Original ArticleHealthcare Professionals' Perceptions of the Use of Pain Scales in Postoperative Pain Assessments
Introduction
An investigation of postoperative pain normally begins with a screening followed by a more thorough assessment if patients are in pain (e.g., including questions on location and duration of the pain). Pain is however a subjective experience that can be hard to communicate, both between patient and staff, as well as between staff with different professions. It is therefore recommended in guidelines that patient's self-report of pain should be screened by using a valid pain scale (Gordon et al., 2005). The extent to which pain scales are used (Abdalrahim et al., 2008, Ene et al., 2008) and how assessments of postoperative pain are performed are explored only in a few studies (Klopper et al., 2006, Manias et al., 2004). The results indicate that the use of pain scales such as numeric rating scale (NRS), visual analogue scale (VAS) or verbal scale (VS) is not an obvious choice.
The implementation of validated pain scales has been difficult in clinical settings despite educational programs (Ene et al., 2008). Screening for the presence of pain, without using pain scales still occurs and is instead based on the patient's appearance and behavior, what they express and how much pain “it usually is” after a certain type of surgery. Age, sex or ethnicity is taken into consideration (Klopper et al., 2006), and changes in vital signs such as pulse rate, blood pressure and respiratory rate are also used (Richards and Hubbert, 2007, Clabo, 2007).
Quality of care is related to a well -functioning communication between healthcare professionals (Havens, Vasey, Gittell, & Lin, 2010), and pain scales are described as improving the screening of patient's pain and communication between healthcare professionals and patients (Gordon et al., 2005). The nurse's performance in screening for postoperative pain is mainly focused in research because they are described as playing an important role in postoperative pain management (Dihle et al., 2006, Schafheutle et al., 2004). No studies describing the enrolled nurse's or physician's use of pain scales have been found. However, in Sweden enrolled nurses perform much of patient's daily care including screening for pain, but they are not trained to distributing drugs to patients. Further, according to Hartog, Rothaug, Goettermann, Zimmer, and Meissner (2010) the physician's competence in this area is necessary to obtain a well-functioning pain management. To contribute to a better understanding on how pain scales can provide an improved communication around pain, the aim of this study was to describe how healthcare professionals perceive the use of pain scales in postoperative care.
Section snippets
Design, method description and setting
With permission from the Regional Ethics Committee for Human Research in Linköping, Sweden, an explorative design with a phenomenographic approach was chosen. The goal with phenomenography is to explore variations in people's perceptions of the surrounding world (e.g., how they perceive, understand and remember various aspects of a phenomenon). It is substance-oriented (searching for the underlying structure of variance) and differentiates between two types of description: the first order
Findings
An overview of the findings and quotations in relation to all perceptions is presented in Table 4.
Discussion of methodological issues
In qualitative research credibility, dependability, confirmability and transferability build trustworthiness. Credibility refers to the truth of interpretation of data (Holloway & Wheeler, 2006). This was strengthened by the knowledge in the research team which consisted of researchers with experience from postoperative pain and phenomenography. Dependability refers to the stability i.e., a high inter subjective agreement in repeated research (Holloway and Wheeler, 2006, Sjöström and Dahlgren,
Discussion
The main findings of this study were that healthcare professionals perceived that pain scales facilitated the understanding of postoperative pain and the choice of treatment and pain relieving care actions. The use of pain scales was described as demanding a multidimensional approach i.e., additional assurance of patient understanding, additional dialogue and observations, but was also expressed to be affected by knowledge, support from ward management, guidelines and tools for documentation.
Conclusion
Healthcare professionals describe that frequent screening for pain with pain scales contribute to the understanding of patient's postoperative pain and facilitate the choice of treatment and other pain relieving care actions if ratings are considered by all healthcare professionals. It is important to ensure patient understanding and be aware about patient's variations in interpretation of pain ratings. Additional dialogue and observations are necessary to reassure what the ratings mean to the
Acknowledgments
The authors express special thanks to the Academy for Health Care, County Council of Jönköping, Sweden and (FORSS) The Research Council of Southeast Sweden.
The authors express special thanks to Sweden and the Department of Anaesthesia and Intensive Care at Ryhov County Hospital who have given financial support.
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Conflict of Interest. None.
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