Time from Pain Assessment to Pain Intervention.

OBJECTIVE: The purpose of this study was to describe factors that influence nurses' time from pain assessment to intervention for acute postsurgical pain. BACKGROUND: Nurses' time is a limited resource that must be optimized to manage patients' pain within budget constraints. Little is known about processes and activities nurses negotiate to manage pain. METHODS: Human factors engineering and ethnography were used to quantify factors influencing time from pain assessment to intervention. RESULTS: On the basis of 175.5 observation hours, nurses spent 11% of shifts (mean, 83 minutes) on pain care activities. Time from alert to intervention with PRN analgesics or biobehavioral strategies for 58 cases ranged from 0 to 48 minutes (mean, <11 minutes). Five factors influenced timeliness. CONCLUSIONS: Nurses most efficiently managed postsurgical pain by giving analgesics ordered PRN on a scheduled basis. Nurse leaders can empower prompt responses to patients' pain through delegation, process improvements, real-time monitoring, and prescriber engagement.

The impact of recreational care activity in the immediate postoperative period / O impacto do cuidado lúdico no pós-operatório imediato / El impacto de la atención de recreo en el postoperatorio inmediato

Objective: The study's goal has been to understand the impact of playful educational actions performed by nurses in the immediate postoperative period, aiming to restore health promotion and maintenance strategies. Methods: It is an action-based research that was carried out in a municipal hospital in the Central region of Rio Grande do Sul State. The participants were hospitalized patients scheduled to undergo cholecystectomy procedure. This research was performed in three stages, as follows: the first one used a semi-structured questionnaire; the second, was the socialization of the recreational strategy developed by the researcher; and the third, sought to evaluate the effectiveness of the recreational activity. Data analysis was done by the content analysis under the thematic modality. Results: "Playfulness allied to therapeutic communication determining the confrontation of the perioperative process" and "Playfulness in the nursing consultation as a strategy toward the health education and self-care stimuli". Conclusion: The playful educational activities toward clients hospitalized for surgical procedure impact as a care methodology with innovative, active, and dialogic characteristics, then providing moments of demystification and understanding of the context that will be experienced in a creative and light way

Objetivo: Compreender o impacto de ações educativas lúdicas realizadas pelo enfermeiro no pós-operatório imediato, visando reconstruir estratégias de promoção e manutenção da saúde. Métodos: Trata-se de uma pesquisa-ação, realizada em um hospital municipal na região central, Rio Grande do Sul. Os participantes foram pacientes internados para realização de colecistectomia. Feita em três momentos, primeiro utilizou um questionário semiestruturado; segundo, a socialização da estratégia lúdica desenvolvida pelo pesquisador; terceiro, buscou avaliar a efetividade da ação educativa lúdica. Submetidos à análise de conteúdo, na modalidade temática. Resultados: "Ludicidade aliada à comunicação terapêutica determinando o enfrentamento do processo perioperatório" e "Ludicidade na consulta de Enfermagem como estratégia de educar para a saúde e estimular o autocuidado". Conclusão: As ações educativas lúdicas a clientes internados para a realização de procedimento cirúrgico impactam como uma metodologia de cuidado inovadora, ativa e dialógica, proporcionando momentos de desmistificação e compreensão do contexto que será vivenciado, de forma criativa e leve. Descritores: Educação em Saúde, Promoção da Saúde, Enfermagem, Ludicidade

Objetivo: Comprender el impacto de las actividades educativas recreativas llevadas a cabo por personal de enfermería en el postoperatorio inmediato, con el objetivo de reconstruir las estrategias de promoción y mantenimiento de la salud. Métodos: Se trata de una investigación en la acción llevada a cabo en un hospital municipal en la región central, RS. Los participantes fueron pacientes hospitalizados para la colecistectomía. Que tuvo lugar en tres etapas, que se utiliza por primera vez un cuestionario semi-estructurado, de acuerdo con la socialización de la estrategia de juego desarrollado por el investigador, en tercer lugar, tuvo como objetivo evaluar la eficacia de las actividades lúdicas educativas. Sometido a análisis de contenido, modalidad temática. Resultados: "Lo lúdico combinan con la comunicación terapéutica determinar la cara del proceso perioperatorio" y "Lo lúdico en consulta de Enfermería como una estrategia para educar a la salud y estimular el autocuidado." Conclusión: Las actividades lúdicas educativas a los clientes hospitalizados para llevar a cabo la cirugía de impacto como una metodología innovadora de atención, activa, y de diálogo, proporcionando momentos de desmitificación y la comprensión del contexto que se experimentará, forma creativa y la luz

STOPDVTs: Development and testing of a clinical assessment tool to guide nursing assessment of postoperative patients for Deep Vein Thrombosis.

