Pain Management Assessment WHAT it TAKES

Because moderate to severe postoperative pain is a common experience among patients, pain management is an essential part of nursing care (Yuceer, 2011). Nurses must evaluate the pain, teach the patient appropriate strategies in dealing with it, implement a treatment plan and monitor the results, educate the patient's family on it and record the outcomes of pain management. It is thus clear that the nurse's effective approach to pain management is of primary importance in reducing patient pain and discomfort after surgery. Studies, however, suggest that nurses' current inadequate management of patients' postoperative pain relates to her level of training and preparedness (Yuceer).

This study aims at assessing the results of a continuous quality improvement program on acute pain management of surgical patients by nurses. It will answer these questions: 1. What is this quality improvement program and how does it improve present pain management standards? 2. How does it upgrade nurses' knowledge and skills in managing postoperative pain?

Review of Relevant Literature (p 1-3)

The poor understanding of pain was perceived to be behind the current inadequacy in the management of postoperative pain (Guardini et al., 2008). A study sought to assess this and determine the cause through a course, consisting of pre-tests and post-tests and a questionnaire set to 168 participants in a public hospital in Udine, Italy from October 2002 to June 2003. The hospital had 710 beds and more than 30,000 admissions each year. Results showed a significant difference in 7 out of 10 test questions after a gap of 18 months, indicating that knowledge deteriorates if not updated by refresher courses (Guardini et al.). A similar study used a pre-test and a post-test in comparing the use of non-pharmacological methods in managing children's postoperative pain by Chinese nurses (He et al., 2008). Results revealed the increased use of this method, which in turn, improved the quality of care and the nurses' knowledge, concluding that sustained pain education among nurses was significant for hospitals (He et al.).

A multi-center observational study of 250 infants in 10 participating NICUs also sought to evaluate pain assessment practices and establish specific areas of improvement...

It found that documentation lacked uniformity and was extremely varied. It strongly suggested that physicians handle pain assessment, the creation of evidence-based guidelines for postoperative care and educational upgrade of professional staff (Taylor et al.). McNamara et al. (2012) tested the effectiveness of an acute educational program in upgrading nurses' knowledge, skills and attitudes in the delivery of postoperative pain management. A sample of 59 nurses filled out questionnaires in the six-week educational program. It improved their knowledge effectively, especially right after the program. The study concluded that continuing evidence-based educational programs improve nurses' knowledge of pain and its management (McNamara et al.). Sloman et al. (2005) investigated a sample of 95 nurses' own ratings of pain intensity and its effects on 95 adult surgical patients in four hospitals in Jerusalem, Israel and if cultural and ethnic differences influenced their ratings. They found that nurses significantly downplayed all the aspects of pain. They, however, accurately evaluated the patients' treatment satisfaction. Neither did ethnic or cultural differences nor the nurses' level of education influence their ratings. The investigation emphasized the need for more accurate assessment of patient pain (Sloman et al.).
A cross-sectional survey study of 945 registered nurses caring for adult postoperative patients in two MidWestern hospitals was conducted if they used three evidence-based postoperative pain assessment practices, the relationships among these practices and the nurses' characteristics (Carlson, 2009). The study found that the nurses were aware of these practices but were not using them consistently, creating a gap between education and practice. The study, however, made them more aware of these practices although awareness does not automatically lead to use. It also concluded that education alone would not enhance the transition but that change agents and opinion leaders may entice the use (Carlson). Simons and Roberson (2003) explored the perception of 20 nurses and 20 parents in managing postoperative pain management in children in the aspects of knowledge and communication. Matched interviews brought out issues connected with communication. Moreover, the nurses were aware of their deficient…