Transforming Practice With Scripted Messages: Improving Pain Management in Outpatient Surgical Patients

2.50
Hdl Handle:
http://hdl.handle.net/10755/621627
Category:
Full-text
Format:
Text-based Document
Type:
Presentation
Level of Evidence:
N/A
Research Approach:
N/A
Title:
Transforming Practice With Scripted Messages: Improving Pain Management in Outpatient Surgical Patients
Other Titles:
Surgical Pain Management
Author(s):
Bellury, Lanell M.
Lead Author STTI Affiliation:
Pi Gamma
Author Details:
Lanell M. Bellury, PhD, RN, AOCNS, OCN, Professional Experience: 2002 - 2009: Staff Nurse Oncology inpatient unit; Saint Joseph's Hospital Atlanta; 2007-2012 Chair Nursing Research Committee. 2004 - present: Oncology Certified Nurse 2011 - present: Advanced Oncology Clinical Nurse Specialist Certification. 2006 - 2013: Trainer for the Oncology Nursing Society Chemotherapy and Biotherapy Course. 2009 - 2012: Nurse Researcher, Saint Joseph's Hospital Atlanta; director of a nurse scholar program to increase research competency among professional nurses. Member Institutional Review Board. 2011 - present: Associate Professor of Nursing; Mercer University Atlanta, GA; teaching responsibilities include graduate and undergraduate research courses, DNP scholarship and project development; DNP philosophy and theory; Member Institutional Review Board; program of research related to the needs of older cancer survivors; multiple peer reviewed presentations and publications. 2012-2016: Research and Scholarship Committee Chair, Pi Gamma Chapter. Author Summary: Dr. Bellury has over 20 years experience as an oncology nurse and seven years in academe. Her program of research is related to the needs of older cancer survivors. Her interest in developing nursing research capacity led to the development of a nurse research scholar program for point-of-care nurses in 2009. This study and 14 others, three publications, and 16 presentations to local, national, and international audiences are outcomes of the scholar program.
Abstract:

Purpose: Outpatient surgeries are increasingly common because of patient convenience, lower cost, and reduced stress but most patients experience pain postoperatively requiring nursing attention to pain management (Mitchell, 2015; Subramanian et al., 2014). Scripting, recommended for consistent, targeted communication with patients, has limited evidence to support its use (Alaouf et al., 2015; Monterroso et al., 2013). The purpose of this study was to explore the effect of providing scripted messages related to pain management in the outpatient surgical setting on self-reported pain control and patient satisfaction in outpatient surgical patients. Additionally, the feasibility of practice change research in clinical settings was examined. The findings may assist others interested in the conduct of clinical research and adds to the body of knowledge around the effectiveness of scripted messages delivered by nurses.

Methods: A retrospective record review pre and post a practice change intervention evaluated implementation of a pain management scripted message delivered at two time points (preoperatively and postoperatively). Intention to treat analysis was used to compare patient reports of pain control and patient satisfaction with care 48 hours post-discharge from outpatient surgical procedures. Feasibility of data collection and measurement issues were also explored.

Results: 231 records (98 pre-intervention; 133 post-intervention) were analyzed. The sample included 144 (62%) male and 156 (68%) married with mean age 57.6 (SD=16.1) years. The large majority (90%) received general anesthesia and the most common surgical procedures were urologic (24%), colorectal (17%), and laparoscopy (13%). A Mann-Whitney U test indicated patient reported pain control was statistically significantly greater for the post intervention group (Mean rank=62.66) than for the pre-intervention group (Mean Rank = 51.95), U=1258, p=0.015. A large number of missing data related to the standard of care post-op phone calls (54% missing) and receipt of the intervention (47% receiving the script at time two).

Conclusion: While it is encouraging that even the small dose of scripting had a significant effect on postoperative pain control, the feasibility issues related to data collection and intervention fidelity will require considerable resources to surmount. Practice change is a complex process requiring sensitivity to work and patient flow especially in specialty care units. Overcoming resistance to change when evidence is not robust is challenging and may be especially difficult related to scripting, which is often perceived as a mandated intrusion into the nurse-patient relationship.

