A Middle Range Theory: Chronotherapeutic Intervention for Postsurgical Pain

1. A Middle Range Theory: Chronotherapeutic Intervention for Postsurgical Pain Theory developed by Susan E. Auvil-Novak By Candice Kiskadden

2. Overview Objectives • Discuss the theory of Chronotherapeutic Intervention for postsurgical pain (CIPP) • Describe purpose and major concepts of CIPP • List contexts for use of the CIPP theory • Discuss nursing implications of CIPP • Characterize the evidence of empirical testing of CIPP • Outline current research articles using CIPP • Communicate application to author’s practice

3. Theory of Chronotherapeutic Intervention for Postsurgical Pain • CIPP theory states pain management is time dependent • “Chronotherapeutic” approaches to pain • Derived from theory, literature review, and studies • Used three separate studies • Analgesic utilization is a feedback loop for pain reception

4. Who is Susan E. Auvil-Novak? • Authored four publications related to nursing • Publication focus was on time aspects Susan E. Auvil-Novak, Ph.D, RN

5. Analysis and Evaluation CIPP Theory

6. Purpose and Major Concepts • Prescriptive Mid-range Nursing Theory • Focused on postoperative pain perception • Pain is chronologically rhythmic • Different pain interventions needed at different levels through cycle • Maximize pain control and minimize adverse effects

7. Context for Use • Theory has evidenced-based practice references to past studies • Clinical evidence supports theory of CIPP pharmacologic administration • Can be applied to different types of pain stimuli • Uses model of Individual Biologic Time Structure • Use of CIPP pain management enhances postoperative outcomes • Can be used for populations unable to verbally communicate: children, neonates

8. Nursing Implications • Recent studies support congruency with CIPP Theory • Patient controlled analgesics currently utilized postoperatively • Theory is socially relevant and can be applied transculturally • Increases the nursing evidence-based practice for pain control • Heathcare professionals can provide better pain control with less adverse effects

9. Evidence of Empirical Testing • Empirical validation of gynecologic oncology patients • Compounding evidence supported the theory in three separate studies • Testing has proved the theory to be accurate and valid • CIPP has been cited in many other scholarly publications

10. Research Utilizing CIPP • Henly, S. J., Kallas, K. D., Klatt, C. M., & Swenson, K. K. (2003). The notion of time in symptom experiences. Nursing Research, 52(6), 410-417. • Sherwood, G. D., McNeill, J. A., Starck, P. L., & Disnard, G. (2003). Changing acute pain management outcomes in surgical patients. AORN Journal, 77(2), 374-395.

11. Henly, Kallas, Klatt, & Swenson • Appropriately uses CIPP Theory to build new SET theory • Uses theory to build on nursing practice • Uses CIPP theory as empirical study to illustrate critical points • Does not continue to develop CIPP theory • Relevant to current evidence-based nursing practices

12. Sherwood, McNeill, Starck, & Disnard • Appropriately uses CIPP theory to increase research knowledge • Supports hypothesis of postoperative pain management • Contributes to chronotherapeutic approach of pain assessment • Contends that CIPP theory enhances postoperative outcomes and precipitate recovery

13. Practice Application • No direct application to Operating Room nursing • Preoperative assessment can include CIPP for greater pain management • Effective for immediately postoperative • OR nurses and CRNAs can influence prescriber for order of CIPP

14. References