Pain Management and Pain

¶ … InterestInterview Coding & Reaction There is little doubt that the experience, events and quality of care that surround expecting and new mothers is extremely important (Berrien, Olledorff & Menard, 2015). The reduction or mitigation of things like excessive pain before and after birth, any sort of disconnect between patient and providers in terms of communication and an explanation of what is and shall be going on and so forth are all important (Taavoni, Abdolahian, Neisani & Hamid, 2016). This research deigns to cover a number of things.

First, it is asked of the interviewee what went well, what did not, what perhaps could or should be compared and contrasted between this or prior birthing experiences (and one did exist in the case of this research), what could have been done better, what was done well, whether proper and full options were made available and so on. The setting and meeting of expectations is one linchpin of what shall be covered in this report (Moore, 2016).

Indeed, is important that patients know what to expect, what can be done, what is a little more difficult and so forth (Daugherty & Martinez, 2016). When patients are expecting more presence and appearances by nursing staff and it does not happen, pain management is needed but is not offered and so forth, it can truly sour the experience of the new mother and this must be avoided if at all possible (Mondy, Fenwick, Leap & Foureur, 2016).

The use of the word of "setting" expectations is also important because patients do need to know what everything means and how it's going to work. Knowing what a medical chart truly and fully says is a stretch but knowing what a whiteboard in a patient room says and what it means is a good starting point and making sure that rounds and patient follow-ups are done well and with regularity is another.

As one can easily see in the rest of the report, there are providers that do not set and/or meet the proper expectations. Theoretical Perspective Postpartum patients experience a range of issues which can affect their satisfaction and ability to manage pain. The literature notes that postpartum rounds are often inefficient and require nurses to spend considerable time with each patient (Segel, et al., 2010). As a result of inefficiency, a relatively low number of patients is actually discharged by the goal time of 11:00 am (Segel, et al., 2010).

Research on the use of whiteboards in patient communication plans has demonstrated that the use of these tools may provide significant communication benefits (Dublon, Spurdle, & Adefunke, 2016). The rationale behind the use of whiteboards in providing patient care is that they can lead to improved communication between nurse and client, which helps to support better care (Dublon, Spurdle, & Adefunke, 2016). Conversely, hourly rounding involves nurses rounding with patients every one-to-two hour to promote improved quality of care (Rondinelli, Ecker, Crawford, Seeliger, & Omery, 2012).

Hourly rounding with postpartum patients, along with the use of whiteboards, has the potential to improve communication, along with patient satisfaction with pain management (Wershofen, Heitzmann, Beltermann & Fischer, 2016). Sample Selection I The author of this study selected an English-speaking postpartum patient after her normal delivery postpartum day two. I The patient was selected this particular patient because this was not her first pregnancy, and thus she would have a frame of reference to compare this experience to her prior experience.

Also, by selecting a patient as my participant, instead of a staff member, can help me to understand how the patient feels about the initiation of hourly rounding and whiteboard use and her concerns of implementing these two interventions on a patient perspective. The combination of factors including a normal delivery, English-speaking patient, and prior pregnancy made this particular patient a good candidate for the proposed research. Inclusion Criteria The participant was recruited through a simple conversation in which it was discussed what would be covered.

Included in that was the following inclusion criteria, proper notifications and other procedures: • we spoke about tThe research and its goals, including its • goals, aA desire to know about her s well as her postpartum experience. • At least one prior birthing experience to compare to • Also, the pParticipant was informed that the interview will would be taped • on my iPhone. A foFormal opening script at the onset of the interview was initiated before the interview began (see Appendix A).

• The patient was being treated within the's position in the postpartum unit • Signed consent form Exclusion Criteria Items that did or could have come up that could have or did disqualify other people include the following: • An unwillingness to be taped • Unwillingness to sign the consent form • Unwillingness to discuss important elements of personal experience • No prior births to compare to • English not the primary language of patient made her an accessible candidate, as recruitment was limited to those patients currently occupying a place in the postpartum unit.