Keywords:
Pain Management; Practice Change; Scripting
Repository Posting Date:
30-Jun-2017
Date of Publication:
30-Jun-2017
Other Identifiers:
INRC17N16
Conference Date:
2017
Conference Name:
28th International Nursing Research Congress
Conference Host:
Sigma Theta Tau International
Conference Location:
Dublin, Ireland
Description:
Event Theme: Influencing Global Health Through the Advancement of Nursing Scholarship

Full metadata record

DC FieldValue Language
dc.language.isoen_USen
dc.type.categoryFull-texten
dc.formatText-based Documenten
dc.typePresentationen
dc.evidence.levelN/Aen
dc.research.approachN/Aen
dc.titleTransforming Practice With Scripted Messages: Improving Pain Management in Outpatient Surgical Patientsen_US
dc.title.alternativeSurgical Pain Managementen
dc.contributor.authorBellury, Lanell M.en
dc.contributor.departmentPi Gammaen
dc.author.detailsLanell M. Bellury, PhD, RN, AOCNS, OCN, Professional Experience: 2002 - 2009: Staff Nurse Oncology inpatient unit; Saint Joseph's Hospital Atlanta; 2007-2012 Chair Nursing Research Committee. 2004 - present: Oncology Certified Nurse 2011 - present: Advanced Oncology Clinical Nurse Specialist Certification. 2006 - 2013: Trainer for the Oncology Nursing Society Chemotherapy and Biotherapy Course. 2009 - 2012: Nurse Researcher, Saint Joseph's Hospital Atlanta; director of a nurse scholar program to increase research competency among professional nurses. Member Institutional Review Board. 2011 - present: Associate Professor of Nursing; Mercer University Atlanta, GA; teaching responsibilities include graduate and undergraduate research courses, DNP scholarship and project development; DNP philosophy and theory; Member Institutional Review Board; program of research related to the needs of older cancer survivors; multiple peer reviewed presentations and publications. 2012-2016: Research and Scholarship Committee Chair, Pi Gamma Chapter. Author Summary: Dr. Bellury has over 20 years experience as an oncology nurse and seven years in academe. Her program of research is related to the needs of older cancer survivors. Her interest in developing nursing research capacity led to the development of a nurse research scholar program for point-of-care nurses in 2009. This study and 14 others, three publications, and 16 presentations to local, national, and international audiences are outcomes of the scholar program.en
dc.identifier.urihttp://hdl.handle.net/10755/621627-
dc.description.abstract<p><strong>Purpose: </strong><span>Outpatient surgeries are increasingly common because of patient convenience, lower cost, and reduced stress but most patients experience pain postoperatively requiring nursing attention to pain management (Mitchell, 2015; Subramanian et al., 2014). Scripting, recommended for consistent, targeted communication with patients, has limited evidence to support its use (Alaouf et al., 2015; Monterroso et al., 2013). The purpose of this study was to explore the effect of providing scripted messages related to pain management in the outpatient surgical setting on self-reported pain control and patient satisfaction in outpatient surgical patients. Additionally, the feasibility of practice change research in clinical settings was examined. The findings may assist others interested in the conduct of clinical research and adds to the body of knowledge around the effectiveness of scripted messages delivered by nurses.</span></p> <p><strong>Methods: </strong>A retrospective record review pre and post a practice change intervention evaluated implementation of a pain management scripted message delivered at two time points (preoperatively and postoperatively). Intention to treat analysis was used to compare patient reports of pain control and patient satisfaction with care 48 hours post-discharge from outpatient surgical procedures. Feasibility of data collection and measurement issues were also explored.</p> <p><strong>Results: </strong>231 records (98 pre-intervention; 133 post-intervention) were analyzed. The sample included 144 (62%) male and 156 (68%) married with mean age 57.6 (SD=16.1) years. The large majority (90%) received general anesthesia and the most common surgical procedures were urologic (24%), colorectal (17%), and laparoscopy (13%). A Mann-Whitney U test indicated patient reported pain control was statistically significantly greater for the post intervention group (Mean rank=62.66) than for the pre-intervention group (Mean Rank = 51.95), U=1258, p=0.015. A large number of missing data related to the standard of care post-op phone calls (54% missing) and receipt of the intervention (47% receiving the script at time two).</p> <p><strong>Conclusion: </strong>While it is encouraging that even the small dose of scripting had a significant effect on postoperative pain control, the feasibility issues related to data collection and intervention fidelity will require considerable resources to surmount. Practice change is a complex process requiring sensitivity to work and patient flow especially in specialty care units. Overcoming resistance to change when evidence is not robust is challenging and may be especially difficult related to scripting, which is often perceived as a mandated intrusion into the nurse-patient relationship.</p>en
dc.subjectPain Managementen
dc.subjectPractice Changeen
dc.subjectScriptingen
dc.date.available2017-06-30T20:10:27Z-
dc.date.issued2017-06-30-
dc.date.accessioned2017-06-30T20:10:27Z-
dc.conference.date2017en
dc.conference.name28th International Nursing Research Congressen
dc.conference.hostSigma Theta Tau Internationalen
dc.conference.locationDublin, Irelanden
dc.descriptionEvent Theme: Influencing Global Health Through the Advancement of Nursing Scholarshipen
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