Testing a preoperative pain management intervention for elders.

The investigators examined whether elders who have been taught pain management communication skills and pain management information obtain greater postoperative pain relief than elders not taught this information. Thirty-one elders were randomly assigned preoperatively to a control or communication group in this posttest-only experiment with repeated measures. Communication group participants were taught pain management, pain communication skills, and the use of two pain-intensity scales. Control group participants were taught to use the two pain-intensity scales. Pain was measured with the McGill Pain Questionnaire Short Form. The communication group elders reported less postoperative pain over the course of their hospital stay. Pain management knowledge alone may have enabled the elders to obtain greater pain relief. Nurses may want to incorporate similar pain management information and pain communication skills when teaching elders how to obtain greater postoperative pain relief.

Adult patients' postoperative pain descriptions and responses to the Short-Form McGill Pain Questionnaire.

This study examined the clinical usefulness of the Short-Form McGill Pain Questionnaire (SF-MPQ). Thirty postoperative patients were asked to describe their postoperative pain and were then administered the SF-MPQ. Eighteen (60%) used exact SF-MPQ sensory or affective words or synonyms to describe their postoperative pain during the interview. These results provide further evidence of the clinical relevance of the SF-MPQ sensory and affective scales. Pain descriptions by patients that go beyond pain intensity descriptions may communicate more precise information about the pain and lead to more effective pain interventions. Patients with difficulty describing their pain might be assisted by using the SF-MPQ.

Communicating pain and pain management needs after surgery.

This descriptive study explored how patients communicate their pain and pain management needs after surgery. Thirty postoperative patients were interviewed. The majority described avoiding or delaying communicating their pain at some point during their hospitalization. Reasons for decreased pain communication included not wanting to complain; not wanting to take the provider away from other patients; avoiding unpleasant analgesic side effects; and not wanting to take "drugs." Postoperative patients may be unclear about their role in pain management. Pain management communication problems identified in this study could be used to design intervention studies to improve pain communication and consequent pain relief.

Nurses' personal pain experiences and their pain management knowledge.

BACKGROUND: This study examined nurses' personal experiences with pain and whether nurses' personal pain experiences were associated with initial pain management knowledge and ability to learn more about pain management. METHOD: This descriptive correlational study was a secondary analysis of a study that used a one-group pretest-posttest design to examine the effect of a pain management education program on nurses' pain management knowledge. The sample consisted of 177 nurses who answered yes to having had a personal pain experience requiring treatment. RESULTS: Nurses reported 13 types of pain, with pharmacological interventions comprising 94.4% of the pain treatments. Nurses' previous personal pain experiences were negatively related to their initial pain management knowledge (r = -.23, p < .01). CONCLUSION: Nurses' personal pain experience may impact their learning of pain management knowledge and should be considered when designing pain management education.

Postoperative pain after hospital discharge.

Thirty postoperative adults were surveyed using face-to-face interviews in their homes after hospital discharge. Participants were asked to describe their pain communication during their inpatient hospitalization and pain-related problems after discharge. This study reports the content analysis of participant responses to their pain after discharge. Eighteen (60.0%) described pain-related problems after discharge. Seven (23.3%) identified pain-related fears or complications. Six (20.0%) identified analgesic management problems. Six (20.0%) described difficulty with positioning or moving. Four (13.3%) described sleep disruption from pain. The results identify several pain-related problems encountered by postoperative patients after hospital discharge. Shortened hospital stays make effective postdischarge pain management an essential aspect of care for surgical patients. Teaching patients additional pain management skills, including when and how to communicate with health care providers when pain-related issues occur at home, may lead to more effective pain relief for patients.

Acute pain reduction strategies used by well older adults.

Thirty older adults, without chronic pain, were interviewed about the acute pain reduction strategies that they used at home and strategies that they might use if hospitalized. Verbatim transcripts from the audiotapes were content analyzed. Successful pain reduction strategies included taking a mild analgesic and positioning. If hospitalized, 16 (53.3%) would request analgesics; four (13.3%) would talk with a health care provider; five (16.7%) would continue their own pain reduction strategies; four (13.3%) provided no pain reduction strategies. Results suggest that many older adults possess pain reduction strategies that may be helpful to incorporate in their pain management when hospitalized.