Data Collection Procedures The Interview Data were collected in Queens Hospital Center, Mother/Baby unit, through the use of a face-to-face qualitative interview format. I asked the patient a series of questions related to her postpartum experience in the past and during this hospital stay, hourly rounding, whiteboard use in her room, and patient care. A list of questions, prompts, and probes is shown in Appendix A. The patient's answers were recorded via the voice memos application on my iPhone.

I used the voice memos recording to later transcribe a full transcription of interview (see Appendix B). The interview took place in the patient's room, with the participants being myself, the patient respondent, and her newborn in the crib at the bedside. The interview lasted approximately 15 minutes, during which time I asked questions and the patient provided her answers. At the end of questioning, we had additional time for the her to ask any questions, as well as debrief about the interview process itself.

Confidentiality was maintained prior and during the interview by taking steps to ensure privacy. According to the Queens Hospital Center's protocol, a consent has to be signed by the patient in order to proceed. Before the patient signed the consent, I, as the interviewer, have to make sure she understands what this interview is about and whether she has any questions or concerns. The consent was witnessed by the head nurse on the postpartum unit. The consent (see Appendix D) was then sent down to Ms.

Elizabeth Sulik, the Associate Director of the Department of External Affairs at Queens Hospital Center. During the interview, the room door was closed, TV in the room was turned off, and the room was free from other observers during the interview itself. I did not record the patient's name on my interview notes, instead opting for a suitable pseudonym. Limitations & Quality of Interview One possible obstacle prior to the interview was sampling bias.

Sampling bias refers to the "systematic over- or underrepresentation of a population segment on a characteristic relevant to the research question" (Polit, & Beck, 2017, p. 251). I choose not to pick any staff members or supervisor whom are working on the postpartum unit as my participant because these people already have the pros and cons in their mind regarding to the impact of hourly rounding and whiteboard use (Hastings, Suter, Bloom & Sharma, 2016).

If I use them as my participant for the interview, they are likely to be over-represented in the sample, and my ability to predict the outcome of the impact of hourly rounding and whiteboard use on patient satisfaction with pain management in postpartum women from the sample will thus be inaccurate (Imbens, Guido & Kolesar, 2016). Another possible obstacle during the interview itself was that the patient was actually breast feeding and providing care for her new baby during the interview process.

In the future, I would attempt to provide alternative care arrangements for the brief period during questioning if possible, so that the respondent is not distracted by any outside issues. Overall, the interview went as well as could be prepared for. The questions seem to have been properly phrased and worded. The interviewee, as noted in the results, did interrupt a lot of the questions. Even with that, clear answers and perspectives were gained so it would seem the overall depth, breadth and scope of the questions were proper.

In retrospect and review, some of the questions probably should have been broken up into smaller parts and interrupted questions should have been posed again if they were not fully answered, albeit with different wording as needed to focus on what was missed. In short, the right and complete set of questions were asked but they probably should have been structured and handled differently, both in general and in reaction to the flow of the interview.

Even with the challenges, the subject selected was a good source of information, although it would be extremely useful to know if her complaints were complete and correct and it is perhaps not possible to truly verify that since the hospital would probably not cooperate fully and complete when it comes to the same. Even with what is missed, the use of side-notes, memos and immediate reflections helps retain and save a lot of information that might be lost in translation when the research is completed.

Results The themes, concepts and results to be seen in this report are clear and prevalent. There were some obvious things that stood out and quite a lot of them directly align with the context and theoretical framework covered in this report. They are as follows: • Pain management, among a few other things like post-partum depression and the like are obviously one of the more prevalent things that should be covered and watched over (Dannenbring, Stevens & House, 1997).

Unless one is to believe that the patient is exaggerating, it would seem that she went hours at a time without seeing anyone. This aligns with the theoretical perspective mentioned earlier in that it clearly goes against what should be happening, if indeed her assessment and summary is accurate (Ogbolu, Scrandis, Fitzpatrick & Newhouse, 2016). Except at night, that is almost certainly improper for "hours" to pass with no visits from a nurse or doctor. Even so, it is possible that her perspective or expectations are not aligned.

