The journey of the pain resource nurse in improving pain management practices: understanding role implementation.

Pain assessment and management continues to be challenging for many nurses. Single educational interventions have proven to be unsuccessful in knowledge retention. This study will assist leaders in nursing in understanding how a 4-day educational program delivered to self-selected pain resource nurses (PRNs) could improve pain assessment and management practices. A focus group study was undertaken at a trisite academic health science center to understand the role implementation of the PRNs and required resources to sustain the role at a unit level. To evaluate the PRN role, a qualitative descriptive study design using focus group interviews was used to answer the following questions: What was the experience of the PRN during role implementation? What barriers and enablers affected the implementation of this role? Organizational support, integration within the interdisciplinary team, and organizational role awareness were key themes highlighted in the focus group results. This article will describe how the three-site academic health science center used the PRN role to foster practice-related change and enhance current knowledge of evidence-based pain management.

Patient-controlled oral analgesia for postoperative pain management following total knee replacement.

PURPOSE: To investigate whether patient-controlled oral analgesia (PCOA) used by individuals receiving a total knee replacement could reduce pain, increase patient satisfaction, reduce opioid use and/or reduce opioid side effects when compared with traditional nurse (RN)-administered oral analgesia. METHODS: Patients who underwent an elective total knee replacement at a quaternary care centre (Toronto Western Hospital, Toronto, Ontario) were randomly assigned to either PCOA or RN-administered short-acting oral opioids on postoperative day 2. Subjects in the RN group called the RN to receive their prescribed short-acting opioid. Subjects in the PCOA group kept a single dose of their prescribed oral opioid at their bedside and took this dose when they felt they needed it, to a maximum of one dose every 2 h. Study outcomes, collected on postoperative day 2, included pain (measured by the Brief Pain Inventory - Short Form), patient satisfaction (measured by the Pain Outcome Questionnaire Satisfaction subscale - component II), opioid use (oral morphine equivalents), opioid side effects (nausea, pruritus and/or constipation) and knee measures (maximum passive knee flexion and pain at maximum passive knee flexion, performed on the operative knee). RESULTS: Study outcomes were analyzed twice. First, for a subset of 73 subjects who remained in their randomly assigned group (PCOA group, n=36; RN group, n=37), randomized analyses were performed. Second, for the larger sample of 88 subjects who were categorized by their actual method of receiving oral opioids (PCOA group, n=41; RN group, n=47), as-treated analyses were performed. There were no differences in study outcomes between the PCOA and RN groups in either analysis. CONCLUSION: PCOA was not superior to RN administration on study outcomes. However, PCOA did not increase opioid use or pain. PCOA remains an important element in the patient-centred care facility.

What do adult surgical patients really want to know about pain and pain management?

This study investigates the informational content about postoperative pain and pain management that patients identify as being most important. In a descriptive quantitative study design, a convenience sample of 150 general day surgery patients were surveyed by telephone within 72 h after discharge from a hospital day surgery unit. The survey consisted of 19 items rated on a 10-point Likert scale of importance. Composite mean scores were calculated for each item. Chi-squared analyses were used to probe for intergroup differences. Mean information item importance scores ranged from 5.9/10 to 8.7/10. The top three were discharge-related items. The majority of the lowest ratings were for general pain management information items. "If I can get addicted to drugs used to treat my pain" was rated the fourth lowest in importance. "I would have liked to have known other ways of dealing with my pain in addition to pain medicine" was significantly associated with duration of pain preoperatively (chi-squared = 0.010). None of the other information items were associated with preoperative pain duration. All of the pain and pain management survey information items were of moderate (5-6/10) to high (>7/10) importance to the general day surgery patient participants. Of prime importance was information related to what to do about pain and side effects after discharge. Because patients place high importance on information about the pain experience, the pain management plan after discharge, and side effect management, health care professionals need to focus their pain management counseling in these areas.

Patient-controlled oral analgesia: a low-tech solution in a high-tech world.

The primary concern of surgical patients is the expected experience of pain. Presently, the standard for acute postoperative pain management is intravenous patient-controlled analgesia (PCA). Many authors have reported that patients prefer intravenous PCA to nurse-administered analgesia because it affords them greater control and optimizes their pain relief. However, when the patient strengthens and is able to resume enteral sustenance, intravenous PCA is routinely discontinued and replaced with nurse-administered oral analgesia. This eliminates much of the patients' control over managing their pain and results in patients waiting, in pain, for a nurse to bring their pain tablets. When PCA is administered in the hospital setting, it is most often administered by intravenous, subcutaneous, or epidural routes. This article describes the implementation of a successful inpatient program that offers patient-controlled oral analgesia (PCOA). Patient-centered care is "an approach that consciously adopts the patient's perspective...about what matters." Patient-centered care is the practice philosophy of the University Health Network, a large tri-site teaching hospital in downtown Toronto, Ontario, Canada, affiliated with the University of Toronto. This philosophy underpins the concept of PCOA as it has been successfully operationalized in a unique PCOA program at the Toronto Western Hospital, one of the three sites comprising the University Health Network.