Purpose

1. Nurses’ Perception of Pain Management: A Survey in Women’s Health Inpatient Units Giselle Rosabal, USF Student Nurse & Brittany Brewer, USF Student Nurse Results Purpose Measures To collect information regarding pain management a survey was conducted and distributed to nurses at Mease Countryside Hospital Labor & Delivery/ Post Partum Unit and Morton Plant Gynecology Medical Surgical Unit. A total of 20 nurses participated in the survey. N= 20 13 (n=13) nurses caring for females undergoing gynecological surgeries and 7 (n=7) nurses caring for pregnant females who delivered vaginally or via a cesarean-section were surveyed • The purpose of this proposed project is to evaluate and analyze issues related to ineffective pain management in the women population at Mease Countryside Hospital and Morton Plant Hospital • This project is employed utilizing the Fish Bone Diagram, visual graphs, and HCHAPS scores to determine the different etiologies behind ineffective pain management • Aimed at determining interventions that could be implemented to improve pain management • HCHAPS Surveys continued to be used and evaluated to monitor progress • Pain intensity scale for the acute monitoring of patient’s pain level • Unit specific surveys distributed to patients based on their pain directly before discharge – rather than the survey simply being emailed to them. This promotes better instant & reliable feedback. Process Improvement • Plan-Do-Study-Act • Assess patient’s current level of pain effectively using the proper pain scale (ex: 0-10 scale, Wong-Baker Faces scale, FLACC scale, OLDCART)-Implement pain control intervention (ex: medication)- Reassess pain after intervention- Use different intervention if pain has not been properly controlled or if properly controlled, continue to keep patient comfortable (ex: use of different medication) • Provide additional training to staff based on pain management education; managers really enforcing it • Additional training should be provided to patient care techs on how to assess pain, intervening with non-pharm interventions • Writing when next pain medication is due on patient's board to encourage patient to actively participate in their plan of care • Having nurses properly EDUCATE patient on pain medication (there wont be a dependence if there is actually in pain being experienced) • Encouraging patient to speak up when they have pain • Reassess Patient after giving medication (RN Response) • Nurse needs to advocate for patient; if physician is not ordering affective pain medication, they need to reach • Implementing different non-pharmacological interventions (ex: relaxation methods) in between scheduled pain medication Background • Female population served at Mease Countryside Hospital Labor & Delivery/ • Post Partum Unit and Morton Plant Gynecology Medical Surgical Unit • If a patient’s pain is improperly managed, it negatively affects all systems of • the body. Studies have proven that physiological healing is delayed, stress is • induced, the patients often experience irregular sleep patterns, anxiety and • depression when pain is prevalent. For the overall physical and mental • wellbeing of the patient, pain needs to be properly controlled. • Pain management is a nursing responsibility and is an important part of professional nursing practice. • Research have shown that females report more severe pain, more frequent bouts of pain, more anatomically diffuse and longer-lasting pain than males with similar disease processes (Hurley & Adams, 2008) • In experimental studies, women have been shown to have a significantly lower pain threshold, lower pain tolerance, greater clinical pain, greater pain-related distress and have heightened neurophysiological responses than men. These sex differences occur as a result of the interplay between biological, psychological, and social factors. (Paller, Campbell, Edwards & Dobs, 2009) • Evidence also indicates some endogenous pain control systems are less strong in women than in men (Fillingim, King, Ribeiro-Dasilva, Williams & Riley III, 2009) • The Institute of Medicine (2011) highlighted in a report the need to address disparities in the experience of pain among patient subpopulations. Furthermore, the article indicates that pain, especially in women is underdiagnosed and undertreated. • At these facilities pain management can be improved upon as evidence by the HCHAPS scores often being below the 60th percentile r/t to the patient’s perception of pain while staying at the hospital for 2013 and previous years. Survey: Quality Indicator Project R/T Pain Management Would you mind participating in a QI indicator project being researched at USF? This is to see how effectively pain is controlled on this unit, looking for areas of improvement, trends, and to implement any new ideas... Do not list your name! How often do you consider non-pharmacological interventions before giving medications? a. never b. sometimes c. usually d. always How often do you reassess pain after implementing an intervention? a. never b. sometimes c. usually d. always How often do you teach your patient on the side effects of their medication? Never Sometimes Usually Always Please list any non-pharmacological interventions you implement before administering pharmaceuticals...  How often do you find that those are affective enough to not have to use any pharmacological interventions?  a.neverb.sometimesc.usuallyd. always Do you think your patient's pain is controlled while under your care?  a.neverb.sometimesc.usuallyd. always Why do you think health care professionals do not implement non-pharmacological interventions all the time? Do you think it is due to lack of time, lack of knowledge, lack of evidence, etc. ? We appreciate you participating in this survey. Thank you so much for your time, Limitations / Lessons Learned • Noncompliance with additional training, • Patient to nurse ratio • Heavy workload and time restraints • Availability of staff and funding Survey Key Results Improvement Tools/Methods Team Members • Cause and effect analysis (fishbone diagram) • Plan-Do-Study-Act Improvement method • HCHAPS results based on GYN/MED SURG Unit and LABOR & DELIVERY units from May 2012 – May 2013 • Run charts, control charts • Surveys distributed to nurses • Nursing Management • Registered Nurses • Student Nurses • Patient Care Technicians References Fillingim, R. B., King, C. D., Ribeiro-Dasilva, M. C., Williams, B. R., & Hurley, R. W., & Adams, M. C. (2008). Sex, gender, and pain: An overview of a complex field. Anesthesia and Analgesia, 107(1), 309-317. doi:10.1213/01.ane.0b013e31816ba437 Institute of Medicine (2011). Relieving Pain in America. Retrieved from http://www.iom.edu/relievingpain Paller, C. J., Campbell, C. M., Edwards, R. R., & Dobs, A. S. (2009). Sex-based differences in pain perception and treatment. The American Academy of Pain Medicine, 10(2), 289-299. doi:10.1111/j.1526-4637.2008.00558.xRiley III, J. L. (2009). Sex, gender, and pain: A review of recent clinical and experimental findings. Journal of Pain, 10(5), 447-485. doi:10.1016/j.jpain.2008.12.001