Nursing Knowledge: ACUTE POSTOPERATIVE PAIN MANAGEMENT IN THE ELDERLY

Abstract

1. The inadequate management of acute postoperative pain among adults is well documented. Studies have shown that 75% or more of hospitalized adult patients following surgery suffer moderate or intense pain even with the use of analgesics. Also, physicians under-prescribe narcotic analgesics and nurses administer less than the patient could receive. 2. Nurses' ineffective approaches to the management of pain have been attributed to inappropriate fears of addiction and respiratory depression, rigid attitudes regarding what constitutes adequate pain relief, and misunderstandings about the physiologic and psychologic components of pain. 3. The results of this study support McCaffery's (1989) finding that nurses do not understand the effective use of narcotics in relation to pain management.

Pain management knowledge of hospital‐based nurses in a rural Appalachian area

“…The results indicated a lack of knowledge of the followmg pam principles (a) the behavioural indicators of pain and the properties of opioid analgesics, and (b) adjuvant drugs employed m pain man^ement Specific areas of weakness were classification of opioids, incidence of opioid addiction as it relates to opioids admimstered for the relief of pam, ceilu^ dose of morphine, equianalgesia, properties of promethazme, and reliance upon nonverbal cues to assess pain These findmgs are similar to those of Hamilton & Edgar (1992) The results indicated that there was no relationship between increased climcal expenence and overall pain management knowledge score This finding supports the findmgs of Watt-Watson (1987) and Hamilton & Edgar (1992) The results also mdicated that there was no relationship between type of nursmg education and mcreased knowledge of pam management This findmg is m keeping with the findings of the study by Watt-Watson (1987) and Brockopp et al (1993)…”

“…The results indicated the nurses had a lack of knowledge regardmg opioids, addiction, and equianalgesia, thereby confirming the earlier results of McCaffery et al (1990) Likewise, Hamilton & Edgar (1992) concluded that the nurses lacked knowledge regarding opioid addiction, equinalgesia, properties of opioids, and clinical differences between acute and chrome pam The researchers foimd no significant differences m the scores by educational preparation or years of clinical experience Knowledge Brockopp et al (1993) conducted a survey of practising nurses (n = 65) eind senior baccalaureate nursing students (il = 70) to assess the level of knowledge regardmg pam management of elderly surgical patients The mean score of a 30-item tool was found to be 23 7 for practising nurses as compared to a mean score of 21 7 for students Even though the overall scores of the practising nurses were higher than those of the students, neither group appeared to understand some of the basic principles of pain management m the elderly These areas of knowledge deficit were the effective use of opioids, confusion m the elderly as it relates to pain assessment and components of pain assessment Thus, there is documentation that nurses have areas of knowledge deficit related to pam management…”

Barriers to pain management in elderly surgical patients

“…Results of a more recent study of 135 registered nurses and senior nursing students from a baccalaureate program assessed the nursing knowledge of the subjects related to postoperative pain management of elderly surgical patients 23 . This study reaffirmed the findings of the previous survey, which determined that myths and misunderstandings about pain management of elderly surgical patients continue to exist among nurses 24…”

Treatment of Pain in Cognitively Impaired Compared with Cognitively Intact Older Patients with Hip‐Fracture

“…In this study, nurses elected to give more subjects meperidine than morphine, regardless of cognitive status, even though many of the subjects had multiple options for pain medications. In a recent survey on postoperative pain management in older patients, 77% of the nurses surveyed agreed with the statement “Meperidine is a better choice for pain relief than other narcotics among older patients following surgery,” and 62.3% disagreed with the statement “Meperidine is shorter acting and more toxic than morphine.” 32 Patients would benefit greatly from health professionals who are well educated about pain medications and treatment strategies that meet the unique needs of older people.…”