Direct Practice Improvement Project Proposal Doctor of Nursing Practice Case Solutoin
According to Al-Shaer, Hill, & Anderson (2011), even though there has been years of research on the subject, health care continues to have significant problems with inadequate pain assessment and management. Lack of knowledge of nurses about pain assessment and management is found to be consistent in the literature. Nurses’ knowledge of pain assessment and interventions are essential in promoting positive outcomes for postoperative patients (Al- Shaer, Hill, & Anderson, 2011)
Purpose of the Project
The purpose of this project is to do a quantitative project to examine the attitudes and knowledge of nurses toward postoperative pain management on a surgery unit of an acute care hospital and find if education of nurses in assessing pain and pain management improves after implementation of a postoperative pain management tool. Nurses play a significant role in pain assessment and management of patient’s postoperative pain. According to Al-Shaer, Hill, & Anderson (2011) nurses need current knowledge and appropriate attitudes regarding pain assessment and controlling to give adequate pain relief to postoperative patients.
Pain is a common experience for patients having surgery. Pain can cause physiological and psychological harm to the patient. Uncontrolled pain can increase the risk for complications such as atelectas is, deep vein thrombosis, and poor wound healing (Francis & Fitzpatrick, 2013). Patients with uncontrolled postoperative pain can lead to chronic pain, if unresolved. Nurses receive minimal training in nursing school about assessing pain in postoperative patients. Actions and unconscious motivations are often influenced by the nurses’ own experiences and background (Abdalrahim et al., 2011). A review of literature is needed to determine how nurses’ attitudes, knowledge, and education affect postoperative pain management.
This project will increase nurses’ knowledge and improve attitudes in assessing and managing pain for postoperative patients after implementation of the Knowledge and Attitudes Survey Regarding Pain (KASRP). Postoperative patients with better pain control will be ambulating earlier thus contributing to decreased postoperative complications and shorter hospitalization (Manwere et al., 2015).
Clinical Questions
The following clinical questions guide this quantitative project:
Q1: Does improving the knowledge and attitudes of nurses regarding Postoperative pain management lead to better pain management for postoperative patients in an acute care hospital?
Q2: Will knowledge and attitudes improve when nurses’on a postoperative unit are educated of postoperative pain assessment and management using a pre and post intervention?
Quantitative research with a descriptive, cor relational design will be used in this project. Demographics such as age, sex, and years of nursing will be included and compared. According to a research by Mędrzycka-Dąbrowska, Dąbrowski, Gutysz-Wojnicka, Basiński,&Kwiecień-Jaguś (2017) knowledge of current practices associated with pain assessment and controlling did increase with the nurse’s level of education. Barriers noted were due to age, seniority, and decreased level of education. The registered nurses on the postoperative unit are the dependent variable as they will be educated on pain management. Improving nurses’ knowledge of assessment and management of pain in postoperative patients will lead to better pain control for postoperative patients.
Educating nurses about knowledge of assessment and management of pain in postoperative patients will lead to better pain control for postoperative patients. The Nurses Knowledge and Attitudes Survey Regarding Pain Tool (KASRP) will be used to survey nurses’attitudes and knowledge about pain management. This is the independent variable. Postoperative patients exhibiting pain are less likely to participate in interventions to prevent complications such as coughing, deep breathing, and ambulating (Francis & Fitzpatrick, 2013).
Advancing Scientific Knowledge
Nurses’ personal beliefs influence pain management decisions. Nurses often underestimate the intensity of postoperative pain reported by patients and rely on their own judgments. Nurses do not generally administer adequate amounts of analgesia due to fear of over sedation or side effects (Kiekkas et al., 2015). Nurses’ lack of knowledge and attitudes about assessment and treatment of pain contribute to inadequate postoperative pain control on the general surgery postoperative unit in an acute care hospital.
A patient’s self-report is the most reliable indicator of pain. Patients communicate verbally or with body and facial expressions. Patient’s observation and visual analog scale (VAS) are ways to assess pain. According to Francis & Kil pat rick (2013), nurses lack assessment skills and have preconceived attitudes that lead to poor pain management for postoperative patients.
Pain is a subjective experience that is hard to evaluate. There is no objective measure that a nurse can use for pain assessment (Al-Shaer, Hill, & Anderson, 2011). Pain must be assessed regularly together with vital signs as basic principles of pain management recommendations (Manwere et al., 2015). Nurses who understand how to assess pain will provide better pain management for postoperative patients in acute care hospitals.
Significance of the Project
Assessment of pain and pain management are important in the care of postoperative patients. Pain management is an important part of recovery for postoperative patients. Nurses have a pivotal role in assessing and managing pain. Pain can impair a patient’s ability to participate in postoperative interventions such as coughing, deep breathing, and ambulating. Early ambulation helps prevent deep vein thrombosis and pulmonary em bolus,the main causes of morbidity and mortality in postoperative patients (Katz & Nelson, 2013). Patients with adequate pain management are more likely to participate in interventions that help prevent postoperative complications such as atelect as is, pneumonia, deep vein thrombosis, and delayed wound healing (Francis & Fitzpatrick, 2013). Early recovery in postoperative patients improves patient satisfaction, decreases re-admissions, and improves cost savings (Katz & Nelson, 2013).
Nurses need to understand that pain assessment and management are vital to
Post-operative recovery. Unrelieved pain can suppress the immune system and
delay the healing process(Wells, Pascero, & McCaffery, 2008).Poor pain control can
limit mobility, interfere with sleep and rest, and contribute to agitation, psychosis, and
aggressive behaviors. Postoperative pain can interfere with the patient’s activities of daily
living (Wahila, Oclimba, &Ngoma, 2018).
Research shows that nurses underrate pain in postoperative patients. Self-report by the patient is the most reliable indicator of pain. Patients communicate verbally and with facial and body expressions (Francis & Fitzpatrick, 2013). Nurses often view a smiling patient not in pain while the patient who is grimacing in pain. Postoperative pain that is unrelieved leads to increased heart rate, blood pressure and oxygen requirement, slow immune response, and poor gastrointestinal motility, resulting in complications. Patients with poor control of postoperative pain can experience anxiety, lack of sleep, prolonged hospitalization, increased costs, and chronic pain development (Kiekkas et al., 2015).............
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