| BackgroundThere was a high incidence of moderate to severe postoperative pain in patients undergoing abdominal surgery,but the postoperative pain has not been effectively controlled yet.Inadequate of postoperative pain management not only increase the risk of postoperative complications,easily cause chronic postsurgical pain,but also lead to adverse psychological reactions such as anxiety and fear.Furthermore,unrelieved postoperative pain could reduce patients’ satisfaction and lower their quality of life,and prolonged the length of hospital stay.Thus,it is of great importance to effectively manage postoperative pain in patients undergoing abdominal surgery.However,most of the postoperative pain assessment and management for abdominal surgery patients were based on clinical experience or a certain guideline,which mainly focused on pain assessment tools and non-pharmacological intervention method.Moreover,only the postoperative pain level and satisfaction of patients were evaluated in present researches.ObjectivesTo evaluate and analyze the best evidence to pain assessment and management of available clinical practice guidelines on postoperative pain management in adults,and to apply the best evidence for postoperative pain assessment and management in adult patients undergoing abdominal surgery and evaluate its clinical effects on pain nursing knowledge and practice,and pain-related patient-reported outcomes.MethodsSubjects:By convenient sampling method,nurses and patients in general surgery and gynecology of a University Affiliated Hospital were recruited..Instruments:1.Appraisal of Guidelines for Research and Evaluation Ⅱ(AGREE Ⅱ)is an internationally recognized and widely used guideline evaluation tool,including scope and purpose,stakeholder involvement,rigor of development,clarity of presentation,application,and editorial independence domains.2.The Knowledge and Attitude Survey Regarding Pain(KASRP)was designed to measure the level of pain knowledge and attitude of nurses.The most recent version was revised in 2014.It consists of 41 questions,one point was given for each correct answer,and the final score was calculated as a percentage of the total questions.3.Checklist of pain assessment and management after surgery was designed by the researcher according to the 10 audit indicators.It consists of 26 questions.The content includes patient’s information,perioperative pain treatment status,nurses’pain management nursing practice behaviors.4.The International Pain Outcomes Questionnaire(IPO)was developed according to the American Pain Society Pain Outcomes Questionnaire Revised,and used to investigate the postoperative pain status of surgical patients.It consists of 13 items,and including intensity of pain,effect of pain on function and emotion,side effects of analgesic drugs,perception of nursing,non-pharmacological intervention method and chronic preoperative pain.Intervention and study procedures:Guidelines on postoperative pain management in adults published from January 2010 to April 2019 were systematically retrieved.AGREE Ⅱ was used to evaluate the quality of eligible guidelines.Sixteen best evidence on postoperative pain assessment were synthesized.According to the best evidence,the guide for pain assessment and management and the flow chart for pain assessment and management were revised,and the education manual for postoperative pain patients was developed.Nurses were trained by researcher using the guide and flow chart in 40 minutes.Nurses carried out the pain assessment and management to patients according the guide,and used the education manual to educate the patients about pain one day before surgery.Before and two months after the evidence-based practice,nurses’ knowledge level of pain management,the implementation of audit indicators and pain-related patient-reported outcomes were investigated.Results1.Comparison of pain nursing knowledge and practice before and after evidence-based practiceAfter implementation of the evidence-based practice protocol,the correct rate of nurses’ pain management knowledge increased from 48.5%to 53.2%(t=2.393,P<0.05).In the first 24 hours after surgery,the total number of pain assessment significantly increased from 4.6 to 5.3(t=3.694,P<0.001),and there was no significant difference in the number of evaluation after using analgesics.2.Implementation status of the audit indicators before and after evidence-based practiceAfter implementation of the evidence-based practice protocol,implementation rate of pain screening( χ~2=17.780,P<0.001),using non-pharmacological intervention method( χ~2=218.956,P<0.001)and participating in pain management( χ~2=10.867.P<0.05)increased to 100.00%.Rate of assessment frequency increased from 77.1%to 98.3%( χ~2=37.702,P<0.001),and rate of postoperative pain education increased from 42.2%to 98.9%( χ~2=145.595,P<0.001).There were no significant difference in rate of other audit indicators before and after evidence-based practice.3.Comparison of pain-related patient-reported outcomes before and after evidence-based practiceAfter implementation of the evidence-based practice protocol,the least pain significantly increased from 0.6 to 1.1(t=-5.116,P<0.001),and the percentage of time of the worst pain significantly decreased from 21.7%to 10.4%(t=6.764,P<0.001),but there was no significant difference in the worst pain.The degree of patients’ self-reported pain relief significantly increased from 75.0%to 85.2%(t=-7.446,P<0.001).And patients who reported that they needed more pain treatment also decreased significantly from 9.2%to 0.6%(t=14.360,P<0.001).The patients’satisfaction with pain treatment increased from 8.0 to 9.0(t=-11.059,P<0.001).The impact of pain on usual everyday activities were significantly reduced(P<0.001).ConclusionsApplication of the best evidence of postoperative pain assessment and management in adult patients undergoing abdominal surgery improved nurses’ pain management knowledge level and pain nursing practice,relieved patients’postoperative pain level,and improved pain-related patient-reported outcomes. |
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