Problem Significance and Review of Literature – Postoperative Pain
Acute postoperative pain remains a clinical challenge as it occurs in approximately 80% of patients, and about 20% report severe levels of pain within the first 24 hours after surgery, as indicated by Small and Laycock (2020). Presently, with improved strategies for managing pain, the aspect of poorly managed postoperative pain remains a concern in the practice setting. This ongoing problem requires appropriate pain management interventions to help patients have better results, fewer hospital stays, and increased patient satisfaction (Akbar et al., 2019). It is for this reason that pain management is such a critically important issue, as poor pain control can result in longer hospital stays, a higher incidence of complications, and the development of chronic pain (Hyland et al., 2023).
Problem Statement
Persistent pain is a common problem found in almost all surgical patients, especially patients who underwent major surgeries like orthopedic, abdominal, and thoracic surgeries. Concerns show that approximately 40% of the patients suffer from moderate to severe pain after the operation which hinders their healing process and well-being, as argued by Park et al. (2023). More specifically, the target population for the current study consists of adult surgical patients treated in urban hospitals, for whom pain management can be heterogeneous across facilities. This is not just a patient satisfaction issue but a public health concern due to the risks of opioid dependency and the overall cost to society. For increased patient satisfaction, decreased healthcare expenses, and prevention of chronic pain conditions, adequate pain control is vital (Becerra-Bolaños et al., 2023).
Significance of the Study to Nursing
The relevance of this research to the nursing profession is based on its ability to identify deficiencies in the best practices for pain management and enhance patient care. In the study by Mahama and Ninnoni (2019), nursing staff are actively involved in the assessment and monitoring of postoperative pain, giving of analgesics, and handling of non-pharmacological measures. As reviewed from the literature, inadequate pain relief has been linked to adverse effects such as longer healing time, increased incidence of complications, and extended hospital stay (Hyland et al., 2023). Therefore, it is possible to identify and apply the enhancement of productivity in the use of pain management strategies to enhance the quality of patient care, reduce the incidence of chronic pain, and improve patient satisfaction among nurses. Furthermore, the outcome of this study could be useful in informing changes in policies and practices that can facilitate better pain management processes to implement efficient pain control mechanisms that are patient-centred.
Literature Review and Synthesis
From a survey of the literature, various techniques that have been used in the management of postoperative pain include multimodal analgesia, psychological therapies, and patient information. These strategies embrace all the dimensions of pain and provide a conceptual map for postoperative care.
Multimodal Analgesia
The use of multiple modalities of analgesics has been thought to have superior pain relief, decreased opioid consumption, and faster patient’ rehabilitation (Jain et al., 2023). This approach blocks several pain pathways and provides better analgesia with fewer adverse effects than high-dose opioids. For example, a recent study indicated that postoperative multimodal analgesia reduces the recovery time and enhances patients’ satisfaction compared to the monoidal therapy of pain (Hinther et al., 2021).
Psychological Interventions
Psychological factors play a very crucial role in pain experience and management. CBT and MBSR have assisted in improving patients’ pain self-efficacy and decreasing pain intensity as concluded by Pardos-Gascón et al. (2021). These interventions help in the care of patients by addressing the emotional and psychological aspects of patients who were operated on. According to Darnall (2021), patients who receive psychological care are likely to have reduced pain levels and better overall outcomes.
Patient Education
Patients must be educated about the methods of pain management and their results after surgery to improve postoperative outcomes (Nasir & Ahmed, 2020). The patients who received education before their surgery regarding topics like pain management, pain relievers, and adherence to prescribed medications have demonstrated significantly lesser levels of pain and higher levels of satisfaction (Darville-Beneby et al., 2023). Bhattad and Pacifico (2022) opined that education enables the patient to participate in the treatment process and to adhere to therapy, thereby improving the management of pain.
Summary of Literature Synthesis
In the literature review, the author also identifies the effectiveness of multimodal analgesia, psychological therapies, and patients’ education in the management of postoperative pain. The strategies described above act on the biological, psychological, and social aspects of pain so that a patient gets comprehensive care. However, further investigations are required to refine these approaches and to ascertain that they are used appropriately in practice. Therefore, closing those gaps could lead to improved management of postoperative pain and the quality of life of the patients.
