A Study On Preoperative Pain Control Teaching Program To Manage Abdominal Postoperative Pain

Objective1. To identify the condition of abdominal postoperative pain controlbefore the teaching program.2. To identify the effect of teaching program on patients' knowledge ofpostoperative pain control.3. To identify the effect of teaching program on abdominal postoperativepatients' behavior for controlling pain.4. To evaluate the effect of teaching program on abdominal postoperativepain control.Instruments1. The Numerical Rating Scale (NRS), 1～3 is mild pain, 4～6 is moderatepain, 7～10 is severe pain.2. The Postoperative Pain Control Questionnaire (PPCQ)PPCQ is designed by the researcher, 17-item that survey patients' painfeeling, knowledge of postoperative pain control, behavior for controlling painand satisfaction with teaching program. The questionnaire's Cronbach'αis 0.73, test-retest reliability is 0.83, content validity is 0.95.3. Patients' Knowledge of Pain Control Questionnaire (PKPCQ)It is used to survery patients' knowledge of postoperative pain controland it contains a total of 9 items, and 8 items are come from the PPCQ.MethodsThe study was conducted in general surgery department of a teachinghospital between August and November 2006. The study was divided intotwo parts. PartⅠ, 109 abdominal postoperative patients were investigatedduring the 2nd postoperative day and completed the PPCQ to collect data asthe baseline information. And we wrote "teaching handbook for controllingabdominal postoperative pain" based on survey's outcome. PartⅡincludedtwo stages. First we collected control group data (n=42). At the 2nd stage,we chose 42 patients according to control group's gender, age, type ofsurgery and PCA to collect experimental group data. Preoperatively, patientsin both groups were administered the PKPCQ pretest that was completed at2nd day after hospitalization. After completing the pretest, we distributedthe teaching handbook to patients in experimental group. At preoperativeday, the experimental group received routine preoperative care and 30mineducation for pain control, while the control group received routinepreoperative care only. All patients were measured their pain atpostoperative 4-hour, the 1st morning and 24-hour, and completed thePPCQ at the 2nd postoperative day posttest. We collected every patient'sanalgesics consumption in postoperative 48h. Data analysisAll data were analyzed by SPSS 13.0. Descriptive statistics weretabulated. Independent t-tests, Wilcox rank tests and Chi-square tests wereused to test the differences between two groups. The level of significancewas set at 0.05.ResultsPartⅠ: Abdominal postoperative pain control survey1. All patients had suffered postoperative pain. At the 2nd postoperativeday, 56.0％felt mild pain; 47.7％had suffered moderate pain at the 1stpostoperative day; 69.7％replied the worst pain they suffered wassevere degree, and 22.0％had reached to 10 score.2. The patients were lack of knowledge of postoperative pain control,mean total score was 20.38. According to each item's correct rate,ascending sort the item was #1,#2,#4,#8,#3,#5,#7,#6 (see appendix 1).3. The patients were placed in a passive position in pain control. Only33.0％recalled they had asked for pain-killer, 27.5％asked when theyfelt severe pain. They had taken few non-medical pain control methods.In 54 PCA patients, 13.0％pressed the button when the pain was severe,48.2％pressed when moderate pain, and only 3 patients had pressedbefore pain happened.4. 42.2％patients were satisfied with the pain control instruction offeredby the medical staff. 45.9％replied nobody had offered the instructionto them. PartⅡ: The effect of teaching program on abdominal postoperativepain control1. The total knowledge score of postoperative pain control on pretestdemonstrated no difference between two groups. The posttest scorewere higher in experimental group than in control group.2. There was more patients in experimental group had taken non-medicalpain relief methods, especially taking deep breath and listening music.Among the PCA patients in both groups, experimental group pressedthe button at 4.39 score while control group at 5.24; the experimentalgroup had 17 patients pressed the button before pain happened, while 1patient in control group; by analysis, the experimental group pressed thebutton at lower pain and had more previous pressed behavior thancontrol group. But there was no statistical difference between twogroups in behavior of asking for analgesic (except PCA) or pain scorewhen they asked.3. Experimental group's pain score at postoperative 4h, the 2nd dayafternoon, past-24h and the worst pain were lower than control group.But the pain score at postoperative 24h and the 1st morning was nodifference between two groups.4. The satisfied rate of teaching in experimental group was significanthigher than control group. 42.5％patients in control group repliednobody had offered pain control teaching to them.5. The analgesic consumption was no difference between two groups.Conclusions1. Abdominal postoperative pain control is still a serious problem in nowadays. Most patients have suffered severe postoperative pain, thepatients are lack of knowledge of postoperative pain control, andpassively received pain treatment.2. Preoperative pain teaching program can improve patients' knowledge ofpostoperative pain control, urge them to participate in pain control.3. The Preoperative Pain Control Teaching Program can improve theeffect on abdominal postoperative pain control.4. Preoperative pain teaching program can improve the patients'satisfaction with health education.Keywordspain, operation, health education, knowledge, pain control.Limitations1. The reinforcement after teaching is not enough, and then cause thepatients' compliance with researcher is not very well.2. The outcome measures don't include patients' satisfaction with paincontrol after teaching program.Suggestions for further study1. Finding a more simply, more effective and more time-saving healtheducational method.2. Exploring a method to change the patients' attitude towards "bearingpain" thoroughly and urge them to use medical methods to controlpostoperative pain.3. Studying the effet of Preoperative pain teaching program on allpostoperative pain control.