Factors affecting the predictive validity of the Braden Scale.

This descriptive correlational study explored the predictive validity of the Braden Scale and factors affecting it A Braden score was determined within 4 hours of admission for 50 adult medical/surgical inpatients. Independent skin assessments were made three times a week and at discharge. Fourteen patients (28%) developed pressure ulcers. A Braden score cutoff of 18 or less resulted in a 71% sensitivity, 83% specificity, 63% predictive value of a positive test, and 88% predictive value of a negative test. Three of the four patients incorrectly predicted to be not at risk scored "inadequate" on the nutrition subscale. Two of the four also were underweight. Of the six patients incorrectly predicted at risk for a pressure ulcer, three had been placed on air mattresses and were receiving levothyroxine (Synthroid). This study provides further evidence of the Braden Scale's predictive validity. The results suggest that patients who are underweight or getting inadequate nutrition be considered at increased risk for pressure ulcers.

Nurses' memory of patient's pain.

This descriptive study examined the relationship between nurses' memory of patient's pain and patient stereotyping. The patient vignette information recalled by 148 nurses was content analyzed for accurate items, accurate analgesic items, and how accurately the patient's pain was recalled. Stereotyping was measured by z-scores for time planned for pain assessment and analgesic administration. No significant relationship was supported between memory and stereotyping. Nurses either recalled the patient's pain accurately (n = 58), inaccurately (n = 18), or completely omitted (n = 70) this information. Further study is needed to explore why nurses recalled the patient's pain differently, and how this might impact pain relief efforts.

The response of women to gender stereotyping during a health interview.

Gender-stereotypical responses and critical health information were examined in this posttest-only experiment. Thirty-eight university women students and staff were randomly assigned to a gender-stereotyped or a nonstereotyped health interview. Gender-biased cues were embedded in three of the five questions in the gender-stereotyped interview. Women in the gender-stereotyped interview responded with significantly more gender-stereotypical responses. However, no subjects felt affected by the gender-biased cues. Findings suggest that women affirm gender-biased questions asked in health interviews.

Gender and ethnic stereotyping and narcotic analgesic administration.

The purpose of this study was to investigate whether nurses provide different amounts of narcotic analgesics to male and female patients, and different amounts to white and ethnic minority patients. A retrospective survey was conducted with the medical records of 101 male and 79 female uncomplicated adult appendectomy patients, 40 of whom were ethnic minority members. Narcotic analgesic doses for the entire postoperative period were converted to equianalgesic doses comparable to intramuscular morphine. Male patients received significantly larger initial doses than female patients. There was no gender difference in the total dose received postoperatively. White patients received significantly more total postoperative narcotic analgesics than ethnic minority patients. The gender difference provides modest external validation for prior experimental results. The ethnic difference suggests that irrelevant cues may be used in nurses' medication decisions.

Postoperative narcotic analgesic administration.

The administration of narcotic analgesics to postoperative patients was examined with 180 uncomplicated adult appendectomy patients. Narcotic analgesic doses were transcribed from the hospital records of these patients for the entire postoperative period. Equianalgesic doses were calculated so that all medications were comparable with meperidine. Eighty-three percent (n = 150) of the patients received meperidine. Patients who received meperidine were given significantly more narcotic analgesics than those who received morphine sulfate. The amount of narcotic analgesics received by patients was significantly related to their length of hospital stay. Meperidine and Tylenol #3 (acetaminophen with codeine phosphate; McNeil Pharmaceutical, Spring House, PA) comprised the significantly associated analgesics. These findings suggest a need to reexamine the current use of meperidine in postoperative analgesia.

Gender stereotyping and nursing care.

The effect of gender stereotyping on nursing care was examined. Eight conditions were created in a posttest-only experiment by completely crossing patient gender (male/female) by memory load (low/high) by patient health status (stable/unstable). One hundred sixty nurses read the same patient vignette. The vignette differed in patient gender, memory load, and patient health status. The nurses then estimated the minutes needed for specific nursing interventions with the patient. Nurses planned significantly more ambulation, analgesic administration, and emotional support time for the male patient, despite the presence of individuating information. More accurate, effective nursing care is possible when nurses are aware of the effect of gender stereotyping on nursing care.