Postoperative pain : nursing management and organisational commitment
Postoperative pain management has been the subject of several national reports (Royal College of Surgeons of England and College of Anaesthetists, 1990; Audit Commission, 1997; Clinical Standards Advisory Group, 2000) that have each made recommendations for practice at ward level and Trust-wide strategies to improve pain management within an organisation. These two areas represent the foci of the work undertaken in this thesis. The research consisted of two studies; the first surveyed hospital Trusts in the Northern and Yorkshire region (n=35) and the second explored nursing care of 120 patients admitted to four English hospitals (two with an acute pain service) through nonparticipant observation, patient interviews and examination of nursing documentation. The questionnaire results highlighted increases in funding for pain management, staff education, audit practices and written guidelines compared to previous work by the Audit Commission (1998) but wide variations in the nature of these activities. In the second study, hospital two (without a pain service) achieved the lowest pain scores at rest (p=0.018) and on movement (p=0.013) but also had one of the lowest rates of analgesic administration and morphine equivalent doses. This ward had the highest number of pain-related interactions (p=0.004), entries onto pain assessment charts (p=0.03) and documented evaluations in nursing care plans. Data also illustrate the differences between observed and documented care in all hospitals and the low use of pain assessment tools in practice to inform analgesic decision-making. This study provides an insight into hospital activities aimed at improving pain management and surgical nursing practice across Trusts. Recommendations are made to further enhance pain relief in hospital including the promotion of pain as a quality of care indicator and increasing accountability within organisations.