Ineffective Postoperative Pain

The pre-operative stage is an important phase in patient’s surgery process. This is the time where the patients is experiencing a lot of anxiety issues and have questions regarding the impending procedure. To help ensure good patient outcomes, it is imperative to provide complete preoperative instructions and discharge instructions (Allison & George, 2014). It is the nurses’ duty to safe guard and protects the patient’s welfare during the surgical experience. Effective preoperative preparation is known to enhance postoperative pain management and recovery. Health professionals need to be cognizant of the contextual factors that influence patients’ preoperative experiences and give context appropriate care (Aziato & Adejumo, 2014).

According to The World Health Organisation (1999), defined pain as an unpleasant sensory or emotional experience associated with actual or potential tissue damage, or described in terms of such damage. Pain is traditionally described as acute or chronic pain. The prevalence of chronic pain (CP) is higher than of acute of pain, as it affects 7.8 million people of all ages in the UK (Chronic Pain Policy Coalition., 2006). The current leading cause of mortality that is accounting for 60% of all deaths is due to chronic diseases and is also a problem as causes an increasing burden on the health care service (World Health Organisation., 2007). CP can affect a person’s quality of life if managed poorly, statistics shows that 25% of people lose their job and 22% leads to depression. (Chronic Pain Policy Coalition.,

The peer reviewed journal article, A Decision Tree Model for Postoperative pain Management, is an article describing postoperative pain management regimens using evidence-based practice. This article’s author has created a guide for prescribers who are managing postoperative pain levels for patients. This article is using evidence-based practice to help future patients have adequate pain relief, but not have the serious ramifications that can occur from the wrong dose or wrong medication for said patient.

Despite recent advances in information regarding perioperative care, postoperative pain continues to go undermanaged. Postoperative pain is the pain patients experience after a surgical procedure. According to Gan, 80% of all people who undergo surgeries experience postoperative pain, and 75% of them rate their pain at a moderate, severe, or extreme level (as cited by Cooney, 2016). Furthermore, inadequately managed pain can lead to patient dissatisfaction, decreased patient outcomes, and overall higher cost of care (Penprase, Brunetto, Dahmani, Forthoffer & Kapoor, 2015). In order to provide higher quality pain management,

this, moderate-to-severe postoperative pain impaired a range of necessary daily functioning activities as walking ability, general daily activity, motivation, social relationships,

The management of postoperative pain has received much interest nowadays. The intensity of postoperative pain depends on many factors such as type and duration of the surgery, type of anesthesia and analgesia used, and the patient’s mental and emotional status (11).

In order to determine if Patient Y was having pain, I assessed her pain level using a pain scale. Once she reported a pain score of a 10 out of 10, I reviewed the pain medications that were ordered for her and chose the medication indicated for severe pain. After 30 minutes I reassessed my patient pain score and the rating changed to a 5 out of 10. During this time, I educated Patient Y on other techniques to decrease her pain. I provided Patient Y with an abdominal binder to place over her abdomen and constrict to the incision. I also told Patient Y to hold a folded blanket on her incision if she needs to cough or sneeze to decrease the pain. Finally, I educated Patient Y on breathing techniques to also decrease her pain.

In previous literature, patients have demonstrated and expressed feelings of helplessness, powerlessness and anxiety (6,9). Surgical interventions and procedures invoke strong reactions around pain, complication risk and death for the patient and their families (5). Additionally, in the preoperative phase of waiting to be transferred to the operating room, previous studies have shown that this can be the most frightening time for many patients (5,6,9). When this preoperative waiting time is compounded with the sudden cancellation or postponement of a patient’s surgery, many patients experience heightened negative effects (5,9).

Throughout my life, I have undergone many dental operations, giving me first hand experience on post-operative pain and it’s management. After being exposed to long term care settings for clinical, I would like to take this opportunity to increase my knowledge on a topic that, besides my own personal experiences, I have not been heavily exposed to in a learning environment. Pain, defined in Kozier et al. (2014) as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage” (p. 739), is inevitable to some degree after surgery; making its management a crucial for a healthy recovery. The recommendations within both the Registered Nurses’ Association of Ontario’s (RNAO) (2013) Best Practice Guideline

‘Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage’ (International association for the study of pain 2014). Pain can be made up of complex and subjective experiences. The experience of pain is highly personal and private, and can not be directly observed or measured from one person to the next (Mac Lellan 2006). According to the agency for health care policy and research 1992, an individuals self-report of pain is the most reliable indicator of its presence. This is also supported by Mc Caffery’s definition in 1972, when he said ‘Pain is whatever the experiencing patient says it is, existing whenever he says it does’.

Introduction A number of postoperative dysfunctions are related directly to postoperative pain. Th e most important of these are pulmonary, circulatory, gastrointestinal, and urinary dysfunction. Th us, it is possible for acute severe unrelieved pain to result in signifi cant morbidity and even mortality [1].

Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in

Significant postoperative pain following major surgical procedures for breast cancer is a common and well-known complication which may lead to a lot of negative consequences as more hospital costs with extended hospital stay, and the increased incidence of chronic post-mastectomy pain (2). Procedural interventions involving regional blocks are found to be more effective than pharmacologic pain relief methods(3). Pecs1 and 2 can provide effective postoperative analgesia for such procedures (4). They are field blocks that aim to deposit the local anesthetic between the pectoralis major and minor muscles and between pectoralis minor and serratus anterior respectively to block the different peripheral nerves supplying the

For years, surgical operations had a reputation for being extremely painful and uncomfortable, hindering the attending physician’s ability to operate on the patient receiving the surgery. However,

Nurses care for patients who undergo emergent and preplanned surgeries. Nurses prepare their patients prior to surgery by educating them what the surgery is, what to expect during surgery and the outcome of the surgery. Preoperative anxiety is a result of patient’s anticipation to the surgery manifested by psychological and physiological indicators (Alanazi, 2014). Review of literature shows that preoperative anxiety is a common phenomenon that nurses encounter in practice as they care for patients undergoing surgery (Yilmaz, Sezer, Gurler, & Bekar, 2011). Preoperative anxiety can increase need for anesthesia, pain patient experiences after surgery therefore increases need for pain medication, increase length of recovery time, and delay of discharge (Alanazi, 2014). With the effects of preoperative in mind it is important to understand what preoperative anxiety is and what the symptoms are. The domains of nursing care will be used to explain preoperative anxiety as a nursing phenomenon. American Nurses Association (ANA) Social Policy Statement and ANA scope and standards of care will be used to provide nursing interventions to help reduce anxiety. Nursing care and practice can help patients reduce and manage patient anxiety. The role of Family Nurse Practitioner (FNP) will be discussed in helping reduce preoperative anxiety.