Postoperative Pain Assessment and Management: The Effects of an Educational program on Jordanian nurses' practice, knowledge, and attitudes

摘要

Aims: The overall aims of this thesis was describe the current nursing postoperative pain assessment and management practices in the surgical wards in Jordan and evaluate the effectiveness of implementing a ostoperative pain management (POPM) program in improving the Jordanian nurses’ POP assessment and management practices in the surgical wards. Lewin’s Force-Field Model for change provided the structure for planning for and implementing the POPM program.Method: Both qualitative and quantitative approaches were used. Qualitative content analysis inspired by the hermeneutic philosophy was used to describe the surgical nurses’ experiences in caring for patients having POP. Data were collected by interviewing 12 registered nurses working in surgical wards at four hospitals in Jordan. A retrospective quantitative design was used to collect data on the documentation system and strategies of the POP assessment and management in the surgical wards. A total of 322 patients’ records obtained from six hospitals in Jordan were audited in six-month period. The records review was performed using three audit instruments. Later, a POPM program for nurses was implemented in two surgical wards at a university hospital in Jordan. The program was evaluated by means of a quasi-experimental design with a nonequivalent control group where the control group (120 patients) and the intervention group (120 patients) were not drawn from the same population. All registered nurses (65 nurses) employed in the two surgical wards participated in the study to implement the program. First, assessment of patients’ communication about pain with nurses and their satisfaction about nurses’ intervention were assessed by means of a questionnaire. Second, the quality of nurses’ pain assessment was evaluated by comparing the attending nurses’ assessment of patients’ pain intensity rating scores with the researcher’s rating scores of the same patients. Third, a questionnaire was used to test the nurses’ knowledge of and their attitudes toward pain. Forth, the records were audited before and after the intervention. The POPM program was implemented for three months.Findings: The findings of the studies I and II formulated the foundation where the researchers can illuminate the main issues and obstacles in the process of change toward better POP management. Findings from these studies draw attention to the fact that there is an urgent need for improving POP assessment, management and documentation. The findings illustrated that the implementation of an educational program for nurses was successful. First of all, the quality communicated information about pain and pain management with patients was significantly improved. Secondly, the nurses developed the habit of assessing POP intensity using numeric rating scales, in addition to the assessment of other pain characteristics. Thirdly, the nurses improved their knowledge about POP, and their attitudes toward it were evidently changed. Finally, the nurses improved their practice in documenting patients’ pain. The patients’ records showed a significant difference in the amount and the quality of nursing documentation which reflected the fact that nurses became more aware about the importance of documentation and might also means that they change their practices toward better POP management.Discussion and Implications: The studies provide several contributions to the knowledge and understanding of the POP current management practices such as the recognition of the surgical patients suffering due to the unsatisfactory pain management routines, the impact of health institutions restraints on nurses that prohibit them from providing quality of care for patients with POP, and the need to change the current practices of nursing documentation of POP. The findings add to a growing body of literature on the benefits of implementing educational programs for nurses to improve their roles in caring for patients with POP. The findings of this thesis provide opportunities for nurses to evaluate themselves in the area of POP knowledge and management practices which may affect their caring abilities. Another implication related to nursing practice is that this study might increase the awareness of the health care professionals and the health institutions administration toward the establishment of team work to induce change with a common purpose in upgrading the quality of pain assessment and management. Managers and supervisors can facilitate the application of educational programs and incorporate with the team to move more quickly in the desired change. Implications of the study may be relevant to nursing education and in continuing education of health care institutions.