FOR THIS ACTIVITY PROFESSOR REQUEST WAS: Change your PICOT to have 1 outcome. Do you want to measure recovery rate or pain relief? How will you measure that? Which measurement tool wi

Student's Name: Maria Diaz

Institution: Florida National University

Course Name: MSN Capstone Project

Professor's Name: Carmen Lazo

Date: July 5. 2023

Inadequate Pain Management in Postoperative Patients

Introduction

An important part of patient care is postoperative pain management, which aims to reduce pain and discomfort after surgical procedures. However, ineffective pain management continues to be a problem, which could impact patients' well-being, healing, and medical outcomes. For surgical patients, postoperative discomfort is a frequent and upsetting experience. Long-term suffering, a slower rate of recovery, lower patient satisfaction, and higher medical costs can all result from insufficient pain treatment (Parthipan et al., 2019). The use of opioids, which run the risk of side effects such as respiratory depression, constipation, and opioid dependence, is a common component of traditional unimodal pain management strategies.

The inadequate handling of postoperative pain has been addressed by numerous research. A comprehensive analysis shows that up to 86% of surgical patients feel moderate to severe pain during the postoperative phase (Cureus, 2020). Poor pain management has been linked to a greater incidence of surgical complications, higher healthcare expenses, longer hospital stays, and lower patient satisfaction. This paper recommends using a multimodal pain treatment strategy for postoperative patients within the first 72 hours following surgery. We intend to enhance pain management, lower opioid consumption, and decrease hospital stays by using a multimodal strategy.

PICOT

In postoperative patients (P), does the implementation of a multimodal pain management approach (I), compared to traditional unimodal pain management (C), resulting in improved pain control, reduced opioid consumption, and shorter hospital stays (O) within the first 72 hours after surgery (T)?

Population: Postoperative patients within the first 72 hours after surgery. Intervention: Implementation of a multimodal pain management approach. Comparison: Traditional unimodal pain management. Outcome: Improved pain control, reduced opioid consumption, and shorter hospital stays. Timing: Within the first 72 hours after surgery.

Vulnerable Population

The vulnerable population in the context of insufficient postoperative pain treatment comprises those who may be at higher risk due to numerous variables such as age, comorbidities, restricted access to healthcare resources, and socioeconomic disadvantages (Cureus, 2020). Their overall health outcomes and capacity to get proper pain care can be greatly impacted by socioeconomic determinants of health, such as income, education, and social support.

Risk Factors Contributing to Vulnerability

Advanced age: Older patients may experience changed pain perception and diminished physiological reserves, necessitating specialized pain management techniques.

Comorbidities: Patients needing tailored pain management plans may have increased pain sensitivity due to chronic illnesses like diabetes or cardiovascular disease.

Limited access to healthcare facilities: Vulnerable groups may struggle to receive effective postoperative pain treatment due to a lack of healthcare services, particularly specialized pain clinics or drug resources (Parthipan et al., 2019).

Socioeconomic disadvantages: People with lower socioeconomic levels may encounter difficulties accessing healthcare services due to problems with transportation, limited resources, or a lack of health insurance.

Evidence-based Interventions

They were using multimodal pain treatment techniques: putting into practice a mix of medical and non-medical therapies suited to each patient's requirements. Non-opioid analgesics, procedures for regional anesthesia, patient-controlled analgesia, and complementary therapies like physical therapy, acupuncture, or breathing exercises may all be used in this situation (Afshan et al., 2021).

Providing patients with thorough preoperative and postoperative education about pain expectations, pain management techniques, and the significance of adhering to drug regimens would improve patient education (Parthipan et al., 2019). The availability of alternative pain management techniques and the potential hazards and advantages of opioid use should be covered in this instruction.

Facilitating communication and cooperation among medical professionals, such as surgeons, anesthesiologists, nurses, and pharmacists, to ensure a comprehensive approach to pain treatment (Parthipan et al., 2019). Regular pain evaluations, specific treatment regimens, and interdisciplinary talks about pain management are required.

