Thai Nurses' experiences of post-operative pain assessment and its' influence on pain management decisions

Background: While many studies have addressed various issues with regards to pain management, there is limited knowledge about how nurses assess pain in surgical wards. This study aimed to describe Thai nurses' experiences of pain assessment in a surgical ward. Methods: A cross-sectional explorative study was conducted. Participants were selected through theoretical sampling. Data was collected through interviews with twelve registered nurses working in surgical wards. Qualitative content analysis guided the analysis of the data. Results: Nurses use a double/triple check system, communicated to the healthcare team via records and protocols, and they used their skills and experiences in pain assessment. The results showed that nurses missed the opportunity to include the patients' self-reported pain in their accounts. Though much evidence of pain was collected, this did not seem to benefit the patients. Furthermore, the nurses were not using instruments to measure pain, which illustrates the potential unreliability of professionals who have differing opinions concerning the patients' pain. Conclusions: Thai nurses worked based on a 'patient-evidence' paradigm when assessing patients in pain; this should be shifted to an evidence-based paradigm. Furthermore, by including the patients' self-reported pain in their assessment, nurses would both improve the quality of the pain assessment and empower patients in their pain management. Pain management practices in Thailand should be improved through education, training, supportive innovation, and collegial competence development in order to improve the quality of care in the post-operative field

Post-operative pain management practice : Current situation and challenges within nursing practice in a Thai context

Patients’ recovery after surgery is one of the most important health processes in planned hospital healthcare and has a direct impact on welfare and welfare systems. Therefore, what nurses do in the im­mediate postoperative period is of vital importance. This thesis addresses the question of understanding how nurses work in managing post-operative pain by exploring their daily nursing practices and experiences in responding to the patient in pain within a Thai cultural context. The project applied a qualitative methodology where the local culture and its day-to-day practices of pain management were studied by using observations, focus groups, in-depth interviews and a critical incident interview approach with nurses. Informants were recruited at a public hospital in Bangkok in a surgical ward. In all, 100 hours of observations, 39 interviews and 69 descriptions of critical incidents related to nurse’s pain management were gathered. The data analysis followed the principles of qualitative research. The findings showed that, although there is a clearly defined approach to pain management, the response system followed by the nurses to address patients’ pain is complex and includes much lead time between assessing patients’ pain and the nurses responding to the pain. Furthermore, nurses are caught in what is labeled a patient pa­radigm, where evidence of pain often is double- and triple-checked by scoring and recording signs that are then subject to confirmation by a third party. Underpinning this is a culture of pain management cultivated between the nurses that rests first and foremost on their own experiences and a working/professional culture where nurses offer each other practical help in urgent situations, but seldom discuss event-based strategies together. Nevertheless, when nurses described situations when they were successful in practicing pain management, they considered their own engagement and their availability of time, space and therapeutic options to be important. Keywords: Culture of nursing, Nursing in pain management, Pain assessment, Perception of pain, Pain management, Pain post-operativ

Core components of an effective pain management education programme for surgical nurses : A Delphi study

PURPOSE: This study aimed to describe the core components of an effective pain management education programme (PMEP) for surgical nurses in Thailand. METHODS: A three-round Delphi method was used. A panel of 40 experts advised regarding the essential components of an effective PMEP for surgical nurses. RESULTS: The core components of a PMEP were derived from experts' panel consensus: (i) multidisciplinary collaboration, (ii) acquisition of innovative knowledge and training by healthcare teams, and (iii) consideration of individual differences when delivering pain management services. To enhance their pain management practices, nurses should adopt multimodal pain approaches that involve family roles and engage in active patient listening. CONCLUSIONS: The PMEP designed in this study, which adheres to international nursing training standards, promotes the competency of professional nurses

A Scoping Review of Pain Management Education Programs (PMEPs): Do They Prepare Nurses to Deal with Patients’ Postoperative Pain?

This is a report of a scoping review undertaken to obtain an overview of studies conducted on pain management education programs (PMEPs). The aim of this review was to describe existing research publications relating to PMEP to map how pain management practice training might directly influence surgical nurses in contributing to successful pain outcomes in patients. The initial search of electronic databases identified 40 articles according to the inclusion criteria and search strategy, which applied the following terms: (“Pain management education program”) AND ∗ OR ∗ (“Nurses”) AND ∗ OR ∗ (“Patient outcomes”) AND ∗ (“Mixed methods”). Titles, abstracts, and keywords were also searched for the term “Nurse education.” After applying exclusion criteria, five relevant peer-reviewed articles were eventually selected for the final charting of the data. The search included articles published between January 2015 and March 2019. The results show that PMEPs employ a variety of computer-based simulation, web-based facilitation, and video materials based on an evidence-based approach in their syllabuses. PMEPs were shown to enhance practice by promoting improved skills in critical thinking, leadership, patient management, and health promotion. Additionally, these programs promote an ability to practice across a variety of inpatient and outpatient settings, wherein nurses’ engagement in managing patients’ pain increased after completing the PMEP. Research within PMEP indicates that these programs may contribute to promoting opportunities for new collaborations within multidisciplinary team projects. Additionally, further research initiatives are needed to explore various aspects of these programs to enhance the nursing skills required for effective pain management, such as computer-based simulation, web-based facilitation, and video materials. Moreover, research relating to PMEPs in low- and middle-income countries is scarce and warrants further study.</jats:p

A Scoping Review of Pain Management Education Programs (PMEPs) : Do They Prepare Nurses to Deal with Patients' Postoperative Pain?