AIMS AND OBJECTIVES: To develop and test a clinical tool to guide nurses' assessment of postoperative patients for Deep Vein Thrombosis. BACKGROUND: Preventing venous thromboembolism in hospitalised patients is an international patient safety priority. Despite high-level evidence for optimal venous thromboembolism prophylaxis, implementation is inconsistent and the incidence of Deep Vein Thrombosis remains high. METHODS: A two-stage sequential multi-method design was used. In stage 1, the STOPDVTs tool was developed using a review of the literature and focus groups with local clinical experts. Stage 2 involved pilot testing the tool with 38 surgical nurses who conducted repeated assessments on a prospective sample of 50 postoperative orthopaedic patients. RESULTS: Stage 1: The focus group members who were members of the nursing leadership team agreed on eight local and systemic signs and symptoms that should be included in a nursing patient assessment tool for early Deep Vein Thrombosis. Local symptoms were pain in the limbs, calf swelling and tightness, changes in the affected limb's skin temperature. Systemic signs included in the tool were as follows: increased shortness of breath, increased respiratory and heart rates, and decreased oxygen saturation. Stage 2: The STOPDVTs tool had acceptable face and content validity, the agreement between the expert nurse and surgical nurses on assessments of individual signs and symptoms varied between 44%-94%. Surgical nurses were less likely than the expert nurse to identify signs indicative of Deep Vein Thrombosis. CONCLUSION: Despite finding the STOPDVTs clinical assessment tool was a useful guide for nursing assessment, surgical nurses often underestimated the potential importance of clinical signs. The findings reveal a gap in nursing knowledge and skill in assessing for Deep Vein Thrombosis in postoperative orthopaedic patients. RELEVANCE TO CLINICAL PRACTICE: This study identified a possible risk to patient safety related to under-recognition of the signs and symptoms of possible Deep Vein Thrombosis (DVT) in postoperative orthopaedic patients. The findings demonstrate the feasibility of developing and implementing a protocol for consistent screening by nurses for possible DVT in the postoperative period.

Auditing the needs of recovery room staff providing care for the child in an acute hospital.

This article examines the results of an audit into recovery nurse knowledge and understanding of paediatric care standards. It will critically analyse the availability of current standards for children's services in the recovery room and discuss the need for a national document specifically dedicated to standards of practise for the care of the child in the recovery room providing immediate post operative care. The article will also look at the development of such a document.

Assessment of Nursing Deficiencies in the Postoperative Care of Microsurgical Patients.

Background Close monitoring is crucial following successful flap surgery. Ideally, all patients undergoing microvascular reconstruction should be evaluated in a dedicated unit with specialized nurses; however, this is not always possible and there is often a varied skill mix of nursing staff. The purpose of this study was to identify deficiencies in microsurgical education among nursing staff in an effort to target future educational efforts. Methods A 22-question electronic survey was sent out to all nursing staff at three sampled hospitals that manage microsurgical patients. Statistical analysis was performed to identify factors that predicted aptitude, comfort, and deficiencies in the treatment of microsurgical patients. Results Of the 160 registered nurses sampled, 106 completed the survey completely (66%). A total of 59 nurses worked at a tertiary care academic institution (55%) and the remaining 47 nurses worked at one of two community hospitals (45%).Regardless of whether the provider self-identified as a critical care or floor nurse, nurses from an academic medical center were significantly more comfortable with their ability to care for microsurgical patients when compared with their community medical center counterparts (p < 0.05). Furthermore, regardless of whether the provider self-identified as a critical care or the hospital setting where they worked, nurses with greater than 5 years of experience were significantly more comfortable with their ability to care for microsurgical patients when compared with nurses who had less than 5 years of experience (p < 0.05).There was no correlation with comfort level and the ability to interpret various postoperative flap-monitoring technologies between intensive care unit nurses and floor nurses. Conclusions We have identified that nurses with less than 5 years of experience or nurses in a community setting may be less comfortable with the care of postoperative microsurgical patients, especially if newer flap monitoring technologies are employed.

