Original research
A survey of current perianesthesia nursing practice for pain and comfort management

https://doi.org/10.1016/j.jopan.2004.03.002Get rights and content

Abstract

Widespread dissemination of information and high-profile press coverage about pain and comfort management has resulted in heightened awareness among health care professionals and the public of the need for improvements in the way pain and comfort are managed. Despite significant advances in treatment options for pain relief and comfort, studies show that both phenomena continue to be poorly managed and undertreated. Providing pain relief and comfort to patients are important fundamental components of good nursing care; however, no studies have been performed to evaluate these responsibilities in perianesthesia nursing practice. Therefore, a descriptive survey was undertaken to assess the current practices for pain and comfort management among perianesthesia nurses. A convenience sample of 220 perianesthesia nurses working in preoperative and postoperative settings in rural and urban hospitals, outpatient centers, and freestanding facilities completed a questionnaire survey. The survey asked 10 questions that addressed various aspects of pain and comfort care, including assessment in different settings, discharge criteria, and obstacles in the management of pain and comfort. Findings showed that perianesthesia nurses assessed pain at a frequency of 58% and comfort at a frequency of 56% on admission. Preoperative assessment of patients’ desired level of pain relief and comfort occurred at frequencies of 21% and 20%, respectively. Pain was assessed most often with self-report pain ratings and ordinal descriptions such as “no pain” to “severe pain.” A moderate pain level was used most often as a discharge criterion. Inappropriate and inadequate physicians’ orders were cited as two of the most common obstacles to managing pain and comfort. Findings of this study can be used to increase awareness of the need to evaluate and improve pain and comfort management education and practices in the perianesthesia settings. ASPAN will also use the results as baseline data as it establishes a strategic plan to address the educational needs of its members.

Section snippets

Review of the pain literature

Pain is viewed as an intriguing phenomenon. It is a personal, subjective event that is difficult to verify. The International Association for the Study of Pain (IASP) and the American Pain Society (APS) define pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.”7, 8 In 1968, Margo McCaffery provided a definition for pain that has been appropriate over the years for clinical practice, “Pain is whatever

Review of the comfort literature

Kolcaba defined comfort as “the immediate state of being strengthened through having the human needs for relief, ease, and transcendence met in the physical, psychospiritual, sociocultural, and environmental contexts of experience.”23 Kolcaba’s theory describes comfort as having physical and emotional components, varied meanings, and defined by the person who is experiencing it.23, 24, 25, 26

Bascom27 has a slightly different interpretation of comfort, stating that comfort measures are more

Sample

A convenience sample of 220 perianesthesia nurses from a variety of perianesthesia practice settings, including the Preoperative Phase and Postanesthesia Phases I, II, and III was surveyed. Table 1 provides an overview of nursing roles and responsibilities in these settings. At the time of the survey, the nurses were practicing in rural and urban hospitals, outpatient centers, and freestanding facilities. The nurses voluntarily completed the survey while attending the 2001 ASPAN Annual

Results

Nurses responded “yes” or “no” when asked if pain assessment and identification of the patient’s expected pain/comfort goal were done on admission (Table 2). In the PACU Phase I, one of the immediate priorities is pain assessment. It is common practice to ask patients their level of pain relief and expectations to determine whether discharge criteria are met. Nurses in PACU Phase I in this study consistently demonstrated that they assessed both pain and comfort and identified the patient’s

Discussion

This survey was conducted shortly after the release of both the JCAHO pain management standards15 and the ASPAN Standards of Practice,31 which mandated assessment of pain and comfort on admission. Some of the findings of this study may reflect the newness of these expectations and the perianesthesia nurse’s struggle to meet the standards in today’s rapidly changing health care environment. Pain and comfort assessments present unique challenges in all of the perianesthesia settings. For example,

Implications and suggestions for further research

Findings of this study may be used in the development of institution-specific pain and comfort guidelines and protocols in the perianesthesia settings. Further evaluation of barriers to pain and comfort management specific to perianesthesia settings is also needed. This study underscores the need for increased and sustained emphasis on physician and nursing education that focuses on recommended approaches and trends in pain management such as multimodal analgesia and prevention of the various

Conclusion

Assessment is the cornerstone for providing relief of pain and discomfort in the perianesthesia patient. Comprehensive baseline pain and comfort assessments are critical to the implementation of individualized, effective treatment plans. Initial and ongoing patient education and goal setting provide direction and a way to evaluate the effectiveness of treatment. The findings of this survey reveal that perianesthesia nurses recognize the importance of a thorough pain and comfort assessment;

Dina A. Krenzischek, MAS, RN, CPAN, is Nurse Manager for Prep and Post Anesthesia Care Units at Johns Hopkins Hospital in Baltimore, MD and is the American Society of Perianesthesia Nurses (ASPAN) Coordinator for the Pain and Comfort Guideline, ASPAN President Elect 2003–2004, and ASPAN President 2004–2005;

References (32)

  • K Kolcaba et al.

    Comfort careA framework for perianesthesia nursing

    J Perianesth Nurs

    (2002)
  • C Pasero et al.

    Accountability for pain reliefUse of comfort-function goals

    J of Perianesth Nurs

    (2003)
  • B Moline

    Pain management in the ambulatory surgery outpatient

    J Perianesthesia Nurs

    (2001)
  • C Pasero et al.

    The undertreatment of pain

    Am J Nurs

    (2001)
  • J.L Apfelbaum et al.

    Postoperative pain experienceResults from a national survey suggest postoperative pain continues to be undermanaged

    Anesth Analg

    (2003)
  • J Wolfe et al.

    Symptoms and suffering at the end of life in children with cancer

    N Engl J Med

    (2002)
  • Cited by (10)

    • Pain Assessment and Management in Patients After Abdominal Surgery From PACU to the Postoperative Unit

      2009, Journal of Perianesthesia Nursing
      Citation Excerpt :

      Those with minimal discomfort or who were pain free were eligible for discharge from the PACU, indicating adequate pain relief as an essential criteria for the patients before PACU discharge. Krenzischek et al3 surveyed PACU nurses who indicated that a mild or moderate pain score meant patients were comfortable enough to be discharged from the PACU. They also suggested that nurses defined a mild or moderate pain score as being ≤4 using a VAS scale of 0 to 10, <3 cm if using a 1 to 5 scale, or described as moderate or less if using ordinal measures.

    • Defining Pain Management Objectives

      2006, Postoperative Pain Management
    • Defining Pain Management Objectives

      2006, Postoperative Pain Management: an Evidence-Based Guide to Practice
    View all citing articles on Scopus

    Dina A. Krenzischek, MAS, RN, CPAN, is Nurse Manager for Prep and Post Anesthesia Care Units at Johns Hopkins Hospital in Baltimore, MD and is the American Society of Perianesthesia Nurses (ASPAN) Coordinator for the Pain and Comfort Guideline, ASPAN President Elect 2003–2004, and ASPAN President 2004–2005;

    Pamela Windle, MS, CNA, CPAN, CAPA, is Nurse Manager for Prep and Post Anesthesia Care Units at St. Luke’s Episcopal Hospital in Houston, TX and was an ASPAN Regional Director 2003–2004;

    Myrna Mamaril, MS, RN, CPAN, CAPA, is the Clinical Nurse Specialist of the Same Day Prep and Post Anesthesia Care Unit in the Johns Hopkins Hospital, Baltimore, MD and is the ASPAN Director for Research 2004–2005.

    View full text