Proposal

Implementing a comprehensive multimodal pain management program is the proposed evidence-based strategy to address the chosen health problem of insufficient pain management in postoperative patients (Parthipan et al., 2019). This initiative will deploy the interventions above, multimodal pain management techniques, improved patient education, inter-professional collaboration, pain management protocols, and technology integration.

Resources Necessary for Intervention

Patient education resources and educational materials.

Drugs for the treatment of pain with various modalities.

Resources for complementary therapy and regional anesthetic procedures.

Platforms or software for analyzing and tracking pain.

Individuals Involved in the Intervention

For perioperative planning and coordination, use surgeons and anesthesiologists.

Nurses with knowledge of pain management for assessment, instruction, and application of pain management procedures.

Pharmacists are responsible for overseeing and managing medications.

Providers of complementary and alternative therapies for physical therapy.

Patients and their families take an active role in pain management.

Feasibility of a Nurse in an Advanced Role:

Nurses in advanced roles, such as nurse practitioners or clinical nurse specialists, hold the knowledge and abilities required to guide and facilitate the implementation of the suggested multimodal pain management program. Their comprehensive training enables them to establish individualized treatment programs, effectively assess and manage postoperative pain, inform patients and their families, work with interdisciplinary healthcare providers, and keep track of patient results (Afshan et al., 2021). Comprehensive pain evaluations, including patient preferences and comorbidities in treatment plans, prescribing and revising suitable analgesics, and coordinating the implementation of non-pharmacological therapies are all skills that these advanced practice nurses possess. Their knowledge includes educating patients about methods for managing pain, possible pharmaceutical side effects, and the significance of following a treatment plan.

Timeline for the proposed intervention:

The allocated time for the intervention is 12 months, where each month is allocated a given task. The first month is allocated for a critical literature search in intervening a success. The protocol is developed in the second month, and stakeholders collaborate in the third month. The implement a multimodal pain management program is done within 6-12 months.

Theoretical Framework

The Health Belief Model (HBM) is the project's theoretical foundation. A popular nursing theory called the Health Belief Model focuses on people's perceptions and beliefs about actions that are related to their health. It emphasizes how perceptions of susceptibility, severity, benefits, and obstacles might affect a person's decision-making and behavior change regarding their health (Parthipan et al., 2019). The Health Belief Model can direct the intervention when there is insufficient pain control in postoperative patients by tackling patients' attitudes and beliefs about pain control. Healthcare providers can design interventions that boost patients' perceived advantages when utilizing multimodal management of pain approaches and decrease perceived barriers, such as fear of side effects or lack of knowledge, by assessing patients' perceived susceptibility to inadequate pain control and the seriousness of the potential consequences (Afshan et al., 2021). The Health Belief Model can help identify the elements affecting patients' adherence to pain management techniques and aid healthcare professionals in creating educational interventions focusing on particular beliefs and perceptions.

References

Afshan, G., Khan, R. I., Ahmed, A., et al. (2021). Postoperative pain management modalities employed in clinical trials for adult patients in LMIC; a systematic review. BMC Anesthesiology, 21, 160. https://doi.org/10.1186/s12871-021-01375-w

Cureus. (2020, January). Knowledge about postoperative pain and its management in surgical patients. Cureus, 12(1), e6685. https://doi.org/10.7759/cureus.6685

Parthipan, A., Banerjee, I., Humphreys, K., Asch, S. M., Curtin, C., Carroll, I., & Hernandez-Boussard, T. (2019). Predicting inadequate postoperative pain management in depressed patients: A machine learning approach. PLoS ONE, 14(2), e0210575. https://doi.org/10.1371/journal.pone.0210575

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Inadequate Pain Management in Postoperative Patients

Student's Name: Maria Diaz

Institution: Florida National University

Course Name: MSN Capstone Project

Professor's Name: Carmen Lazo

Date: July 26, 2023

Inadequate Pain Management in Postoperative Patients

PICOT Question:

For postoperative adult pain patients, does effective pain management processes result to high recovery rate and relief as after surgery?

