Post Anesthesia Care Unit Nurses’ Experience Caring for Opioid Tolerant Patients

Abstract

<h3>Introduction</h3> Nearly 20% of same-day surgery patients regularly consume opioids, with the majority undergoing orthopedic or neurosurgery procedures for relief from chronic pain. Many have become opioid intolerant and subsequently, experience more pain and consume more opioids postoperatively than opioid naïve patients. Despite higher dosing, their pain is often unrelieved. Evidence-based guidelines include <i>preoperative identification</i> of opioid tolerant patients; however, postoperative nurses often learn of their patient's tolerance only after the patient exhibits an extreme reaction to pain. These experiences can be stressful and lead to nurse compassion fatigue and moral distress, particularly in a fast-paced post anesthesia care unit (PACU). <h3>Identification of the problem</h3> Several studies examine perioperative nurses' experiences with opioid tolerant patients in managing pain, though none explore the day-to-day personal challenges faced by nurses in the care of these patients. <h3>Purpose of the Study</h3> To explore PACU nurses' experiences in caring for opioid tolerant patients. <h3>Methodology</h3> A narrative research design was used. Six full-time PACU nurses with one or more years of PACU experience were recruited in Fall 2020. Subjects were asked to discuss an experience caring for an opioid tolerant patient and how they felt afterward. They were also asked to identify supports that would help them care for these patients. <h3>Results</h3> Interviews will be analyzed inward, outward, back in time, and forward in time to understand the participants' experience through five contexts – personal (feelings, reaction), social (environment, other people), past, present, future, and situation (professional practice). <h3>Discussion</h3> Narrative threads and their interpretation will be discussed to better understand how nurse's feelings are expressed and directed in professional practice. <h3>Conclusion</h3> This study made it possible to think about nursing practice in a new light through honoring experiences that are difficult to share yet are an important source of knowledge. <h3>Implications for perianesthesia nurses and future research</h3> Insights into the nature, causes, and strategies used to handle experiences caring for opioid tolerant patients will be identified as well as ways to better support nurses in the practice environment.