Surgical wound assessment and documentation of nurses: an integrative review.

OBJECTIVE: Surgical site infections (SSI) are serious complications that can lead to adverse patient outcomes such as prolonged hospital length of stay, increased health-care costs, and even death. There is an imperative worldwide to reduce the morbidity associated with SSIs. The importance of surgical wound assessment and documentation to reduce SSI complications is increasingly recognised. Evidence-based guidelines have been published internationally to highlight recommended practices. The aim of this integrated review is to evaluate current surgical wound assessment and documentation practices of nurses in order to inform future evidence-based research on acute wound care practices. METHOD: Databases including CINAHL, Cochrane, Medline and Proquest Nursing were searched using key terms of 'wound assessment' AND 'surgical, wound assessment' AND 'documentation, wound assessment' AND 'practice, wound assessment' AND 'postoperative, wound assessment' AND 'nurse, and wound assessment' AND 'surgical site infection'. RESULTS: A total of 188 articles were identified from the database searches; searching the reference lists provided an additional 8 articles. After careful exclusion processes, a total of six papers were included in the review. Despite the recommendations around wound assessment, there is little discussion on how the clinical characteristics of surgical wounds should be assessed, the frequency of the wound assessments and to what extent wound assessments are documented in the literature. CONCLUSION: There is limited research evidence on acute wound assessment and documentation. Therefore, further research is needed to provide evidence for surgical nurses in relation to wound assessment and documentation practices. DECLARATION OF INTEREST: The authors declare that they have no conflict of interest.

Stoma creation: does onset of ostomy care education delay hospital length of stay?

BACKGROUND: Balancing patient safety with hospital length of stay (LOS) and associated cost is critically important. Subjectively, we have observed that patients undergoing ostomy creation early in the week have a shorter LOS. METHODS: We retrospectively reviewed LOS based on day of the week the operation was performed. RESULTS: We reviewed 180 patients undergoing minimally invasive surgery with planned ostomy. Group 1 underwent surgery on Monday to Wednesday (n = 77), Group 2 on Thursday (n = 49), and Group 3 on Friday (n = 54). The average LOS for Group 1, 2, and 3 was 6.2, 4.9, and 7.2 days, respectively. The average number of visits with ostomy nursing for Group 1, 2, and 3 was 2.7, 1.8, and 2.3, respectively. Day of initial ostomy nursing visit was significantly correlated between the delay to initial visit and LOS with Group 3 delayed most. CONCLUSIONS: Patients with the longest delay to initial nurse visit had the longest LOS, with Friday operations being most delayed. A contributing factor may be absence of ostomy teaching over the weekend.

The value of a progressive care environment for neurosurgical patients.

Intensive care is expensive and stressful for patients and families. With rising healthcare costs, hospitals need other options. This retrospective, descriptive study explored the efficacy of using a progressive care environment to manage stable, complex patients out of the intensive care unit. Data were collected on 114 neurosurgical patients using specific inclusion and exclusion criteria before and after implementation of progressive care beds within a standard medical-surgical unit. Patients in the "after" group had a statistically significant decrease in the number of intensive care unit days and overall hospital length of stay. The results suggest that it is possible for positive patient outcomes using this model if these patients are carefully selected, nurses are appropriately educated, and a collaborative approach is used.

Postsurgery wound assessment and management practices: a chart audit.

AIMS AND OBJECTIVES: To examine wound assessment and management in patients following surgery and to compare these practices with current evidence-based guidelines for the prevention of surgical site infection across one healthcare services district in Queensland, Australia. BACKGROUND: Despite innovations in surgical techniques, technological advances and environmental improvements in the operating room, and the use of prophylactic antibiotics, surgical site infections remain a major source of morbidity and mortality in patients following surgery. DESIGN: A retrospective clinical chart audit METHODS: A random sample of 200 medical records of patients who had undergone surgery was undertaken over a two-year period (2010-2012). An audit tool was developed to collect the data on wound assessment and practice. The study was undertaken across one healthcare services district in Australia. RESULTS: Of the 200 records that were randomly identified, 152 (76%) met the inclusion criteria. The excluded records were either miscoded or did not involve a surgical incision. Of the 152 records included, 87 (57·2%) procedures were classified as 'clean' and 106 (69·7%) were elective. Wound assessments were fully documented in 63/152 (41·4%) of cases, and 59/152 (38·8%) charts had assessments documented on a change of patient condition. Of the 15/152 (9·9%) patients with charted postoperative wound complications, 4/15 (26·6%) developed clinical signs of wound infection, which were diagnosed on days 3 to 5. CONCLUSIONS: The timing, content and accuracy of wound assessment documentation are variable. Standardising documentation will increase consistency and clarity and contribute to multidisciplinary communication. RELEVANCE TO CLINICAL PRACTICE: These results suggest that postoperative wound care practices are not consistent with evidence-based guidelines. Consequently, it is important to involve clinicians in identifying possible challenges within the clinical environment that may curtail guideline use.