She did admit that her pain level at the time of the interview was a two on a scale of ten, which is quite good given that she had just given birth. Thus, at least things were properly in place at that time. Regardless, what she expected and what actually happened were clearly not aligned and that is something the staff should be concerned about. It is certainly something the author of this study is concerned about (Hueston & Kasik-Miller, 1998).

• One of the conceptual and thematic items covered in the theoretical framework of this case is the whiteboard and how the patient should not be confused or underinformed about what is stated and present on that board. More complex charting information and such should be on something other than the whiteboard and whatever is ambiguous or nebulous to the patient should be explained, per the related research (Chaboyer, Wallen, Wallis & McMurray, 2009). • The patient did interrupt a number of the questions.

This has been mentioned in passing before but it should be mentioned as its own theme and presence in the interview, not to mention the coding of the same (Rabel, Cunningham & Stephenson, 2014). • For whatever reason, the patient was very prone to laughing. It could be her nature or she might have been nervous (Elliott, 2017). References Berrien, K., Ollendorff, A., & Menard, M. K. (2015). Pregnancy Medical Home Care Pathways Improve Quality of Perinatal Care and Birth Outcomes. North Carolina Medical Journal, 76(4), 263-266.

doi:10.18043/ncm.76.4.263 Chaboyer, W., Wallen, K., Wallis, M., & McMurray, A. M. (2009). Whiteboards: one tool to improve patient flow. The Medical Journal of Australia, 190(11 Suppl), S137- Dannenbring, D., Stevens, M. J., & House, A. E. (1997). Predictors of Childbirth Pain and Maternal Satisfaction. Journal of Behavioral Medicine, 20(2), 127-142. Daugherty, J., & Martinez, G. (2016). Birth Expectations of U.S. Women Aged 15- 44. NCHS Data Brief, (260), 1-8. Dublon, V., Spurdle, A., & Adefunke, A. (2016). G173 Use of daily plan whiteboards to improve communication. Archives of Disease in Childhood, 101, A90-A91. Elliott, C. (2017).

Why Research Oversight Bodies Should Interview Research Subjects. IRB: Ethics & Human Research, 39(2), 8-13. Hastings, S. E., Suter, E., Bloom, J., & Sharma, K. (2016). Introduction of a team-based care model in a general medical unit. BMC Health Services Research, 161-12. doi:10.1186/s12913-016-1507-2 Hueston, W. J., & Kasik-Miller, S. (1998). Changes in Functional Health Status During Normal Pregnancy. Journal Of Family Practice, 47(3), 209-212. Imbens, G. W., & Kolesar, M. (2016). ROBUST STANDARD ERRORS IN SMALL SAMPLES: SOME PRACTICAL ADVICE. Review Of Economics & Statistics, 98(4), 701-712.

doi:10.1162/REST_a_00552 Mondy, T., Fenwick, J., Leap, N., & Foureur, M. (2016). How domesticity dictates behaviour in the birth space: Lessons for designing birth environments in institutions wanting to promote a positive experience of birth. Midwifery, 4337-47. doi:10.1016/j.midw.2016.10.009 Moore, M. F. (2016). Multicultural Differences in Women's Expectations of Birth. ABNF Journal, 27(2), 39-43. Ogbolu, Y., Scrandis, D. A., Fitzpatrick, G., & Newhouse, R. (2016). Leading Organizational Cultural Competency: Nurse Leader Rounds and Care for Diverse Patients. The Journal of Nursing Administration, 46(12), 627-629. Polit, D. F., & Beck, C. T. (2017).

Nursing research: Generating and assessing evidence for nursing practice (10th ed.). Philadelphia, PA: Wolters Kluwer. Rabel, B. V., Cunningham, S. A., & Stephenson, R. (2014). Interview Interruption and Responses to Questions About Domestic Violence in India. Violence Against Women, 20(8), 937-947. doi:10.1177/1077801214546905 Rondinelli, J., Ecker, M., Crawford, C., Seeliger, C., & Omery, A. (2012). Hourly rounding implementation: A multisite description of structures, processes, and outcomes. Journal of Nursing Administration, 42(6), 326-332. Segel, S., Hashima, J., Gregory, W. T., Edelman, A., Li, H., & Guise, J.-M. (2010).

