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Excerpt
Introduction: Pain is a major concern of patients in the intensive care unit (ICU). Unrelieved pain increases morbidity and mortality and may increase hospital length of stay. Recent attention to these facts has led to the development of pain management guidelines. The purpose of this study was to determine the impact of implementation of nursing pain management guidelines on patient pain and satisfaction with pain control.
Methods: Prior to implementation of pain management guidelines and nursing education, 50 consecutive patients admitted to a surgical ICU were surveyed to assess their pain acuity, degree of pain relief, and satisfaction with pain control for the first 72 hours in the ICU. Unaware of these results, the staff was inserviced on the principles of pain management. Three months after the education, a second consecutive group of patients were surveyed. Pre and post education survey results were compared for pain level, relief, and patient satisfaction. Data was analyzed by nonparametric methods (Chi square) with significance set to 0.05.
Results: Nursing education focused on improving: pain assessment skills and documentation, frequent monitoring, attention to patient's analgesic care, use of concomitant anxiolytic agents, patient education of non-pharmachologic interventions. A Visual Analog Scale (VAS) evaluated pain control. The percent of patients whose pain was well controlled (VAS < 4 out of 10) increased from 28% to 33% (NS). Subjective patient measure of the degree of pain relief improved from 57% to 79% and patient satisfaction improved from 81% to 90% (p < 0.05).
Conclusions: Subjective assessment of patient pain relief and overall satisfaction with pain management improved significantly; however, there was no significant difference in pain acuity measured by VAS. Pain management satisfaction does not correlate with pain acuity as assessed by VAS. Patient satisfaction with pain control can be improved by the concomitant utilication of non-pharmachologic methods and increased nurse-patient interactions.