Ward-based, nurse-led, outpatient chest tube management: analysis of impact, cost-effectiveness and patient safety.

OBJECTIVES: Prolonged drainage and air leaks are recognized complications of elective and acute thoracic surgery and carry significant burden on inpatient stay and outpatient resources. Since 2007, we have run a ward-based, nurse-led clinic for patients discharged with a chest drain in situ. The aim of this study is to assess its cost-effectiveness and safety. METHODS: We present a retrospective review of the activity of the clinic for a period of 12 months (November 2009-10). An analysis of the gathered data is performed, focusing specifically on the duration of chest tube indwelling, the indications, complications and cost efficiency. RESULTS: The nurse-led clinic was housed in the thoracic ward with no additional fixed costs. Seventy-four patients were reviewed (53 males, 21 females, mean age of 59) and subsequently discharged from the clinic in this time period, accounting for 149 care episodes. Thirty-three (45%) of the patients underwent a video-assisted thoracoscopic surgery procedure, 35 (47%) of them a thoracotomy and 7 (9%) had a bedside chest tube insertion. Following hospital discharge, the chest tubes were removed after a median of 14 days (range 1-82 days). Fifty-eight percent of the patients were reviewed because of a prolonged air leak, 26% for persistent fluid drainage and 16% due to prolonged drainage following evacuation of empyemas. For the care episodes analysed, we estimate that the clinic has generated an income of €24,899 for the department. Hourly staffing costs for the service are significantly lower compared with those of the traditional outpatient clinic: €15 vs. €114. CONCLUSIONS: Our results show that a dedicated chest tube monitoring clinic is a safe and efficient alternative to formal outpatient clinic review. It can lead to shorter hospital stays and is cost effective.

Pressure ulcer prevention in high-risk postoperative cardiovascular patients.

BACKGROUND: Little has been published about how to prevent pressure ulcers in severely debilitated, immobile patients in intensive care units. OBJECTIVE: To present a possible prevention strategy for postoperative cardiovascular surgery patients at high risk for development of pressure ulcers. METHODS: Staff chose to implement air fluidized therapy beds, which provide maximal immersion and envelopment as a measure for preventing pressure ulcers in patients who (1) required vasopressors for at least 24 hours and (2) required mechanical ventilation for at least 24 hours postoperatively. RESULTS: Only 1 of 27 patients had a pressure ulcer develop while on the air fluidized therapy bed (February 2008 through August 2008), and that ulcer was only a stage I ulcer, compared with 40 ulcers in 25 patients before the intervention. CONCLUSIONS: Patients spent a mean of 7.9 days on the mattress, and the cost of bed rental was approximately $18000, which was similar to the cost of treatment of 1 pressure ulcer in stage III or IV (about $40000) and was considered cost-effective.

Does the postoperative dressing regime affect wound healing after hip or knee arthroplasty?

OBJECTIVE: The aim of this literature review is to enable practitioners to make informed decisions about how to manage patients with hip or knee arthroplasty wounds. METHOD: A systematic critique of the evidence in relation to how the postoperative dressing regime may affect wound healing after hip or knee arthroplasty, was undertaken. RESULTS: No single treatment emerged as the ideal postoperative dressing regime for hip and knee arthroplasty wounds. CONCLUSION: A selection of dressings is recommended for hip and knee arthroplasty wounds, on the basis of reducing the incidence of postoperative blistering and wound infection.

Healthcare utilization in women after abdominal surgery for ovarian cancer.