A new approach to postpartum rounds: Patient-centered collaborative care improves efficiency. Journal of Graduate Medical Education, 2(1), 67-72. Taavoni, S., Abdolahian, S., Neisani, L., & Hamid, H. (2016). Labor pain management: Effect of pelvic tilt by birth ball, sacrum- perinea heat therapy, and combined use of them, a randomized controlled trial. European Psychiatry, 33S626. doi:10.1016/j.eurpsy.2016.01.1851 Wershofen, B., Heitzmann, N., Beltermann, E., & Fischer, M. R. (2016). Fostering Inter-professional communication through case discussions and simulated ward rounds in nursing and medical education: A pilot project. GMS Journal For Medical Education, 33(2), Doc28.

doi:10.3205/zma001027 Appendix A. - Opening Script, List of Questions, Prompts, and Probes Formal Opening Script Hello, Ms. Madiha. I'm glad that you have agreed to be interviewed today. As I said before, this study is about the impact of hourly rounding and whiteboard used for postpartum women on patient satisfaction in the pain management. This interview is going to take approximately 15 minutes. There are no right or wrong answers, or desirable or undesirable answers.

I would like you to feel comfortable saying what you really think and how you really feel. If it's okay with you, I will be tape-recording our conversation since it is hard for me to write down everything while at the same time carrying an attentive conversation with you. Since this interview required recording, as per Queens Hospital Center protocol, a consent have to obtain from you, is it okay with you? (Yes / No).

Everything you say will remain confidential, meaning that only myself and my professor for this course will be aware of your answers. So, before we began recording, do you have any questions that I can answer for you right now? (Yes / No). Now I'm going to begin the recording and turning on the recording device, are you at the comfortable place? Introductory Questions: 1.

Is this your first pregnancy? • If not, did you deliver your previous baby in this same hospital -- Queens Hospital Center? • If not at Queens Hospital Center, which hospital did you deliver your baby before? 2. How does your care in here (Queens Hospital Center) as compared to previous hospitalization? • Could you say some more about that? 3. Do you know what is hourly rounding? • Would you elaborate on that? 4.

Do you know what the whiteboard in your room used for? • Would you elaborate on that? • Did they update the board constantly? • How often do your nurse utilize the pain management information on the whiteboard? Questions related to WHITEBOARD: 1. What is your pain now? From 0 -- 10 scale? • Types of pain: breast pain, abdominal pain, perineal pain, episiotomy/laceration pain, leg/calf pain 2.

What pain meds have been prescribed/given to you? • Types of usual pain medications prescribed at Queens Hospital Do you know your pain management plan/schedule? • Frequency of taking the pain medication • What if the pain medication they gave you did not help to relieve your pain? Are there any other options? 3.

Do you feel you are included in your pain management plan? • What did the staffs tell you? • Did the staffs tell you what the medication is for? Its benefits and side effects? • What makes you think that you are included in the plan? 4.

What information does your nurse usually write on the whiteboard? • Could you say some more about that? • Types of information that can be written on the board: goal for the day, pain medication given, time for the next pain medication, other options of pain medication, etc. • How did you feel about that? • Do you feel that using the whiteboard helps in your communication with your nurse for pain management? Questions related to HOURLY ROUNDING: 1.

Did you notice that a staff person (nurse, PCA, or CNA etc.) was coming in to check on you every hour? • How did you feel about that? • Who else do you think should check on you besides nurses, PCAs, or CNAs? 2. How do you feel about the number of times the staff was in your room? • Frequency of rounding: one hour, two hour, three hour, etc. • Do you think they are bothering you? If so, could you give me more detail? 3.

Describe what staff did when they checked on you during their hourly rounding. • In addition to what they did when they checked on you during their hourly rounding, did they do anything extra? • (If applicable) As compare to your prior hospitalization in another hospital, when staffs are rounding, did they check on you the same thing we did in here (Queens Hospital Center)? If not, some more examples might help.