Purpose
The purpose of this study is to identify the effects of multifaceted pain relief and psychological interventions in addressing postoperative pain in adult surgical patients. The hope lies in applying useful knowledge in enhancing patient care by identifying what best to implement in addressing patients’ pain.
Research Question
Does the use of multimodal analgesia and psychological interventions affect postoperative pain in adult surgical patients as compared with routine analgesia?
Methodology
Research Design
A randomized controlled trial (RCT) will assess the outcomes of multimodal analgesia with psychological therapies compared with usual postoperative pain care. An RCT is an experimental research design in which subjects are randomly divided into two groups; the experimental group and the control group as stated by Zabor et al. (2020). This design is suitable because it enables the exclusion of possible confounding factors as well as gives reliable data on the effectiveness of the interventions.
Extraneous Variables
Certain variables will also be kept constant to ensure that the study is valid. Environmental factors, including the hospital environment, will be controlled for as much as possible to include maintaining constant room temperature and reduced noise. Demographic variables such as the number of hours slept by the patients before the study will also be observed. To avoid researcher bias, all the staff who will be involved in the collection of data will undergo training to ensure that they follow the protocol to the letter. Also, the validity of the self-report instruments will be recognized as possessing biases, and every precaution shall be taken to eliminate bias, such as anonymous responses and the use of standardized tools.
Sampling Plan
Due to the need to select participants proportionally from the subgroups of the target population, a probability sampling technique, stratified random sampling, will have to be used. This approach will assist in attaining a wider sample that is more generalizable and also minimize variability based on the type of surgery and patients’ characteristics (Althubaiti, 2022).
Population
The target population includes adult surgical patients within urban hospitals. The minimum number of participants needed for the study to have adequate power to support the difference is 200, divided into two groups. Major surgeries like orthopedic, abdominal, or thoracic surgeries form the basis of inclusion criteria, and all the patients should be over 18 years willing to participate. Patients with cognitive deficits, those unable to understand English, or those already participating in another interventional study concerning pain relief will be excluded.
Obtaining Sample
The participants will be identified through the health records of hospitals, recommendations by other physicians, and fliers placed on the conspicuous part of the hospital. Permission to participate in the study will be sought from each subject before enrollment into the study. Randomization will be done using a computer-generated random number table to minimize the possibility of the participants being assigned either to the intervention or control group as indicated by Sil et al. (2019).
Plan for Data Collection
IRB Approval and Informed Consent
First, the researcher will apply for permission from the Institutional Review Board (IRB) to conduct the research ethically. Each of the subjects will sign consent forms that detail the purpose, procedure, risks, and benefits of the study.
Data Collection Procedures
Data collection will occur at three time points: Preoperatively, postoperative day 1, and before discharge. The data will be collected by trained research assistants using documented procedures to reduce measurement variation. Pain will be assessed by self-reported numerical rating scales, quality of life, and psychological status by standardized questionnaires. Participants will be recruited, and all data collection procedures will be conducted at the hospital, hence facilitating ease of participant recruitment.
Data Collection Tools/Measures
Pain Assessment Tool
To measure pain intensity, the Numeric Rating Scale (NRS) will be utilized. This tool involves using a self-administered and short pain intensity rating scale of 0 to 10. The NRS is highly internal and inter-observer reliable and consistently correlates with other pain assessment tools (Nugent et al., 2021).
Psychological Well-being Tool
The Hospital Anxiety and Depression Scale (HADS), which has 14 items, will be used to determine the patients’ psychological health levels. It has been applied in many previous studies, and its reliability and validity have been verified (Fernández-de-las-Peñas et al., 2022).
Consistency in Data Collection
To minimize variability across the observers, all the data collectors shall be trained on how to complete the NRS and HADS appropriately. It is also important to note that the administration and scoring procedures will also be discussed during calibration sessions. Besides, it is crucial to assess the inter-observer reliability from time to time to be sure that the data collected are of high quality.