BACKGROUND: Women undergoing surgery for ovarian cancer are severely ill and are high users of health services. Contributing to these increased utilization rates are the multiple modalities used to treat ovarian cancer and the complications and side effects from those treatments. OBJECTIVE: The purpose of this study was to evaluate the effectiveness of an intervention provided by advanced practice nurses and a psychiatric consultation-liaison nurse on patients' self-report of healthcare utilization compared with an attention control intervention in women undergoing surgery for a suspected diagnosis of ovarian cancer. METHODS: A two-group, experimental, longitudinal design was used to compare women who were assigned randomly to the intervention group or to an attention control group at baseline within 48 hours after surgery and 1, 3, and 6 months after surgery. Healthcare utilization was measured as the number of self-reported inpatient admissions and outpatient visits, including emergency room visits, oncology outpatient visits, and primary care visits. Nurse interventions consisted of 16 contacts: symptom management, counseling, education, direct nursing care, coordination of resources, and referrals. The attention control interventions consisted of nine contacts that included instructions on use of a symptom management toolkit and strategies on how to manage symptoms. RESULTS: There were no differences in hospitalizations and oncology outpatient visits between the two groups. The main finding of this study was a significant difference in the number of primary care visits between the two groups. Women in the attention control group went to their primary care providers more often than the intervention group. The women who reported more visits also reported more depressive symptoms. In addition, a trend was found in the number of emergency room visits between the two groups. The intervention group visited the emergency room more often because the nurse instructed patients to go when they recognized symptoms that needed urgent care after hours. DISCUSSION: Women in the intervention group appropriately used the emergency room to manage their problems after hours, whereas more women in the attention control group reported significantly more primary care visits. These findings highlight the need for healthcare providers representing various disciplines to coordinate services across specialties, especially for women who have depressive symptoms.

Post-operative telephone review is cost-effective and acceptable to patients.

INTRODUCTION: Patients undergoing selective minor emergency and elective procedures are followed up by a nurse-led structured telephone review six weeks post-operatively in our hospital. Our study objectives were to review patients' satisfaction, assess cost-effectiveness and compare our practice with other surgical units in Northern Ireland (NI). PATIENTS AND METHODS: Completed telephone follow-up forms were reviewed retrospectively for a three-year period and cost savings calculated. Fifty patients were contacted prospectively by telephone using a questionnaire to assess satisfaction of this follow-up. A postal questionnaire was sent to 68 general and vascular surgeons in NI, assessing individual preferences for patient follow-up. RESULTS: A total of 1378 patients received a telephone review from September 2005 to September 2008. One thousand one hundred and seventy-seven (85.4%) were successfully contacted, while 201 (14.6%) did not respond despite multiple attempts. One hundred and forty-seven respondents (10.7%) required further outpatient follow-up, thereby saving 1231 outpatient reviews, equivalent to £41,509 per annum. Thirty-nine (78%) patients expected post-operative follow-up, with 29 (58%) expecting this in the outpatient department. However, all patients were satisfied with the nurse-led telephone review. Fifty-three (78%) consultants responded. Those who always, or occasionally, review patients post-operatively varies according to the operation performed, ranging from 2.2% appendicectomy patients to 40.0% for varicose vein surgery. CONCLUSION: Current practice in NI varies, but a significant proportion of patients are not routinely reviewed. This study confirmed that patients expect post-operative follow-up. A nurse-led telephone review service is acceptable to patients, cost-effective and reduces the number of unnecessary outpatient reviews.

Barrier dressings in surgical site infection prevention strategies.

Healthcare-associated infections (HCAIs) are a matter of priority for the NHS. They are associated with significant morbidity, and frequently lead to increased length of hospital stay, pain and discomfort for the patient, and in some cases even permanent disability. It is estimated that surgical site infections (SSIs) constitute around 14% of all HCAIs. Any break in the skin affords a portal of entry for microbial pathogens, and hence places the patient at an increased risk of infection. To address the issue, a multi-factorial strategy for the prevention of SSIs is essential, with postoperative dressings playing a key part alongside universal precautions such as hand hygiene and aseptic technique. The available guidance specifies the need for a postoperative dressing which provides an effective physical barrier and a moist environment for optimal wound healing. Vapour-permeable barrier dressings appear to be effective in meeting both of these criteria and also offer additional advantages both to patients and practitioners, such as patient comfort and the ability to stay in place whilst the patient showers. However, regular wound assessment must be carried out to ensure the vapour-permeable postoperative dressing is the right choice for a specific patient at a given time.

Pain assessment tool in the critically ill post-open heart surgery patient population.

