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Abstract

Pain Management in Nursing Practice of Intensive Care Post-Operational Stage Patients

Background: Pains are one of the commonest symptoms of illness in any branch of the medicine. International Association for the Study of Pain defines pains as an unpleasant sensations and emotions associated with the real and potentially possible tissue damage or are described as such damage. In spite of different causes and mechanisms, pains always are subjective sensations with multidimensional nature, formed by physical, emotional and cognitive components. Post-operational pains represent a kind of acute pains and are related to extensive lung tissue injuries and traumatic edemas of surgical wounds that turn into the sources of long lasting pathological impulsations. There is a certain risk for intensive care unit patients to evaluate their pains and it is based on utilization of pain assessment scales and pain management resulting from the severity of patient’s condition.

Aim of the study: The aim of the work was to study the pain management in post-operational period of intensive care unit patients.

Material and methods: Study utilizes quantitative research method. As an investigation tool was chosen questionnaire. Study took place in intensive care and post-operative observation wards in two university type clinics in Latvia. In research were involved 50 intensive care unit nurses and 50 postoperative period patients (74% - female, 26% – male) undergoing treatment in intensive care and post-operative observation wards. In the research participated nurses, 10% of them were with lenght of service in health care 0-3 years , 26% - 4-15 years, 34 % - 16-29 years, but 24% -30 years. But, nurses particularly from the intensive therapy ward and anesthesiology: 26 % of respondents had length of service 0-3 years, 28 % - 4-15 years, 30 % - 16-29 years and 16 % over 30 years. Professional education of respondents: secondary vocational education – 58%, 1st level higher professional education – 28%, higher education – 14%. 98% of respondents were women, 2% men. P.Stradi?š Medical College of the University of Latvia Ethics commission has given the permission to conduct the study. There are no risks associated with this study. Data is collected only via survey and responses to the survey will be confidential. Participation is voluntary. Statistical data analyses were performed using MS Office Excel program. For assessment of statistical credibility was utilized x2 test method (Chi-square method). Results: One of the preoperational stage tasks is to provide patients with the information about the post-operational stage pain assessment and possibility of pain relief therapies. Research data present that information was rather sufficient and patients felt safe. Such answers were given by the 32% nurses and 72% patients. 62% patients consider that pains are normal sensation in post-operational stage and 14% of nurses agree with them. In pain management of intensive care patients 5% of nurses utilize pain assessment scales (verbal or visual analogue scale). 59% of respondents like to question patients about their pains, whereas 25% mention, that they assess pains by performing activation of patient or by changing their position. 8% of respondents use special equipment but did not inform patients about it. Evaluating the mutual connection between the nurse’s length of service and visual, as well as analogous pain scale, the acquired data point at mutual connection between the nurses with working experience more than 15 years and the use of analogous and verbal pain evaluation scale ( p < 0.02).

Conclusions: Efficiency of pain management in post-operational stage increases due to psychological preparation and information of patients about the post-operational stage pains and methods that can be used in assessment of pain intensity and possible pain relief therapies already in pre-operational stage. In intensive care practice verbal and visual analogue scales are utilized less while more common and for patients more understandable are nursing staff’s questions about the pains they experience. Pain management is mostly based on World Health Organization’s advised “analgesic ladder” guidelines, monitoring data and it’s analyze.


Author(s): Iveta Strode , Sandra Seimane , Dzintra Biksne

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