Australian Journal of Advanced Nursing 2007 Volume 24 Number 4
Australian Journal of Advanced Nursing 2007 Volume 24 Number 4
Women who felt that the information provided
was easy to understand were less likely to report pain
following discharge from hospital (regression co-efficient
-0.334, 95% CI, 0.14 - 0.85, p ≤ 0.05), regardless of type
of surgery and within 48 hours of discharge (regression
co-efficient -0.74, 95% CI, 0.24 - 0.95, p ≤ 0.05). However
no statistically significant association was found between
understanding information and reporting pain levels on
the Likert scale.
Most women (83.8%) reported that it was easy to follow
the information provided. Private patients were about three
times more likely than public patients to find information
inadequate (X2 = 9.67; p ≤ 0.01). Based on information
received, most patients expected little pain associated with
day surgery, and persistent pain led them seek medical
advice and reassurance that their pain was ‘normal’.
Bivariate analysis indicated a statistically significant
association (X2= 13.25, p ≤ 0.001) between time spent
in recovery and reporting pain 48 hours following
discharge (see table 3). Continuity of nursing care in
recovery and rapport with the nurses influenced women’s
ability to negotiate the length of their stay in recovery,
and ultimately pain free recovery at home: ‘In recovery,
I had two nurses in particular… they were really good
with me, let me stay in bed because I wanted to… I only
had painkillers at hospital, not at home, not even the next
day; I didn’t take anything’ (23 years, Australia-born,
medical termination of pregnancy).
Time spent in recovery room and pain within 48 hours
Still in pain Time spent in the
Yes 87 (33.7%) 51 (19.8%) 138 (53.5%)
No 100 (38.8%) 20 (7.8%) 120 (46.5%)
Total 187 (72.5%) 71 (27.5%) 258 (100%)
Most respondents self-managed their pain (80.8%),
relying on analgesics (78.5%) or alternative remedies (eg.
massage and/or herbal medicine) (2.3%). About a fifth
of the sample (19.2%) did nothing to cope with the pain.
No statistical differences emerged in factors influencing
pain management and in-depth interviews revealed that
the pain management depended on a woman’s individual
preference. There was a statistically significant association
(X2= 9.33, p ≤ 0.05) between women reporting the
purchase of non-prescription analgesics (31.2%) and type
of procedure; women with dilation and curettage combined
with laparoscopy, pelviscopy or hysteroscopy (50%) were
most likely to self-medicate than those undergoing medical
termination of pregnancy (38.5%), multiple surgeries
(27.5%), and various single procedures (23%) such as cone
biopsy, laser treatment, or sterilisation.
In total, 86% of women received help at home. Women
who reported pain 48 hours following discharge were
about 2.3 times more likely to receive help at home from
significant others (regression co-efficient 2.34. 95% CI,
1.26-4.36, p ≤ 0.01). Women who reported that it was
inconvenient for their caregivers to take care of them
(1.9%) were more likely to resume their own caregiving
roles following discharge (X2 = 18.21; p ≤ 0.001), with
some respondents reporting difficulties in caring for
small children following day surgery, and identifying this
as a disadvantage of day surgery (see also Barthelsson et
al 2003). This was compounded for those who received
inadequate help, or for those whose caregivers were
unable or reluctant to be available to them following
discharge: ‘I had to pretend a little bit at home, in front
of my little girl, that I was feeling alright …you know, you
have to’ (38 years, Australia-born, multiple procedures).
The experiences of women in Australia undergoing
reproductive health day surgery resemble those of
women internationally: day surgery is not pain-free
and there is scope for improving discharge assessment
and pain management. The majority (69.5%) reported
pain following discharge from day surgery and more
than a half were still in pain 48 hours after surgery. The
experience of postoperative pain varies greatly however
and it may be difficult to predict pain-related experiences
of patients (see also Barthelsson et al 2003; Burumdayal
and MacGowan-Palmer 2002). Factors that may be
relevant include age, previous day surgery experience
and information provision prior to surgery.
Our research corroborates other accounts of an
inverse relationship between reports of postoperative
pain and age (Callesan et al 1998; Yellen and Davis
2001), raising questions about changes in reporting
patterns. Burumdayal and colleagues (2002) argued,
‘some patients may believe that pain builds character and
feel ashamed to admit pain unless questioned in depth
or indirectly.’ Our findings demonstrate that the pain
experience may be worse for women with more than one
experience of day surgery than those without, suggesting
that patients’ previous experience with pain may cloud
their postoperative pain perception’ (Magnani et al 1989)
and ‘might well alter their pain threshold’ (Burumdayal
et al 2002), suggesting the value of demographic and
medical data for pain assessment.
Our data also indicate the positive role of information
provision on patients’ experience of pain (Kratz 1993;
Linden and Engberg 1996): women who felt that the
information provided was easy to understand were
less likely to report having pain following discharge or
within 48 hours of discharge from hospital. As reported,
private patients were more likely to report that day
surgery information was inadequate. It is therefore
necessary to improve information provision, particularly
given the ‘push’ of the current Australian government
for people to access private health insurance and seek
health care as private rather than public patients (Moorin
and Holman 2006).
Given the diversity of patients’ experiences,
individual assessment of each patient is necessary.
Information provision needs to be improved for all
people undergoing day surgery, particularly private
patients. Roberts and colleagues (1995), based on the
Australian study on patients’ pain-related difficulties
almost 10 years ago, recommended that in the
immediate postoperative period health professionals
or social workers provide routine home visits: this
has not eventuated. Our finding that women reported
difficulties managing at home, reinforce the continued
need for day surgery patients to access services that
provide domiciliary and community-based care.
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