• Do you think they should ask you further questions when they are rounding? Such as help to take care of your baby? Extra supplies? Extra diapers for the baby? Pain medication? What are your thoughts on this? Do you think it will make a difference? As a conclusion, overall, do you feel that your pain been adequately controlled during your stay? • Do you need to ring the call bell every time you are in pain in order for the nurses to come and medicate you? • What do you think if nurses do their hourly rounding on you and asked about your pain, and if you tell them you need pain medication, they can medicate you right away, instead of the nurses waiting for you to ring the call bell to ask for pain medication, will it make a difference? • Do you have any questions for me before we ended our interview? Appendix B -.

Full Transcription of Interview Interviewer represents Me; Interviewee represents Patient on the Mother/Baby unit Interviewer: Okay, uhm. so. ah. we, I have some questions related to my study, okay? Hmm. how you feeling today? Interviewee: Good! Thank you. Interviewer: Good! Okay, so this is your number what baby? Interviewee: No, this is my second baby. Interviewer: Second baby. Hmm. did you deliver your first one in this hospital? Interviewee: No in the Elmhurst -- different hospital. Interviewer: Different hospital, okay.

So, how you compare your care from Elmhurst hospital to Queens hospital center? Interviewee: Hmm. it looks like same. (*Interviewee was laughing) Interviewer: It looks the same? Interviewee: Yeah. Interviewer: There is no difference? Interviewee: It looks like same. Interviewer: Alright. Interviewee: Oh yeah. Interviewer: Okay. So, as I said, my research is about hourly rounding from the nurses and also how effective to use the whiteboard, okay? Interviewee: Hmm. hmm Interviewer: Do you know what is hourly rounding? Interviewee: Yeah, they are going to round every hourly. Interviewer: Hmm.

hmm. How about do you know what that board in your room used for? Interviewee: Yeah, I see them they write down something on the board. But. (*Interviewee paused for a second, then continued her reply). . I just understand the date and the name and the other things...I don't know. (*Interviewee was laughing) Interviewer: So, you actually don't really know what that board used for besides writing the date and the name? Interviewee: Yeah, I guess so.

They didn't tell me what they are going to write down and why they writing. I just know the date on it and the nurse's name on it. (Interviewee was laughing) Interviewer: Okay. Did they update the board every day? In the morning? Or every shift? Interviewee: Yeah, every shift. Every new nurse come she writes down her own name. Interviewer: Okay, good! Good! Good! So, I'm going to ask some questions related to the board, okay? Interviewee: Okay. Interviewer: So. tell me in. uhm.

what is your pain right now? What is your pain scale from a 0-10, 0 being no pain at all, 10 is like very severe. Interviewee: I think you can say 2. Interviewer: 2. Okay. And when did the last time your nurse give you the pain medication? Interviewee: Ahh. just. just few minutes ago. Interviewer: Few minutes ago. Interviewee: Yeah. Interviewer: Alright. Do you know what kind of pain medicine they give it to you? Interviewee: Yeah. They giving me Motrin. Interviewer: Motrin. Okay.

Did they tell you how often you can get Motrin? Interviewee: Yeah, every eight hours. Interviewer: Every eight hours. Very good. If Motrin is not relieved your pain, did they tell you what other options? Interviewee: Yeah. She told me the other one, but other one make me dizzy, so I prefer the Motrin. Interviewer: So, do you know the name of the other medication? Interviewee: Ahh. she told me. But I forgot. haha Interviewer: Oh, alright. And. okay. and Hmm.

do you feel you are included in the pain management plan since you moved from labor and delivery to postpartum? Do you think you are part of the team that when they. you know when you are in pain, they kind of include you in the plan? Interviewee: Yes. Interviewer: Yes, okay.

What did they tell you? What makes you think that you are included in the plan? Interviewee: Because doctors tell me, "You are going to ask every 4 hours, you have to take the pain medicine." So, I have pain, you gave me pain medicine. I don't want to wait for the pain and then take the medicine. you know. Interviewer: That's good! Interviewee: So, I just called them to give me my medicine. you know. Interviewer: So, you did call them every time you feel pain? Or they come and.