This is a report of a scoping review undertaken to obtain an overview of studies conducted on pain management education programs (PMEPs). The aim of this review was to describe existing research publications relating to PMEP to map how pain management practice training might directly influence surgical nurses in contributing to successful pain outcomes in patients. The initial search of electronic databases identified 40 articles according to the inclusion criteria and search strategy, which applied the following terms: ("Pain management education program") AND ∗ OR ∗ ("Nurses") AND ∗ OR ∗ ("Patient outcomes") AND ∗ ("Mixed methods"). Titles, abstracts, and keywords were also searched for the term "Nurse education." After applying exclusion criteria, five relevant peer-reviewed articles were eventually selected for the final charting of the data. The search included articles published between January 2015 and March 2019. The results show that PMEPs employ a variety of computer-based simulation, web-based facilitation, and video materials based on an evidence-based approach in their syllabuses. PMEPs were shown to enhance practice by promoting improved skills in critical thinking, leadership, patient management, and health promotion. Additionally, these programs promote an ability to practice across a variety of inpatient and outpatient settings, wherein nurses' engagement in managing patients' pain increased after completing the PMEP. Research within PMEP indicates that these programs may contribute to promoting opportunities for new collaborations within multidisciplinary team projects. Additionally, further research initiatives are needed to explore various aspects of these programs to enhance the nursing skills required for effective pain management, such as computer-based simulation, web-based facilitation, and video materials. Moreover, research relating to PMEPs in low- and middle-income countries is scarce and warrants further study

Towards person-centered pain management in surgical care : Addressing the overlapping pain management systems in nursing education to enhance practice

Since nurses’ work is knowledge-based an ineffective pain management may be the nurse’s perceptions of the patient in pain, which are a barrier of communication between nurses and patients’ pain within individual contexts. The purpose was to explore nurses’ post-operative pain management practices. A qualitative triangulation design was used, applying numerous qualitative methods: observations in a postoperative pain management setting (100 hours); in-depth interviews (12 nurses), three focus group discussions (18 nurses), and narratives relating to 69 critical incidents gathered during recurrent visits over a period of ten weeks (9 nurses). Content analysis, as outlined in grounded theory, was applied.The findings revealed the complex communication system that were nurses affirmed patient’s pain by using double- and triple-control methods to document and record it. As a consequence, they were managing pain by administrative prescription when the patients had requested rather than being proactive in providing pain relief. Mainly of ineffective succeed of communication tasks and information about the patients’ pain in post-operative pain that was available analgesics as causes delayed for pain relief.From the findings the complex communication system was discuss within the responding to and addressing patients’ postoperative pain system model, it was most helpful in creating a meaningful way of communicating education can prepare students for effective communication in a complex understanding about pain management, it must seek opportunities to challenge and change the way nurses think address how pain management within different interacting structures in practice and are create new and important ways of communicating with patients.</p

Using Critical Incident Technique to understand pain management situations in Thailand

Background: Nursing care is an important concern in the field of pain management as it addresses situated efforts to achieve a person-centered care in pain management. Although it is clear that the effectiveness of the pain management practice needs to be improved, there is limited knowledge about the pain management practices of Thai nurses. This study address if Critical Incident Technique be a used to increase our understanding of Pain management in a Thai context.Methods: Critical Incident Technique was used to explore postoperative pain management provided by nurses in a surgical ward in Thailand. A purposive sample of nine registered nurses over a five-week period using a semi-structured interview guide were conducted and collected. Findings: All 69 situations were used to illustrate the successful and unsuccessful aspects of managing postoperative pain, and included Engagement is a manner of commitments, Availability is characteristic in the practicalities of managing pain for the patients, and Imbalance is being inconsistency between the patients' needs and nurses maintain their undertaking routines. Discussion: Nurses’ experience helped to grasp and understand how nurses treat pain in the postoperative setting; this study was conducted in order to further the understanding of this topic. The result show that Critical Incident Technique can serve to expand our knowledge how existing guidelines are facilitated by nurses. Further, the knowledge gained can serve as foundation to development of new nursing guidelines and/or policies in pain management, including improving nursing skills and education programs in pain management settings. </p

Engagement and availability in shaping nurses’ management of postoperative pain: a qualitative study

Background: Studies reporting inadequate nursing care for patients indicate that nurses are negatively affected in such situations, and research is needed to study nursing care in postoperative situations. Objective: To describe situations of postoperative pain management in a surgical ward in Thailand. Methods: A qualitative approach using the Critical Incident Technique was chosen to investigate situations of postoperative pain management from the perspective of surgical nurses in Thailand. Data were collected through multiple semi-structured interviews with nine nurses over a five-week period. Results: The situations of surgical nurses described three elements that heavily influenced the quality of postoperative pain management: engagement in a trustful nurse-patient relationship, availability of pain medication and nursing care when needed, and imbalance between meeting the patient’s needs and completing routine nursing duties. Conclusion: The results help to expand our understanding of how Thai nurses manage pain in postoperative situations and indicate areas that could be improved in terms of how nurses respond to patients’ pain. Nurses challenge existing guidelines and facilitate development of new nursing guidelines and/or policies in pain management

Treating without Seeing : Pain Management Practice in a Thai Context

Pain management is a core nursing function, and it plays a key role in postoperative care. It is important to understand the cultural context of nursing practices and how this affects effective pain management. The aim of this study was to describe the professional and cultural framework within which pain management is practiced on a Thai surgical ward. Spradley’s ethnographic methodology was used. Data were collected through 98.5 hours of field observations and interviews at a surgical ward in Thailand. Three themes were constructed that describe the way Thai nurses practiced pain management: (i) complex communications system to address pain and to respond to it, (ii) the essence of Thai-ness, and (iii) a passive approach to pain management. The results indicate that, in the response to discomfort and pain, better pain management will result if there is a shift from functional to patient-centered care. The nursing culture needs to be further researched and discussed, in order to set priorities in line with the goals of national and international organizations for improving postoperative care and promoting patient comfor