Literature Review

Introduction

Effective postoperative pain management can provide considerable benefits for patients recovering from surgery in various surgical facilities in Miami, Florida. These facilities may include postoperative, normal, day surgery, ICU, or ARO settings. The presence of highly skilled nursing personnel who possess the necessary expertise in delivering appropriate postoperative pain management is of utmost importance (Kelley et al., 2015). The experience of postoperative pain is frequently observed in those who have undergone surgical procedures, and it is frequently accompanied by feelings of anxiety and panic. Therefore, it is imperative for healthcare providers to possess the requisite knowledge and abilities to successfully provide comfort and decrease post-surgical discomfort for patients.

In order to ensure optimal management of postoperative pain, it is imperative to perform thorough assessments of pain with standardized pain scales. It is imperative to establish individualized pain management interventions that are informed by these assessments. In spite of the existence of global guidelines pertaining to the management of postoperative pain, adherence to these recommendations in clinical settings is not consistently observed. The present literature analysis, conducted within the specific setting of Miami, Florida, highlights the notable deficiencies in the overall understanding and implementation of postoperative pain management among general nurses. Furthermore, it is imperative to establish comprehensive protocols and utilize appropriate methodologies for assessing pain in the immediate postoperative phase (Dowell et al., 2022). Pain management specialists advocate for the prompt assessment of postoperative pain and emphasize the significance of augmenting the training and education of general nurses in Miami, Florida, with regards to the management of postoperative pain. By considering these factors, it is possible to enhance the recovery rates and alleviate postoperative pain more effectively among adult patients in Miami, Florida.

The findings of the literature research suggest that despite the existence of globally acknowledged recommendations for the management of postoperative pain, the implementation of these guidelines within the healthcare system in Miami, Florida is not consistently observed. The insufficient adherence to evidence-based guidelines has resulted in substandard patient care, mostly attributable to nurses' limited comprehension of effective postoperative pain management. The lack of information and training presents a notable obstacle for healthcare practitioners, as they may encounter challenges in recognizing and attending to the distinct pain requirements of postoperative patients (Kelley et al., 2015). As a result, it is possible that patients may not be provided with the requisite degree of pain management, which could impede their recuperation and overall state of health.

A further significant discovery derived from the study pertains to the lack of well-defined methods and standardized instruments for assessing pain in the immediate postoperative phase within Miami's healthcare system. The existence of this gap poses significant obstacles in delivering efficacious pain management for adult patients (Dowell et al., 2022). The absence of standardized and reliable pain assessment tools and techniques might provide challenges for healthcare practitioners in accurately gauging the severity of patients' pain and subsequently delivering suitable therapies. As a result, the absence of standardized methods in pain management may lead to a delay in pain relief and recovery among postoperative patients, due to the potential diversity in approaches employed across various healthcare settings.

Present State of Postoperative Pain in United States

Currently, the care of postoperative pain in the adult population in the United States is characterized by a combination of advancements and obstacles. The field of pain management has witnessed notable progress due to developments in medical knowledge and technology (Yang et al., 2017). Consequently, numerous people have had improved recovery and alleviation as a result. Nevertheless, a number of unresolved matters continue to exist, exerting an influence on the overall standard of postoperative pain management. To begin with, the United States of America has made significant progress in the adoption and implementation of evidence-based guidelines for the management of postoperative pain. Healthcare institutions are progressively embracing standardized protocols and best practices as advised by international authorities. This advancement has played a significant role in enhancing the assessment and management of pain, thereby guaranteeing that patients receive suitable pain alleviation following surgical procedures.

Notwithstanding these endeavors, disparities in the management of postoperative pain continue to exist among various healthcare establishments and geographical areas within the United States. There may be variations in the availability and accessibility of pain treatment services, which can result in inequities in the provision of care to patients (Meissner et al., 2017). Limited access to specialized pain management instruments in certain regions can impede healthcare practitioners' capacity to deliver appropriate pain relief for postoperative patients. Additionally, the opioid crisis in the United States has had a substantial impact on the management of postoperative pain. The growing apprehension surrounding opioid addiction and overdose incidents has prompted a more prudent attitude towards the prescription of opioids for the purpose of pain management. The implementation of this measure has played a pivotal role in mitigating the issue of opioid abuse (Dowell et al., 2022). However, it has also presented difficulties in identifying substitute methods of pain treatment that adequately target postoperative pain while minimizing dependence on opioids.

