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Dissertation
Enhancing Pain Management and Evaluation in Post-Cardiac Surgery Patients
University of Iowa
Doctor of Nursing Practice (DNP), University of Iowa
Spring 2024
Abstract
Background: Pain is experienced by all patients undergoing cardiac surgery (Bills et al., 2022). Inappropriately managed postoperative pain can lead to negative clinical outcomes such as respiratory failure, postoperative pneumonia, poor rehabilitation, and longer hospital stays (Bills et al., 2022). Enhanced Recovery After Cardiac Surgery (ERACS) recommends usage of multimodal analgesia with decreased opioid usage (Bills et al., 2022). The use of non-pharmacological pain interventions can diminish pain intensity (Tsegave et al., 2023). Purpose: The purpose of this evidence-based practice project was to implement the usage of a nursing-led pain decision tree as tool to increase frequency of assessment, intervention, and documentation of postoperative pain in cardiac surgery patients in the first 48 hours after surgery Methods: Literature review and synthesis via two databases and organizational policy review led to the creation of the Postoperative Pain Decision Tree (PPDT). Manual chart review of pain reassessment and non-pharmacological pain intervention documentation in post-cardiac surgery patients in the first 48 hours after surgery occurred. CVICU nurses were education on the PPDT. Implementation period occurred from June-August of 2023. Post intervention chart review and data analysis using medians and Mann-Whitney U testing occurred. Findings: Frequency of pain reassessment increased from median of 2 to 6 post implementation of the PPDT (p<0.001). Non-pharmacologic pain intervention documentation increased from median of 0 to 2 with the implementation of the PPDT (p<0.001). The delivery of MME remained unchanged with the usage of the PPDT (median 87.5 to median of 92). Modified Knowledge and Attitude Regarding Pain Survey (m-KARPS) scores increased from 26 pre-intervention to 27 post. (p<.029) Discussion: Use of PPDT lead to increased reassessment of pain after administration of analgesia, increased implementation of non-pharmacological pain intervention, and similar opioid analgesia administered. Nursing knowledge scores had a modest increase, though likely not clinically significant.
Details
- Title: Subtitle
- Enhancing Pain Management and Evaluation in Post-Cardiac Surgery Patients
- Creators
- Emmalee Oxley - University of Iowa
- Contributors
- Heather Dunn (Chair) - University of Iowa
- Resource Type
- Dissertation
- Project Type
- Poster
- Degree Awarded
- Doctor of Nursing Practice (DNP), University of Iowa
- Degree in
- Adult/Gerontology Nurse Practitioner (Acute Care)
- Date degree season
- Spring 2024
- Publisher
- University of Iowa
- Number of pages
- 1 page
- Copyright
- Copyright © 2024 Emmalee Oxley
- Language
- English
- Academic Unit
- College of Nursing; Doctor of Nursing Practice Projects
- Record Identifier
- 9984627255702771
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