Thai Nurses’ experiences of post-operative pain assessment and its’ influence on pain management decisions

Abstract

BackgroundWhile many studies have addressed various issues with regards to pain management, there is limited knowledge about how nurses assess pain in surgical wards. This study aimed to describe Thai nurses’ experiences of pain assessment in a surgical ward.MethodsA cross-sectional explorative study was conducted. Participants were selected through theoretical sampling. Data was collected through interviews with twelve registered nurses working in surgical wards. Qualitative content analysis guided the analysis of the data.ResultsNurses use a double/triple check system, communicated to the healthcare team via records and protocols, and they used their skills and experiences in pain assessment. The results showed that nurses missed the opportunity to include the patients’ self-reported pain in their accounts. Though much evidence of pain was collected, this did not seem to benefit the patients. Furthermore, the nurses were not using instruments to measure pain, which illustrates the potential unreliability of professionals who have differing opinions concerning the patients’ pain.ConclusionsThai nurses worked based on a ‘patient-evidence’ paradigm when assessing patients in pain; this should be shifted to an evidence-based paradigm. Furthermore, by including the patients’ self-reported pain in their assessment, nurses would both improve the quality of the pain assessment and empower patients in their pain management. Pain management practices in Thailand should be improved through education, training, supportive innovation, and collegial competence development in order to improve the quality of care in the post-operative field.

Treating without Seeing: Pain Management Practice in a Thai Context

“…They have added to the policies of all hospitals the recommendation that healthcare providers should assess pain as the fifth vital sign. In practice, the nurses record a patient's level of pain every 4 hours (6 times per day) in a variety of methods (i.e., a verbal scale such as the Numeric Rating Scale (NRS), a graphic sheet record, and medical records) with all of the patients in the studied surgical ward [18]. …”

Engagement and availability in shaping nurses’ management of postoperative pain: a qualitative study

“…One of our previous studies regarding Thai Nurses’ experiences of postoperative pain assessment found that nurses were using the double/triple check system as well as many forms of evidence, such as documentation and pain records, to communicate with the care team. Furthermore, the nurses have used their own previous experiences to assess pain and interpret pain intensity (10). Previous studies have revealed that nurses were limited in their abilities to manage the patients’ pain due to a lack of education and skills in pain management (e.g., administration of sedation, nursing interventions) (11, 12).…”

Children's Hospital of Eastern Ontario Pain Scale: The Study of Validity and Reliability

“…Ağrının subjektif bir veri olması, çocuğun yaşı, gelişimsel düzeyi, mizacı, sosyokültürel faktörler, geçmiş ağrı deneyimleri, çocuklarda ağrı ile ilgili yanılgılar, ağrı belirtilerinin ayırt edilememesi, doğru ağrı ölçme araçlarının kullanılmaması çocuklarda ağrı değerlendirilmesini güçleştirmektedir. (5,7) Çocuklarda ağrının değerlendirilmesi için bazı ölçme araçlarından yararlanılmaktadır. Çocuklarda ağrı şiddetini ölçmek için kullanılacak araçların seçimi, çocuğun yaşı, genel durumu, ağrıyı tanıma düzeyi dikkate alınarak yapılmalıdır.…”

“…Çocuklarda postoperatif dönem ağrı değerlendirmesine yönelik yapılan çalışmalarda hemşirelerin çoğu zaman kanıta dayalı ölçekleri kullanmadığı görülmektedir. (4,5,10,14) Çocuk hemşirelerinin çoğunun daha çok kendi deneyimleri ya da hasta ifadeleri doğrultusunda ağrıyı değerlendirdiği bildirilmektedir. (5,10,11) Çocuk hemşirelerinin ağrı değerlendirmesine yönelik tutum ve davranışlarının incelendiği bir çalışmada, hemşirelerin postoperatif ağrıyı değerlendirirken ölçek kullanma oranlarının düşük olduğu, bu oranın özellikle 5 yaşın altındaki çocukların ağrısının değerlendirilmesinde daha da düşük olduğu belirtilmektedir.…”