Development of a research-based standard for assessment, intervention, and evaluation of pain after neonatal and pediatric cardiac surgery.

This analysis of retrospective and prospective data quantified children (age range 0-18 years, total n = 132) during their stay in a cardiothoracic intensive care unit and examined pain management and sedation practices. Data on both factors that could potentially affect pain and its management, and analgesics/sedatives ordered for and administered to subjects were collected from chart review. In the prospective group, pain intensity was measured twice daily using the Wong-Baker FACES Pain Rating Scale. Repeat cardiac surgical procedure subjects reported significantly more pain than nonrepeat subjects on the first postoperative night. Subjects with sternal incisions reported significantly more pain than subjects with submammary incisions. Not all subjects were premedicated with analgesia for invasive procedures. Significantly greater amounts of analgesia were received by the 0-3 year-old subjects. Large amounts of sedation were used, especially in children under 3 years of age. The results prompted development of a nursing standard to assess and manage pain and sedation in this population.

Analgesic administration, pain intensity, and patient satisfaction in cardiac surgical patients.

BACKGROUND: Pain can adversely affect a patient's physiological and psychological recovery, yet little is known about the pain experience of cardiac surgical patients. OBJECTIVES: To examine nursing practice regarding analgesic administration and measure pain intensity and patient satisfaction with pain management practices. METHODS: To establish baseline nursing practice regarding analgesic administration, charts were reviewed retrospectively in 50 adult cardiac surgical patients, and the same information was collected concurrently for a prospective sample of 51 patients. The subjects completed visual analogue scales as a measure of pain intensity twice daily while in the cardiothoracic intensive care unit and Pain Relief Satisfaction Questionnaires on the day after transfer from the unit. RESULTS: Patients in the prospective group received significantly more analgesia. Pain intensity was moderate (4 or greater on the Visual Analogue Scale). Women had higher overall visual analogue scale scores than did men, 4.57 versus 3.70. Patients in whom an internal mammary artery had been used as a bypass graft had significantly higher scores compared with patients with vein grafts. The Pain Relief Satisfaction Questionnaire responses indicated that 96% of the patients experienced effective pain management in the cardiothoracic intensive care unit. CONCLUSIONS: Despite receiving analgesic doses twice those reported elsewhere for similar populations, the patients in this study reported moderate pain intensity. This finding was confounded by the fact that 96% expressed satisfaction with their pain management in the cardiothoracic intensive care unit. Frequent assessment and documentation of both pain and pain relief from interventions are necessary if the healthcare team is to implement an individualized analgesic regimen.

Holding death at bay: the experience of the spouses of patients undergoing cardiovascular surgery.

This study utilized a grounded theory design to investigate the experiences related to being the spouse of a cardiovascular surgical patient during five subject-identified phases: a) finding out the surgery was necessary, b) waiting for surgery, c) waiting during surgery, d) the intensive care unit (ICU) experience, and e) the recovery period before hospital discharge. Data were collected from each of eight subjects via three unstructured, tape-recorded interviews conducted a) on the day of the patients' hospital admission, b) during the first 48 hours of the patients' ICU stay and c) just before the patients' hospital discharge. Holding Death at Bay was identified as the core category. Three main categories: uncertainty, helping commitment and reorganization emerged from the data and were apparent in each of the five subject-identified phases of the spouses' experience. Main categories and subcategories of the core category emerging from the data are described. Implications of this research for nursing practice and further nursing research are discussed.