Patient participation in postoperative pain assessment after spine surgery in a recovery unit.

Abstract

To explore how patients undergoing spine surgery participated in postoperative pain assessment in a recovery unit. Despite advances in medicine, pharmaceutical and technical knowledge, patients report considerable postoperative pain after spine surgery. Research shows that patients require efficient individual pain treatment and that their participation has a positive effect on pain treatment. This study was based on a phenomenological hermeneutic design. Fifteen qualitative interviews were conducted in 2014. Meaning condensation was used to analyse data. Three themes emerged: (1) communication and knowledge; anaesthesia, analgesics and severe pain affected patients' ability to assess and communicate their pain. (2) Pain assessment using a numerical rating scale; this theme was characterised by individual differences in rating perception. Also, new postoperative pain sensations were described as different kinds of pain and variation in the pain intensity during activity. (3) Patient-nurse relationship; this theme was characterised by reports of frequent and direct contact on the part of the nurses about pain assessment. Patients' lack of knowledge about pain treatment resulted in inactivity and uncertainty of when to ask for analgesics. This study indicates that nurses and patients would benefit from building a mutual understanding of pain perceptions and numerical rating scale as this would pave the way for a more accurate pain assessment. Patients' ability to participate in pain assessment was affected by anaesthesia, analgesics and severe pain. Patients needed knowledge about complications and needed to understand when they should ask for analgesics. Results indicate that patient perceptions of numerical rating scale and variation in patients' ability to communicate in the initial postoperative period should be given more attention to underpin patients' pain assessment. This may be a key factor in ensuring patient participation in pain assessment and thereby improving postoperative pain management.