Interviewee: I called. I called them give me my medicine. you know. Interviewer: So, if you don't call them, they will. no one coming in? Interviewee: They came in. They came in. But you know they take. they are going to come on time. Interviewer: Oh! Interviewee: But sometimes I need earlier. Interviewer: Earlier. Okay, alright. Sound good. Okay, and then besides the nurse and the shift, and you know. the date on the board, did they.

did any nurses or like any doctors put on different information on the board that you noticed? Interviewee: No, just the date and the name. Interviewer: Okay. Do you think that if they put on some. you know. let say. okay. hmm. let say your goal for today, okay. uhm. they put what medication you were taking, okay, and then how, what is the next time you take the medication, or what other options you can choose, do you think that would help? Interviewee: Uhm.

Interviewer: Besides they just put the date, the shift, and the name? Interviewee: No. I don't think so that they are going to need to put the medicine name or something on it. Interviewer: You don't think it would be helpful. Interviewee: No because you know the person (*Interviewee was laughing). I was in the bed, you know. I was in pain. Interviewer: Hmm. Interviewee: And I have to take care of my baby. you know. it's really hard to notice the board on the wall.

Interviewer: Oh! Interviewee: And reading. you know. (*Interviewee was laughing) Interviewer: Okay, alright. Interviewee: So, I think if they are going to put her name and the date. (At the same time, Interviewer: That's fine.) Interviewee: Yeah, that's fine. Interviewer: Okay, alright. Okay. And uhm. but you don't feel like if they put some information there, it helps to communicate better with...you know. the nurses or any doctors? Interviewee: Maybe. Then they don't need to put like this.

They just need to write down but they need to tell the patient what they going to write down and why they writing. Interviewer: They have to tell. you feel like they don't really tell you that. (*Interviewer did not finish the sentence yet and interviewee already responded) Interviewee: They just write down by herself. you know. the lady. So, if she is not telling me why she is writing down this, and this is for me or for her.

(*Interviewer did not wait until the interviewee finished her response and already said, "this is no reason.") Interviewee: It didn't matter for me what she writes down or not. Interviewer: Okay. I agree I'm totally agreed. Okay, so you feel like they need to explain more before they do something. Interviewee: Yeah. Yeah. Interviewer: Okay, sound fair. Interviewee: Yeah. If something she is writing is for me, then she has to tell me. Interviewer: Has to tell you. Okay. Interviewee: Yeah. Interviewer: Did they tell you like. ahh.

before they give you anything, like pain medicine, prenatal vitamins. Interviewee: Yeah. She told me. Interviewer: Did they tell you what this is for? Interviewee: Yeah. She told me. This is for your gas, this is for your iron medicine. She explained. Interviewer: Oh...okay. Interviewee: When every shift changed, the nurse came. She said, "Hello, my name is this and I'm your nurse for the night time, for the morning time." So. it's okay for me to know.

Interviewer: That's good! That's good! Okay, so now I'm asking some questions about the hourly rounding, okay? Interviewee: Okay. Interviewer: Alright. So, do you noticed any staff members. okay. either nurses or CNA or PCA or even doctors, did they come and round on your like you know every hour? Did they come to the room to check on you? Interviewee: When I came here from the recovery room to over here, the first night they come every one hour, but the next day, they didn't come, the next day.

whole night, nobody come. Interviewer: Nobody come? Interviewee: Yeah, maybe in the night time and in the day time check the blood pressure. Interviewer: That's? Interviewee: That's! Yeah! Interviewer: You don't see them come? Interviewee: No, they didn't come or nothing. Interviewer: Okay. Interviewee: If I need. I need something, I ring the bell. Interviewer: Okay, so only the first night when you first transferred. . (*Interviewer did not finish the sentence yet and interviewee already responded) Interviewee: Yeah, when I transferred, I feel more pain. First night they come more.

Interviewer: Hmm. Interviewee: And then second less, and the third, nobody came. (*Interviewee was laughing) Interviewer: Oh. okay, alright. Interviewee: Maybe we don't need it. That's why you know better. But if I need something, I ring the bell, and they come quickly. Interviewer: That's good! That's good! Uhm. but how do you feel about that? Like. do you feel like you are lack of care? Do you feel like. okay .