Physiologic Measures
If any physiologic measure such as pulse rate or blood pressure is to be taken, then it will be done using calibrated instruments and by professional nurse researchers. To reduce variability, there will be fixed times and conditions for these measurements.
Conclusion
The following is a breakdown of how this research will evaluate the effectiveness of multimodal analgesia and psychological interventions in managing postoperative pain. To enhance the validity and reliability of the study, a Randomized Controlled Trial design, low variability of extraneous variables, clear sampling methodology, and accurate data collection methods will be used. This study will have implications for nursing practice and enhance the quality of care in post-operative patients.
References
Akbar, N., Teo, S. P., Artini Hj-Abdul-Rahman, H. N., Hj-Husaini, H. A., & Venkatasalu, M. R. (2019). Barriers and Solutions for Improving Pain Management Practices in Acute Hospital Settings: Perspectives of Healthcare Practitioners for a Pain-Free Hospital Initiative. Annals of Geriatric Medicine and Research, 23(4). https://doi.org/10.4235/agmr.19.0037
Althubaiti, A. (2022). Sample Size determination: a Practical Guide for Health Researchers. Journal of General and Family Medicine, 24(2), 72–78. https://doi.org/10.1002/jgf2.600
Becerra-Bolaños, Á., Armas-Domínguez, A., Valencia, L., Jiménez-Marrero, P., López-Ruiz, S., & Rodríguez-Pérez, A. (2023). Pain Prevalence and Satisfaction with Pain Management in Inpatients: A Cross-Sectional Study. Healthcare, 11(24), 3191. https://doi.org/10.3390/healthcare11243191
Bhattad, P. B., & Pacifico, L. (2022). Empowering patients: Promoting Patient Education and Health Literacy. Cureus, 14(7). https://doi.org/10.7759/cureus.27336
Darnall, B. D. (2021). Psychological Treatment for Chronic Pain: Improving Access and Integration. Psychological Science in the Public Interest, 22(2), 45–51. https://doi.org/10.1177/15291006211033612
Darville-Beneby, R., Lomanowska, A. M., Yu, H., Jobin, P., Rosenbloom, B. N., Gabriel, G., Daudt, H., Negraeff, M., Tania Di Renna, Hudspith, M., & Clarke, H. (2023). The impact of preoperative patient education on postoperative pain, opioid use, and psychological outcomes: A narrative review. Canadian Journal of Pain, 7(2). https://doi.org/10.1080/24740527.2023.2266751
Fernández-de-las-Peñas, C., Rodríguez-Jiménez, J., Palacios-Ceña, M., de-la-Llave-Rincón, A. I., Fuensalida-Novo, S., Florencio, L. L., Ambite-Quesada, S., Ortega-Santiago, R., Arias-Buría, J. L., Liew, B. X. W., Hernández-Barrera, V., & Cigarán-Méndez, M. (2022). Psychometric Properties of the Hospital Anxiety and Depression Scale (HADS) in Previously Hospitalized COVID-19 Patients. International Journal of Environmental Research and Public Health, 19(15), 9273. https://doi.org/10.3390/ijerph19159273
Hinther, A., Nakoneshny, S. C., Chandarana, S. P., Matthews, T. W., Hart, R., Schrag, C., Matthews, J., McKenzie, C. D., Fick, G. H., & Dort, J. C. (2021). Efficacy of Multimodal Analgesia for Postoperative Pain Management in Head and Neck Cancer Patients. Cancers, 13(6), 1266. https://doi.org/10.3390/cancers13061266
Hyland, S. J., Wetshtein, A. M., Grable, S. J., & Jackson, M. P. (2023). Acute Pain Management Pearls: A Focused Review for the Hospital Clinician. Healthcare, 11(1), 34. https://doi.org/10.3390/healthcare11010034
Jain, Y., Lanjewar, R., Lamture, Y., & Bawiskar, D. (2023). Evaluation of Different Approaches for Pain Management in Postoperative General Surgery Patients: A Comprehensive Review. Cureus, 15(11), e48573. https://doi.org/10.7759/cureus.48573
Mahama, F., & Ninnoni, J. P. K. (2019). Assessment and Management of Postoperative Pain among Nurses at a Resource-Constraint Teaching Hospital in Ghana. Nursing Research and Practice, 2019(9091467), 1–7. https://doi.org/10.1155/2019/9091467
Nasir, M., & Ahmed, A. (2020). Knowledge About Postoperative Pain and Its Management in Surgical Patients. Cureus, 12(1). https://doi.org/10.7759/cureus.6685
