Women's perspectives of pain following day surgery in Australia.
ABSTRACT To investigate the incidence of pain following discharge from reproductive day surgery.
Cross-sectional descriptive study.
A public hospital for women in Melbourne.
315 women participated in phone interviews and 10 in face-to-face interviews.
Self-reports of pain were assessed in relation to age, English and non-English speaking background, prior experience of day surgery, type of surgery, time in recovery, information provision prior to surgery, and access to significant others at home.
Older women were less likely to report having pain immediately following discharge (regression coefficient = -0.72, 95% CI, 0.58 to 0.88, p < or = 0.01), or within 48 hours following discharge (regression coefficient = - 0.71, 95% CI, 0.57 to 0.88, p < or = 0.05). Women with a prior experience of day surgery were 1.9 times more likely to be in pain within 48 hours following surgery (regression co-efficient 1.88, 95% CI, 1.134 to 3.10, p < or = 0.05). Women who understood information were less likely to report that they experienced pain within 48 hours of discharge (regression co-efficient -0.74, 95% CI, 0.24 - 0.95, p < or = 0.05).
Younger patients, those who have had prior experience of day surgery and those who received inadequate information prior to surgery were most likely to report pain. Adequate individual patient assessment will ensure that patients' experience of pain following day surgery is minimised.
Full-textDOI: · Available from: Mridula Bandyopadhyay, May 28, 2015
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ABSTRACT: To describe the development and evaluation of a pre-emptive and multimodal pain management protocol that aims to improve patient experiences following vitreo-retinal day surgery. Vitreo-retinal surgery has been increasingly performed as day surgery that requires patients to undertake postoperative self-care, including the management of pain. While vitreo-retinal surgery is known to be painful in the convalescent period, pain management following day surgery has been described as problematic across many surgical specialties. One hundred patient audit and in-depth qualitative interviews with nine participants. A pain management protocol was developed from research evidence, established knowledge and expert opinion, then implemented and evaluated. The pre-emptive and multimodal protocol used intravenous Parecoxib in conjunction with regional ocular anaesthesia and oral paracetamol. Parecoxib 40 mg was administered prior to discharge, and participants were instructed to take the paracetamol six hours post-regional anaesthesia. Rescue analgesia was also provided. Following implementation of the protocol in a single clinical site, low levels of pain were reported in the audited patient cohort and confirmed in the qualitatively explored experiences of nine participants. The results of this study were encouraging, in that post vitreo-retinal day surgery pain appeared to have been successfully self-managed with a multimodal and pre-emptive protocol. The protocol was flexible and sensitive to patient comorbidities, surgical complexity, previous experiences and medical preferences. Further research is required to consolidate the success of this protocol to effectively support patients' self-care pain management and provide capacity to generalise the findings. Knowledge developed through this clinically based research has the potential for informing future patient care across many sites where day surgery is an integral component of treatment for people with vitreo-retinal disease.Journal of Clinical Nursing 02/2014; 23(21-22). DOI:10.1111/jocn.12572 · 1.23 Impact Factor
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ABSTRACT: Aim: To evaluate the experiences of patients and caregivers in the early transition phase of recovery at home following day surgery. Background: A global increase in elective day surgery has taken place over the last two decades. This has arisen from enhanced surgical and anaesthetic techniques, healthcare cost containment and patient preference. Minimal hospital stay ensures meticulously managed medical practices are uppermost leaving nursing-based knowledge limited room for expression. However, patients may require much help once discharged hence providing nurse-led involvement in this area with much potential. Data Sources: Five databases from 2000 – 2011 were searched including MEDLINE, CINAHL, British Nursing Index, PsychINFO and Cochrane Database of Systematic Reviews. Reference and citation tracking was performed on included publications. Review Methods: One reviewer screened titles and abstracts for possible inclusion over a 10 month period. Data synthesis involved thematic analysis informed by the findings of the included literature. Results: Twenty-five studies were included in the review. Common themes were pain, information provision and anxiety. Pain management was a concern exacerbated by reduced information. Much information had been forgotten due to latent effects of anaesthesia, limited opportunity on the day of surgery or information booklets lacking a problem-solving approach. Anxiety was associated with inadequate information, unexpected events or by carers striving to supervise a successful recovery. Conclusions: Recovery at home with limited access to healthcare professionals presented a number of challenges mostly relating to inadequate knowledge/ information. Future research should explore continued nurse/ patient contact, nurse-led support services and patient and carer information booklet content.