Processes and outcomes of pain management in patients undergoing open heart surgery in a cardiac surgery critical care unit

Abstract

            This retrospective descriptive study aimed to describe the independent, dependent, and interdependent roles of nurses in pain management and outcomes. Following the purposive sampling method, 110 patients undergoing open heart surgery in a cardiac surgery critical care unit from October 2014 to September 2015 were the subjects, and their demographic data and health history records, process of pain management records, and outcomes of pain management records were collected. Descriptive statistics including one sample t-test was used to analyze the data.

            The findings showed that the independent role of nurses in pain assessment using numeric pain scale was consistent to pain management protocol; however’ pain reassessment was lower than 50%. Moreover, non-pharmacologic pain management, such as care of personal hygiene and comfort as well as positioning, was mostly used in combination with pharmacologic intervention. Regarding their dependent role, opioid drug, i.e. morphine and fentanyl, were mostly used during 24 and 48 hours after operation. In terms of their interdependent role, less than 10% were found to have inadequate pain management during 24, 48, 72 hours reported to surgeons after operation, and the side effect of pain medication was less than 3%. In terms of outcomes of pain management, the level of pain during 24 and 48 hours was at a moderate level whereas a period of 72 hours was at mild level. Compared against the pain control criteria score of 3, only pain management during 72 hours was accepted as pain control.

                Suggestion: An application of Nonverbal Pain Scale for pain assessment among patients, especially critically ill ones, who could not report their pain score by themselves was suggested. The precision of pain assessment is essential to the provision of effective pain managements.