Implementing a pain management nursing protocol for orthopaedic surgical patients: Results from a PAIN OUT project

• Published in: Journal of clinical nursing 2018-04, Vol.27 (7-8), p.1684-1691
• Main Authors: Cui, Cui, Wang, Ling‐Xiao, Li, Qi, Zaslansky, Ruth, Li, Li
• Format: Article
• Language: English
• Subjects: Adult; Analgesics, Opioid - therapeutic use; China; Clinical competence; Continuing education; Female; Health Knowledge, Attitudes, Practice; Humans; Knowledge; Male; Middle Aged; nurse education; Nurses; Nursing; Nursing care; Nursing Staff, Hospital - education; orthopaedics; Orthopedics; Orthopedics - education; Orthopedics - methods; outcomes; Pain management; Pain Management - standards; pain relief; Pain, Postoperative - drug therapy; Pain, Postoperative - nursing; Patients; postoperative pain; Practice Guidelines as Topic
• ISSN: 0962-1067; 1365-2702
• DOI: 10.1111/jocn.14224

Aims and objectives To investigate the effect of introducing a standardised pain management nursing protocol in orthopaedic patients undergoing surgery. Background Postoperative pain is a common phenomenon but is still undertreated in hospitalised patients. Nurses’ lack of sufficient knowledge and skills about pain management may be a contributing factor to poor outcomes. Design An interventional, separate sample pre‐ and post‐test. Methods A pain management nursing protocol was introduced and a handbook and training sessions regarding management of postsurgical pain were provided to the nurses on a Joint Orthopaedic ward at a university‐affiliated general hospital in Guangzhou, China. Before and after the intervention, nurses’ knowledge about pain management and attitudes were assessed, and perioperative management practices and pain‐related patient‐reported outcomes were evaluated. Results Sixteen and 15 registered nurses, and 77 and 71 patients participated in the study before and after the intervention, respectively. Nurses’ scores related to knowledge and skills increased significantly after the protocol was introduced but were still insufficient with regard to pharmacological‐related items. The proportion of patients receiving a combined opioid and nonopioid increased after the intervention. Clinically significant changes were observed in some patient‐reported outcomes, such as worst pain since surgery, percentage of time experiencing severe pain, and pain interference with activities out of bed. There were significant changes in nonpharmacological methods administered by nurses to patients or used by patients to relieve pain. Conclusions Implementation of a pain management nursing protocol combined with education in one surgical ward was associated with nurses’ increased knowledge and attitudes regarding pain, a change in some management practices, and improvement in a number of pain‐related patient‐reported outcomes. Relevance to clinical practice It was feasible to develop and implement a standardised pain management nursing protocol and use it in the clinical routine. The intervention had an effect on changing some features of care, with an improvement in patient‐reported outcomes. Support by leaders and medical team facilitated the process of the implementation.