The presence of well qualified healthcare providers is an additional factor that impacts the status of postoperative pain management. Ensuring the presence of sufficient nursing and pain management personnel is imperative in order to facilitate the prompt and suitable evaluation and intervention of patients' pain (Meissner et al., 2017). Nevertheless, an increasing demand has emerged for further pain management education and training initiatives, aiming to equip healthcare professionals with the necessary expertise to successfully handle postoperative pain. The condition of postoperative pain management is significantly influenced by patient education and involvement (Meissner et al., 2017). Enhancing patient education regarding pain expectations, available therapeutic options, and the significance of appropriately communicating pain can result in improved pain outcomes. The active involvement of patients in their pain management has the potential to boost their recovery and increase overall satisfaction with the surgical process.

Practice Change Objectives:

Implement a structured postoperative pain management education program for healthcare providers (nurses and physicians) in the surgical facility to enhance their knowledge and skills in postoperative pain assessment and management (Meissner et al., 2017).

Utilize standardized pain assessment instruments and methods for evaluating postoperative pain in patients within the first 72 hours after surgery.

Introduce a multi-modal analgesia approach for pain management in postoperative pediatric patients, including non-pharmacological therapy, NSAIDs, and opioids as appropriate.

Improve pediatric patients' analgesic prescribing and administration practices to prevent underdosing and medication errors.

Problem Existence and Proposition for Change:

The issue of insufficient postoperative pain management is common in several areas of healthcare, including adult population surgery in Florida and U.S in general. Notwithstanding their availability, there is a lack of adherence to worldwide recommendations in clinical practice. Poor patient care and inadequate pain therapy are common results of nurses' and doctors' insufficient understanding of postoperative pain management (Dowell et al., 2022). In addition, the situation is exacerbated by the lack of well-established methods and assessment instruments for monitoring postoperative pain.

Relevant Pros and Cons:

Pros of the Practice Change:

Enhanced knowledge and skills of healthcare providers in pain assessment and management will improve pain control for postoperative patients.

The use of standardized pain assessment instruments will facilitate better and more accurate pain evaluation, allowing for tailored pain management treatments.

Implementing a multi-modal analgesia approach in adult patients can provide effective pain relief and minimize opioid use, reducing the risk of adverse effects.

Improved analgesic prescribing and administration practices will ensure appropriate dosing and minimize medication errors in adult patients.

Cons of the Practice Change:

Implementing a structured education program may require financial and time investments for training healthcare providers.

Resistance to change among healthcare providers may hinder the adoption of standardized pain assessment methods and multi-modal analgesia in adult patients.

Adherence to the new protocols may vary among healthcare providers, affecting the consistency of pain management practices.

Limited resources and infrastructure in certain healthcare settings may pose challenges in achieving optimal pain management outcomes.

References

Kelley, B. P., Shauver, M. J., & Chung, K. C. (2015). Management of acute postoperative pain in hand surgery: a systematic review. The Journal of Hand Surgery, 40(8), 1610–1619. doi:10.1016/j.jhsa.2015.05.024

Lovich-Sapola, J., Smith, C. E., & Brandt, C. P. (2015). Postoperative pain control. Surgical Clinics of North America, 95(2), 301–318. doi:10.1016/j.suc.2014.10.002

Yang, M. M. H., Hartley, R. L., Leung, A. A., Ronksley, P. E., Jetté, N., Casha, S., & Riva-Cambrin, J. (2017). Preoperative predictors of poor acute postoperative pain control: a systematic review and meta-analysis. Retrieved from http://orcid.org/0000-0003-4907-3510

Dowell, D., Ragan, K. R., Jones, C. M., Baldwin, G. T., & Chou, R. (2022). CDC Clinical Practice Guideline for Prescribing Opioids for Pain — United States, 2022. Recommendations and Reports, 71(3), 1–95. Retrieved from https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm

Meissner, W., Huygen, F., Neugebauer, E. A. M., Osterbrink, J., Benhamou, D., Betteridge, N., & et al. (2017). Management of acute pain in the postoperative setting: the importance of quality indicators. [Journal Title], [Volume number], 187-196. https://doi.org/10.1080/03007995.2017.1391081

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