?I think PCA is great, but�.�.�.??Surgical nurses' perceptions of patient-controlled analgesia

Nurses' knowledge and attitudes toward patient-controlled analgesia for postoperative pain control in a tertiary hospital in South Korea

BACKGROUND

This study investigated the knowledge and attitude of surgical ward nurses toward patient-controlled analgesia (PCA) to develop educational material for nurses on the use of PCA.

METHODS

This study was a cross-sectional study comprising 120 nurses from eight surgical wards in a tertiary hospital in South Korea. A questionnaire addressing 6 domains of knowledge of and attitudes towards PCA was conducted over 1 week and analyzed using descriptive and inferential statistical methods. Knowledge was measured on a categorical scale of 0 and 1 (20 points), and attitude was measured on a Likert scale of 1 to 4 points (60 points).

RESULTS

The total score quantifying the knowledge of and attitudes toward PCA of surgical ward nurses was 59.5 ± 5.5 out of 80.0 points. The average age of the subjects was 28.58 ± 5.68 years old, and nurses above the age of 28 had significantly greater knowledge and better attitudes (61.7 ± 5.5) than those below the age of 28 (57.9 ± 4.9) (p < .001). Nurses working on the upper abdominal surgical ward had significantly greater knowledge (16.2 ± 1.9) than nurses working on other wards (thorax: 14.0 ± 2.3, lower abdominal: 15.4 ± 1.9, and musculoskeletal: 14.5 ± 2.2) (p = .001). Nurses who received education about PCA had significantly better attitudes (45.3 ± 4.6) than those who did not (41.3 ± 3.5) (p < .001). The average correct answer rate for knowledge of opioid analgesics was lower (68.2%) than that for knowledge of the basic configuration of PCA equipment (73.3%) and areas to be identified and managed when using PCA (84.6%), and there was a significant correlation with attitudes toward side effect management (p < .05, r = .19).

CONCLUSIONS

There was a significant correlation between the knowledge and attitude of nurses regarding opioid use in PCA. Older nurses with greater clinical experience on the surgical wards who had received PCA education had a better attitude toward PCA. Therefore, newly trained nurses on surgical wards with no experience of PCA education should undergo an intensive education program on opioid analgesics used in PCA.

Enhanced preoperative education about continuous femoral nerve block with patient-controlled analgesia improves the analgesic effect for patients undergoing total knee arthroplasty and reduces the workload for ward nurses

Background

Total knee arthroplasty (TKA) is the most common treatment for end-stage knee osteoarthritis and continuous femoral nerve block (CFNB) has become the gold standard for analgesia. But the lack of knowledge about CFNB and patient-controlled analgesia (PCA) often leads to inappropriate dose of medications and increased workload for ward nurses.

Methods

After retrospectively registering to http://www.chictr.org.cn (ChiCTR1800018957), 60 patients undergoing unilateral TKA were randomly divided into groups A and B (n = 30 each). Patients in group B and their families received a nurse-led preoperative visit the day before surgery focusing on PCA educational pamphlets for postoperative pain management. Before returning to the ward, patients and their families in both groups received face-to-face PCA pump operation training. The usual postoperative follow-up was performed by nurse anesthetists for 2 consecutive days. Visual Analogue Scale (VAS) scores at rest and during movement, knowledge of the PCA evaluated by a ten-question questionnaire, knee flexion angles, and the number of PCA-related nurse calls were recorded.

Results

The VAS scores at rest and during movement of the patients in group B were both significantly lower than in group A on postoperative days 1 and 2. The questionnaire scores of the patients in group B were much higher than those in group A on postoperative day 1, but not on day 2. Patients in the 2 groups had similar knee flexion on postoperative days 1 and 2. Patients in group B asked for assistance from the ward nurses with the PCA fewer times than those in group A, and the ward nurses were more satisfied with the analgesic protocol in group B.

Conclusions

Enhanced preoperative education for CFNB with PCA can provide patients with a better grasp of postoperative pain management, improve the postoperative analgesic effect after TKA, and reduce the PCA-related workload for ward nurses.

