PREOPERATIVE PCA TEACHING PROGRAM T...

PREOPERATIVE PCA TEACHING PROGRAM TO MANAGE POSTOPERATIVE PAIN D Knoerl et al MEDSURG Nursing Vol 8 (February 1999) 25-33 36

The use of patient-controlled analgesia (PCA) has many advantages in controlling patients' postoperative pain. These include patients' having dominion government over their pain as well as faster storm of pain control. The authors of this investigation cited several studies that failed to demonstrate that PCA therapy is more efficacious than conventional intramuscular therapy. Factors that may contribute to the lack of efficacy include inadequate preparation of patients in the use of PCA and patients' fear regarding the use of PCA. The authors' review of the literature identified that no studies address the import of educating the patient in the use of PCA, that studies about PCA placed little importance upon preoperative patient education in the use of PCA, and that there were no studies regarding patient understanding of PCA.

view Educating surgical patients in the use of PCA therapy in today's fast-paced preoperative setting is challenging. Researchers have waysed studies that examine the effectiveness of preoperative education. The object of this study was to compare the effectiveness of a structur preoperative teaching program to that of the usual informal teaching.

courses Bandura's cognitive theory of perceived self-efficacy was used as a guide to bring out a preoperative teaching program. Bandura's cognitive theory asserts that patients determine to a great class whether they will achieve pain relief and that misbeliefs can alter their behavior. Attitude and behavior changes can be addressed using instructional and motivational factors.

Hypotheses evolveed using Bandura's theory included the following.

* Postoperative patients who receive structur preoperative teaching about PCA therapy will demonstrate increased knowledge about managing their postoperative pain using IV narcotics.

* Postoperative patients who receive structur preoperative teaching about PCA therapy will report lower pain intensity scores.

* Postoperative patients who receive structur preoperative teaching about PCA therapy will report greater satisfaction with their pain management.

This prospective research used an experimental group-control form into groups design with random assignment of make liables Researchers received institutional review board approval at a 500-bed Midwest medical center and obtained informed coherence from all participants. Researchers used convenience sampling and asked patients being admitted by the agency of ambulatory surgery in a hospital-based performance unit to participate.

Participant criteria included patients who

* were prescribed PCA using meperidine or morphine for postoperative pain sway for more than 12 hours,

* were 18 to 67 years of age,

* were able to read and speak English,

* were designated Class I and II according to the American Society of Anesthesiologists' physical status scale, and

* received general anesthetic.

Exclusion criteria included previous users of a PCA or if the patient was a health care provider.

Patients were randomly assigned. All participants complet a 12-item pretest which took approximately five minutes to whole The treatment group then received structur preoperative teaching about the PCA, watched an 11-minute videotape, and practiced pushing the PCA button. Follow-up began four hours after the PCA was initiated and continued at the eight- and 24-hour intervals. the two groups completed a 12-item posttest Researchers assessed the two groups' pain intensity scores, patient satisfaction scores, and analgesic consumption.

inferences and discussion. The sample consisted of 76 patients (ie, 829% female, 526% Caucasian, 382% African-American). There was no statistical difference between disposes for the pretest. There was a statistical difference between clusters for the posttest. The treatment form into groups presented with overall higher scores (ie, 956 versus 741) demonstrating an increase in knowledge about PCA therapy and attitudes toward using pain medication. The treatment clump presented with lower mean pain scales than the superintendence group. Using the Mann-Whitney U trial researchers determined there was no statistical difference between disposes at the four-, eight-, and 24-hour pain assessment. The treatment cluster demonstrated higher satisfaction. There was no statistical difference in PCA consumption.

application of mind results demonstrated the treatment cluster had a statistically significant increase in knowledge associated with a statistically significant difference in pain management parameters. Structur preoperative teaching demonstrated a significant issue on improving patients' knowledge and attitudes toward pain management.

research results demonstrated that the greatest in quantity common way of educating patients about the PCA was on telephone by either nursing staff members or anesthesia care providers in conjunction with other preoperative information. One-third of the patients prescribed the PCA had not heard of PCA therapy before their surgery Patient-controlled analgesia therapy was most numerous often initiated in the postanesthesia care unit when patients were emerging from a general anesthetic.