Nugent, S. M., Lovejoy, T. I., Shull, S., Dobscha, S. K., & Morasco, B. J. (2021). Associations of pain numeric rating scale scores collected during usual care with research-administered patient-reported pain outcomes. Pain Medicine, 22(10), 2235–2241. https://doi.org/10.1093/pm/pnab110
Pardos-Gascón, E. M., Narambuena, L., Leal-Costa, C., Ramos-Morcillo, A. J., Ruzafa-Martínez, M., & van-der Hofstadt Román, C. J. (2021). Psychological Therapy in Chronic Pain: Differential Efficacy between Mindfulness-Based Cognitive Therapy and Cognitive Behavioral Therapy. Journal of Clinical Medicine, 10(16), 3544. https://doi.org/10.3390/jcm10163544
Park, R., Mohiuddin, M., Arellano, R., Pogatzki-Zahn, E., Klar, G., & Gilron, I. (2023). Prevalence of postoperative pain after hospital discharge: systematic review and meta-analysis. Prevalence of Postoperative Pain after Hospital Discharge: Systematic Review and Meta-Analysis, 8(3), e1075–e1075. https://doi.org/10.1097/pr9.0000000000001075
Sil, A., Kumar, P., Kumar, R., & Das, N. K. (2019). Selection of control, randomization, blinding, and Allocation Concealment. Indian Dermatology Online Journal, 10(5), 601–605. https://doi.org/10.4103/idoj.idoj_149_19
Small, C., & Laycock, H. (2020). Acute postoperative pain management. British Journal of Surgery, 107(2), 70–80. https://doi.org/10.1002/bjs.11477
Zabor, E. C., Kaizer, A. M., & Hobbs, B. P. (2020). Randomized controlled trials. Chest, 158(1), 79–87. https://doi.org/10.1016/j.chest.2020.03.013
Appendices
Appendix A: Numeric Rating Scale (NRS)
The Numeric Rating Scale (NRS) is a basic 0-10 Visual Analogue Scale where patients indicate the level of pain they are experiencing. The scale is presented as follows:
0 – No Pain
1 – Very Mild Pain
2 – Mild Pain
3 – Moderate Pain
4 – Slightly Severe Pain
5 – Severe Pain
6 – Very Severe Pain
7 – Extremely Severe Pain
8 – Unbearable Pain
9 – Excruciating Pain
10 – Worst Possible Pain
Appendix B: Hospital Anxiety and Depression Scale (HADS)
The Hospital Anxiety and Depression Scale (HADS) is a 14-item inventory with seven items tapping anxiety and seven items tapping depression. The patients are then asked to rate each item according to what they have experienced in the recent past. The items and scoring details are as follows:
Anxiety Subscale
- I feel tense or ‘wound up’: Yes (3), Often (2), Sometimes, rarely (1), Never (0)
- I get a sort of frightened feeling as if something awful is about to happen: Very definitely and quite badly (3), Yes, but not too badly (2), A little, but it doesn’t worry me (1), Not at all (0)
- Worrying thoughts go through my mind: Most of the time (3), Often (2), Sometimes but not very frequently (1), Rarely (0)
- I can sit at ease and feel relaxed: Strongly Agree (0), Agree (1), Disagree (2), Strongly Disagree (3)
- I get a sort of frightened feeling like ‘butterflies’ in the stomach: Never (0), Sometimes (1), Fairly Often (2), Very Often (3)
- I feel restless as I have to be on the move: Yes, strongly agree (3), Agree (2), Disagree (1), Strongly disagree (0)
- I get sudden feelings of panic: Frequently (3), Sometimes (2), Rarely (1), Never (0)
Depression Subscale
- I still enjoy the things I used to enjoy: Not at all (0), Slightly (1), Moderately (2), Very little (3)
- I can laugh and see the funny side of things: As much as I always could (0), Not nearly as often as I used to (1), A little less than that (2), Not at all (3)
- I feel cheerful: Never (3), Rarely (2), Occasionally (1), Frequently (0)
- I feel as if I am slowed down: Almost always (3), Often (2), Occasionally (1), Rarely (0)
- I have lost interest in my appearance: Definitely (3), I don’t take as much care as I should (2), I may not take quite as much care (1), I take just as much care as ever (0)
- I look forward with enjoyment to things: To the same extent as ever (0), Slightly less than before (1), A good deal less than before (2), Barely (3).