Trial registration

This study was retrospectively registered to ChiCTR (identifier: ChiCTR1800018957) on October 18, 2018.

Electronic supplementary material

The online version of this article (10.1186/s12871-019-0826-3) contains supplementary material, which is available to authorized users.

Patient-controlled epidural analgesia versus conventional epidural analgesia after total hip replacement - a randomized trial

AIMS

Patient-controlled analgesia (PCA) is usually considered a better option for pain management compared to conventional analgesia. The beneficial effect of PCA has been assessed in a number of studies; however, the results are inconsistent. The goal of this study was to compare of patient-controlled epidural analgesia (PCEA) to conventional epidural analgesia after total hip replacement (THR).

METHODS

This prospective study was performed at the Department of Anesthesia and Intensive Care Medicine at a tertiary university hospital. After THR, patients were admitted to the intensive care unit (ICU) and randomized to one of two groups (PCEA and non-PCEA). Postoperative pain in the PCEA group was treated using a standardized protocol, while the analgesia in the non-PCEA group was based on physician prescription according to the patient's clinical condition. The total consumption of analgesics, patients' satisfaction, pain intensity, and analgesia-related complications were recorded for 24 h after surgery.

RESULTS

The final sample consisted of 111 patients (PCEA group, n=55 and non-PCEA group, n=56). The PCEA group had significantly lower total consumption of analgesic mixtures (0.9±0.3 and 1.3±0.4 mL/kg per day, P<0.001).There was greater patient satisfaction (P<0.001) in the PCEA group. The mean pain intensity over 24 hours postoperatively was similar for both groups (P=0.14). There was no significant difference in rate of analgesia-related complications between the groups (hypotension, P=0.14; bradypnea, P=0.11).

CONCLUSION

Compared to conventional epidural analgesia based on physician prescription, PCEA led to less total analgesic consumption and greater patient satisfaction after THR.

Nurses' Perceptions and Attitudes Toward Use of Oral Patient-Controlled Analgesia

Patient-controlled analgesia (PCA) administered intravenously is a generally well-accepted therapy by nurses and patients. PCA devices are now available for oral medications, allowing patients to self-administer pain pills without requesting them from the nurse. Successful introduction of new pain medication delivery devices can depend on nurses' knowledge and attitudes. The aim of this institutional review board approved project was to evaluate nurses' perceptions and attitudes toward using an oral PCA device for patients' pain. A 4-week study was designed and conducted at an academic medical center on an orthopedic unit and a women's health unit. Nurse participants received education on using the oral PCA device and were invited to complete a pre- and poststudy knowledge and attitude survey regarding pain management. Nurses and patients also completed a questionnaire about perceptions related to using the oral PCA device. Findings showed that nurses' attitudes toward using the oral PCA device were less favorable than those of patients, suggesting that nurses may require additional education for acceptance of this device. Results from 37 nurses showed improvement in overall knowledge and attitudes, from 70.8% pretest to 74.2% post-test. Although improvement was not statistically significant (p = .1637), two items showed significant improvement. Knowledge about the effectiveness of NSAIDS was 27.5% pretest compared with 60.0% post-test (p = .0028); and understanding about use of opioids in patients with a history of substance abuse was 50% pretest compared with 70% post-test (p = .0531). Helping nurses overcome the perceived barriers to use of an oral PCA device has potential implications for better pain management as well as enhanced patient satisfaction.

Qualitative research on pain

PURPOSE OF REVIEW

This review brings together developments over the past year in pain research using qualitative methodologies. In line with the goals of the current biopsychosocial model of pain, such a research framework offers in-depth understanding of the experience of pain within its cultural, familial and socioeconomic environmental context.

RECENT FINDINGS

Using 'qualitative' and 'pain' as title and keyword Medline and CSA database searches, the pain literature revealed four main areas where qualitative studies have contributed significantly to knowledge development. These are: general chronic pain care: perspectives of patients and practitioners; pain experience across the lifespan; psychosocial aspects of back pain; and experience of underresearched conditions.

SUMMARY

The detailed insight into subjective experiences of the pain sufferer or healthcare provider offered by qualitative research can make important contributions to evaluating and improving practice and also in theory development.