The purpose of this review was to outline and evaluate pain assessment techniques and tools commonly used in the postoperative recovery room to assist in pain management. Problem Identification and Evidence Pain after surgery is stressful to patients and is a major problem in post anesthesia care unit (PACU). Recent data suggest 80 percent of patients experience pain post operatively (Wells, Pasero, & McCaffery, 2008).
Ineffective pain management in the immediate postoperative period can prolong the patient’s length of stay in Post Anesthesia Care Unit (PACU) which may lead to increased cost of care (Wells, Pasero, & McCaffery, 2008). Poor assessment of pain is a huge obstacle to successful post-operative pain management. Additionally, outdated attitudes, myths, and misconceptions about pain and its treatment among nurses and patients contribute to unsafe, inadequate, and inappropriate pain management (Dihle, Bjolseth, & Helseth, 2006).
There is developing research literature that supports the problems to inadequately pain assessing related to post-operative pain management. In a review of the articles supporting ineffective pain assessment and pain management were identified in post-operative patients: 1) Pain scales have limitations because they do not take into account important details of the pain such as location, intensity, duration, etc. 2) Patients ineffective communication on level pain such as in dementia patients and in children.
Nurses are lacking in the use in pain assessment tools. Review of the Literature The search for journals on pain assessment was done mainly using Med, Pub Med, CINAHL, and NCBI. The original search using the search terms: pain assessment, and pain management, post surgical and PACU nurses, published between 2001-2016. The study members included nurses who are participated in the assessment and management of pain in patients post surgery.
Other criteria for inclusion in each database were English language, full text articles, and studies published within the last 15 years, 2001 to 2016. Brown implements a very important point when she quotes Kehlet and Dahl (2003), “the practical aims of pain relief are to provide subjective comfort and enhance the patient’s ability to deep breathe, cough and move easily, thus avoiding postoperative complications. ” Pulmonary atelectasis is the main concern for postoperative nurses due to patient’s lack of deep breathing because deep breathing usually increases pain.
I also agree with Brown that achieving ‘subjective comfort’ is challenging and that many times it is difficult for both the patient and the nurse to have a mutual understanding of the specifics of the patient’s pain, such as intensity, quality, and location, because of the patient’s age, educational level, language barriers, and cognitive limitations. Brown describes multiple unilateral pain rating scales such as the Verbal Rating Scale, Numerical Rating Scale, Visual Analogue Scale, the Faces of Pain Scale and Wong-Baker FACES of pain scale, which are commonly use when caring for pediatric patients.
These tools can be used at the nurse’s discretion assisting in the documentation and the measurement of pain and ultimately, pain relief, as well. Brown also describes that these pain scales have limitations because they do not take into account important details of the pain such as location, intensity, duration, etc. Brown describes additional challenges in the management of pain for those with chronic pain conditions, pediatric and elderly populations and those with all levels of cognitive impairments and which of the pain scales can best be utilized in the management of pain.
Despite the accessibility of proven assessment tools for pain in children, the Shrestha-Ranjit & Manias (2010) journal indicates that nurses tend to use pain assessment tools in limited ways and several studies have reported that children receive significantly less analgesic than recommended amounts. Nurses only administered a mean of 22% of available total analgesic doses to these children (Shrestha-Ranjit & Manias, 2010). Nurses can miscalculate the pain levels in post-operative patients.
Nurses can improperly diagnose pain level by using blood pressure or pulse readings; however, these can be untrustworthy signs of pain assessment because they are predisposed by a large number of other causes. Evidence implies that post surgery pain in the elderly is still being under-assessed and under-treated. Higher levels of postoperative pain in older adults have been associated with greater risks of harmful effects, such as delayed ambulation, increased hospital length of stay, increased incidence of ostoperative pulmonary complications and chronic pain syndromes (Guo, Li, Liu, & Herr, 2015).
Pain assessment in the elderly can be difficult due to factors such as anesthesia and pain medication. Conclusion After reviewing the selected articles for this literature review paper along with supportive research, patients may be helped if nurses and health care providers evaluate their pain experiences carefully, but the main concept is to keep in mind that different people respond to pain in different ways.
Therefore, comparing patient’s post-operative pain is somewhat impossible, even where the underlying cause of pain is the same. By the most part, I have found these articles to be well rounded and comprehensive article on the challenges and potential tools used for the management of pain in the recovery room. Various pain assessment tools were presented together with their practical uses and possible limitations for assisting the recovery room nurse in measuring a patient’s subjective postoperative experience on an individual basis.