperative and other contexts across nursing.

  • 2.
    Warrén-Stomberg, Margareta
    et al.
    University of Skövde, School of Life Sciences.
    Lorentzen, Per
    Skaraborgs Hospital, Skövde, Sweden.
    Joelsson, Håkan
    Skaraborgs Hospital, Skövde, Sweden.
    Lindquist, Helene
    Skaraborgs Hospital, Skövde, Sweden.
    Haljamäe, Hengo
    Sahlgrenska University Hospital, Göteborg, Sweden.
    Postoperative pain management on surgical wards: impact of database documentation of anesthesia organized services2003In: Pain Management Nursing, ISSN 1524-9042, E-ISSN 1532-8635, Vol. 4, no 4, p. 155-164Article in journal (Refereed)
    Abstract [en]

    Postoperative pain management (POPM) should be based on an organization exploiting existing expertise and documenting the outcome of the POPM in each individual patient. The aims of the present study were to evaluate the adequacy of database documentation of POPM of an anesthesia organized, nurse-based, anesthesiologist-supervised acute pain service (APS) on surgical wards and to assess to what extent the information obtained was continuously used to improve practice. From 2890 registered cases in the database (patient controlled analgesia, n = 1975; epidural analgesia [EDA], n = 915), a homogeneous two-year sample of documentation charts from use of EDA for POPM in connection with major, open, abdominal surgical procedures (n = 381) was chosen for detailed analysis. The data charts contained information on patient data, drug dosage, total amount of infused drug, duration of EDA treatment, occurrence of side effects, and patient’s level of satisfaction. The database information was easily accessible making assessment of relevant aspects of the routines, including associations between analgesic technique, patient related factors, and satisfaction with the services, immediately available. Only 58% of the data charts were properly completed and fed into the database but the clinical safety of the missing nondatabase documented sample was not found jeopardized. Although the database documentation routines were considered to fulfill basic requirements of data collection and monitoring of the appropriateness of POPM, they were not found to function optimally. The reason seemed to be inadequate feedback of information between the parties involved in the POPM services. The present study stresses the importance of establishing routines for adequate, continuous feedback of recorded audit data from the APS team to the surgical wards for the maintenance of a high level of compliance with accepted guidelines.

  • 3.
    Warrén-Stomberg, Margareta
    et al.
    University of Skövde, School of Life Sciences.
    Wickström, Kerstin
    Sahlgrenska University Hospital, Göteborg, Sweden.
    Joelsson, Håkan
    University of Skövde, School of Life Sciences. Skaraborgs Hospital, Skövde, Sweden.
    Sjöström, Björn
    University of Skövde, School of Life Sciences. Sahlgrenska University Hospital, Göteborg, Sweden.
    Haljamäe, Hengo
    Sahlgrenska University Hospital, Göteborg, Sweden.
    Postoperative pain management on surgical wards: do quality assurance strategies result in long-term effects on staff member attitudes and clinical outcomes?2003In: Pain Management Nursing, ISSN 1524-9042, E-ISSN 1532-8635, Vol. 4, no 1, p. 11-22Article in journal (Refereed)
    Abstract [en]

    Postoperative pain management (POPM) remains suboptimal on surgical wards in many countries despite the availability of effective analgesics, new technologies for drug administration, and clinical practice guidelines for pain management. The aim of the present study was to assess remaining long-term effects on pain management routines, patient experiences, and staff member attitudes in surgical wards more than 3 years after introduction of a quality assurance program for POPM and compare the findings to those of an organization where a corresponding systematic, entire hospital, quality assurance program had not been completed. A descriptive and comparative design, based on survey data from both patients (N = 110) and staff members (N = 51) on urologic surgery wards, was used. Significant (p < .05 to p < .0002) overall relationships were observed for identified shortages in pain management routines (lack of preoperative information, inadequate preoperative discussions on pain management, wait for pain killer) and reported experience of pain, nausea, or vomiting in the postoperative period. The quality assurance program, anesthesia-based pain services using a nurse-based anesthesiologist-supervised model, resulted in more adequate pain management routines, better patient satisfaction with POPM, and increased confidence in pain management among nurses on the surgical wards. On the basis of the present study it may be concluded that more than 3 years after the introduction of a quality assurance program for POPM in surgical wards, the pain management routines, patient experiences, and staff member attitudes have remained markedly improved and in accordance with the aims of accepted clinical practice guidelines for surgical pain management.

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