- I can enjoy a good book or radio or TV program: Very often (1), Sometimes (2), Rarely (3)
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Question 
This assignment will focus on the research methodology for the study that you proposed in your Problem Significance and Review of Literature Assignment. Once again, your modules and your textbook will help you develop the sections of this paper. For example, when you are deciding on your study design, you will go to Module 6 and review the PowerPoint slides and read Chapters 9 and 10 in your textbook. The information in these resources will help you decide on the type of design that best fits your study.
Postoperative Pain
Here are some tips for the sections of the Methodology Assignment. Use the following headings to develop APA headings for your paper. Include the following information in each section.
Purpose: Use the corrected draft from your other assignment. Identify the purpose of the study. You will write this as: The purpose of the study is to….
Methodology
Research Design: Identify the type of design you will use. Be specific—descriptive, quasi-experimental, or experimental is not enough. Examples might include: Randomized control trial, cohort, correlational, pre-test-post-test, etc. The text provides descriptions of the designs. Be sure to include why the design is appropriate for the study. This sentence should be referenced. For example:
Type of design: A cross-sectional, correlational study will be conducted to examine the relationship between knowledge of HIV transmission, prophylactic use of antiretroviral medications, altruism, and the use of safe sexual practices (no reference needed since this is our study). A cross-sectional design is a non-experimental research design in which the data are collected at one point in time (LoBiondo-Wood & Haber, 2019). Because participants will be completing variable-specific questionnaires at one point in time, the research design is appropriate for the study.
Extraneous variables: These can be situational, such as a cold environment when taking a test, personal, such as an individual taking a test being sleepless, or researcher-based, such as if the researcher gave clues on how to act or respond during the study. Additionally, using self-report instruments or tools might be an extraneous variable, because the individual is having to ‘self-report information’.
Sampling plan: describe the type of sampling plan you will conduct—usually a non-probability or probability sample—the LoBiondo-Wood and Haber textbook describes the types of sampling plans you can choose to fit your study. Be sure to indicate the specific sampling plan and to reference the information.
Population: include the population your sample will represent and the estimated sample size you would obtain to conduct the study. Be sure to include exclusion and inclusion criteria, and remember that these criteria can help to control extraneous variables and bias too.
Obtaining sample: Describe how you would obtain the sample. Describe your recruitment process or any plans for using flyers or advertisements. If you plan a randomized study, how will you randomize the participants (coin toss/computer program)?
Plan for Data Collection: describe the how, when, and where of data collection. Be sure to include that you will first obtain IRB approval and how you will obtain informed consent—include the venue where you would conduct the study.
Data Collection Tools/Measures:
If you decide to use a tool (questionnaire or instrument) from a study you read, include the number of items (or questions) the tool has, who created the tool, and the reliability and validity of the tool. A copy of the tool should be added as an appendix to the paper. If the reliability and validity of the tool are not available in the literature, this would be a limitation.
If you plan to develop your own data collection tool, a copy must be provided as an appendix. Be sure to describe how your methodology speaks to reliability and validity and how the tool you develop ensures accurate measurement of the variable. For example, if you plan to examine the number of hours someone walks per week, how will you document that to ensure consistency among participants? If you plan to develop a table for data entry, that must also be included as an appendix. All appendices are placed behind the references.
If using physiologic measures, describe how you will ensure consistency in data collection among all participants.
This is a continuation of ORDER ID: 56857. This assignment starts at the Methodology portion of the Bare Bones template.