Critical-care patients are at higher risk for untreated pain, because they are often unable to communicate owing to altered mental status, mechanical ventilation, and sedation. Pain that is persistent and untreated affects most body systems and results in development of complications chronic pain, and increased length of stay. This descriptive repeated-measures study compared three pain assessment tools in nonverbal critically ill patients in a cardiac postanesthesia care unit (n=24). Tools included the Critical-Care Pain Observation Tool (CPOT), adult Nonverbal Pain Scale (NVPS), and the Faces, Legs, Activity, Cry, and Consolability scale (FLACC). Two painful events, suctioning and repositioning, were studied. Data were collected immediately before the event, 1 minute after, and 20 minutes after. Both the CPOT and the NVPS demonstrated high reliability (Cronbach alpha coefficients 0.89). The NVPS and the CPOT were highly correlated for both raters (r>0.80, p=.00) (11 out of 12 times). Correlations between the two raters was generally moderate to high, but higher with the CPOT. There was more disagreement between raters in overall pain scores for the NVPS. When raters disagreed, it was most often in rating the face component on both scales. Disagreement was highest during the event. Both scales adequately capture pain in the nonverbal sedated critically ill patient based on assessment of patients' face, body movements, muscle tension, and respirations, with the NVPS also considering vital signs. Pictures depicting facial expressions for scoring purposes are helpful. Adequate education and understanding of use of the scales is critical for accurate assessment and subsequent interventions.

Increasing nurse staffing levels in Belgian cardiac surgery centres: a cost-effective patient safety intervention?

AIM: This paper is a report of a cost-effectiveness analysis from a hospital perspective of increased nurse staffing levels (to the level of the 75th percentile) in Belgian general cardiac postoperative nursing units. BACKGROUND: A previous study indicated that increasing nurse staffing levels in Belgian general cardiac postoperative nursing units was associated with lower mortality rates. Research is needed to compare the costs of increased nurse staffing levels with benefits of reducing mortality rates. METHOD: Two types of average national costs were compared. A first calculation included the simulation of an increase in the number of nursing hours per patient day to the 75th percentile for nursing units staffed below that level. For the second calculation (the comparator) we used a 'do nothing' alternative. The most recent available data sources were used for the analysis. Results were expressed in the form of the additional costs per avoided death and the additional costs per life-year gained. The analysis used 2007 costing data. FINDINGS: The costs of increasing nurse staffing levels to the 75th percentile in Belgian general cardiac postoperative nursing units amounted to euro1,211,022. Such nurse staffing levels would avoid an estimated number of 45.9 (95% confidence interval: 22.0-69.4) patient deaths per year and generate 458.86 (95% confidence interval: 219.93-693.79) life-years gained annually. This corresponds with incremental cost-effectiveness ratios of euro26,372 per avoided death and euro2639 per life-year gained. CONCLUSION: Increasing nurse staffing levels appears to be a cost-effective intervention as compared with other cardiovascular interventions.

Postoperative pain characteristics in Turkish orthopedic patients.

Postoperative pain is a subjective concept that can only be defined by the individual experiencing it. This research was planned as a descriptive study to make postoperative pain assessments of patients who have undergone major orthopedic surgery. The study sample consisted of 150 patients who met the inclusion criteria and agreed to participate in the study. Data were collected using a questionnaire form that included sociodemographic, postoperative pain characteristics, and the McGill Pain Questionnaire. The data obtained were assessed using the SPSS 10.0 program. The mean age of the patients was 54.13 +/- 18.12 years, 67.3% were female, 72.7% of the patients had a history of previous surgery, 43.3% had had hip prosthesis surgery, and 70.7% when their analgesic medications were taken on PRN basis. They experienced "external" pain at the surgical site and in pressure areas according to type of surgery and verbalized their pain at the highest percentages as "throbbing," "tiring," "troublesome," and "nagging." In addition the majority of the patients (95.3%) stated that their pain was decreased with analgesic medication administration, and 78.7% stated that position change and physical therapy (69.3%) increased their pain. In the assessment of pain severity on the third postoperative day, the Present Pain Intensity was determined to be a mean of 1.75 +/- 1.02 (on a scale of 0 to 5), and 78.7% had "intermittent" pain. In addition, worst/severe pain severity was determined to be a mean of 4.55 +/- 0.70 on the third postoperative day. Statistically significant differences were found between patients' pain severity scores (p