Phuong Hoang Vu
,1,2 Duc Viet Tran,2 Yen Thi Le,2 Ha Thi Thu Do,2 Sao Thi Vu,2 Huong Thanh Dinh,2 and Tu Huu Nguyen1,2
Abstract
This study examined the postoperative pain management practices among registered nurses in an urban hospital in Vietnam. Data of 90 nurses about postoperative pain management practices and pain management at the department were collected. Results indicated that 83.3% of nurses reported that they regularly assessed the degree of pain for postoperative patients. Only 32.2% used assessment tools such as the numeric rating scale to measure pain. Experience in pain management and having guidelines in the department were associated with a higher score in pain management practice. Findings suggested that facilitating the use of pain instruments and developing pain management guidelines should be prioritized.
1. Introduction
Postoperative pain management is a great issue although substantial progress in analgesic technologies and clinical guidelines has been made in recent years . Previous reports revealed a large proportion of patients experiencing mild-to-severe pain after surgery , as well as pain-related consequences . Health professionals play a major role in poor postoperative pain management. Many studies underlined that insufficient pain management education and negative attitude toward patients who sought medical treatment for their pain were significant barriers . Moreover, the culture of the hospital and the context of pain have been found as contributors to the pain treatment failure .
Among health professionals, nurses are key personnel to support patients experiencing pain in both assessment and treatment, given their large amount of time to spend with the patients . Nonetheless, prior literature points out the lack of knowledge in pain management among nurses . Moreover, in the clinical setting, nurses’ knowledge and practices are not always consistent . They seem to normalize pain after surgery as an acceptable condition that patients have to suffer, leading to a lack of effort or priority in relieving the pain . This causes a huge gap between nurses’ perception and implementation in postoperative pain management, which possibly poses a great challenge to effective pain management in the hospital. Therefore, understanding how nurses practice postoperative management as well as identify factors related to these practices are critically important. This study aimed to examine the postoperative pain management practices among registered nurses in an urban hospital in Vietnam.
2. Methods2.1. Study Design and Sample
This is a descriptive cross-sectional study that was conducted in May 2019 at the Hanoi Medical University Hospital, Hanoi, Vietnam, as a baseline of an intervention. Nurses were recruited from eight departments who carried out minor and major surgeries in the hospital including Otorhinolaryngology (ORL), Plastic Surgery, Oncology, Odonto-Stomatology, Outpatient, Trauma and Orthopaedics, General Surgery A (Neuro and Spine Surgery), and General Surgery B (Gastro-Intestinal Surgery, Hepato-Biliary Surgery, and Urology Surgery). They were included in the study if they (1) were aged 18 years or above; (2) worked in the selected departments of the hospital for at least 6 months, and (3) agreed to participate in the study. A total of 90 nurses were invited, and all of them accepted to be involved in the study (response rate 100%). The protocol of this study was approved by the Institutional Review Board of Hanoi Medical University (code: 165/QD-DHYHN) and the leaderboard of the hospital.
2.2. Data Collection and Measurement
Data collectors were members of the research team who were junior physicians working at the hospital. They were trained intensively with two training sessions in order to collect data consistently and with the highest quality. Training contents included communication skills, interview skills, and questionnaire. The questionnaire was developed and piloted with ten nurses by the data collectors to ensure the language and logical orders of items. The revised questionnaire was then approved by principal investigators and the hospital’s leaderboard.
Face-to-face interviews were performed using a finalized structured questionnaire. Each interview lasted from 15 to 20 minutes. Nurses were first invited to a private room at their department to ensure their privacy. After being informed of a brief introduction of the study, they were asked to give their signature for the written informed consent forms. Participants were then asked to report the following information: demographic characteristics (including age, gender, education, and previous training in pain management), postoperative pain management practices, and pain management protocol at the department.
2.2.1. Postoperative Pain Management Practices
To measure the practices on pain management among nurses, we asked them to report what types of pain they had care experience (acute/chronic/both/none), types of patients receiving the assessment, time for pain assessment, and their knowledge about basic side effects of pain relief medications. Then, they were asked to report whether they regularly performed pain assessment (yes = 1 point/no = 0 point) and the frequency of (1) side effects monitoring; (2) pain level assessment when changing patient’s position; (3) patients’ self-reported pain information collection; and (4) care plan change based on results of pain assessment, with four options: none (0 point)/rarely (1 point)/usually (2 points)/always (3 points). The practice score was a sum of five questions, resulting in a total score ranging from 0 to 13, in which a higher score indicated a higher level of practice.
2.2.2. Pain Management at the Department
Participants were asked to report whether (1) pain management service, (2) pain management guidelines, and (3) pain medication’s side effects management guidelines were available at the department. We assumed that nurses working in a similar department might receive similar pain management training and perceive similar barriers regarding postoperative pain management. Moreover, they were asked to report whether the prescription of pain relief medication was based on pain assessment at the department or not, as well as available pain relief medications and barriers of pain management implementation at the department.
2.3. Statistical Analysis
Data analysis was performed using the Stata software version 15.0. Descriptive statistics analysis was conducted including mean and standard deviation for continuous variables and frequency and percentage for categorical variables. The mixed-effect linear regression model was employed to determine the associated factors with the practice score via controlling the cluster effect within the department. The dependent variable was practice scores, while the independent variables were age, gender, education, types of pain experienced in care, having training about pain management, availability of pain management service/pain management guideline/side effects management guidelines, and barriers in pain management implementation. The regression coefficient, value, and 95% confidence interval (CI) were presented. A value of less than 0.05 was recognized to detect statistical significance.
3. Results
Among 90 nurses participating in the study, most of them were female (75.6%). The mean age was 30.7 (SD = 3.9) years old. The majority of nurses had college or vocational training degrees (51.1%) and did not have training about pain management previously (72.2%) (Table 1).