| Popis: |
Background and Aims: Acute pain services (APSs) have developed worldwide to improve the quality of postoperative pain management (POPM). Although there is evidence that APSs can reduce pain and side effects after surgery and improve nurses’ knowledge regarding pain management, the processes through which APSs influence these outcomes remains unclear. Previous studies regarding the influence of APSs on these outcomes have reported conflicting findings and there has been little research exploring clinicians’ perceptions of the APS, and POPM practice. The development of a nurse-based, anaesthetist-supervised APS in one of Jordan’s hospitals in February 2010 provided an interesting and timely opportunity to investigate the influence of an APS on POPM in Jordan, as compared to a similar hospital that has yet to develop this service. This study seeks to address the gap in our knowledge concerning the impact of an APS on the quality of POPM, the knowledge and attitudes of clinicians relating to pain, and to explore clinicians’ views and perceptions of the APS, and current POPM practice. Methods: A comparative multiple-case (embedded) study was conducted between July 2011 and October 2011 at two hospitals in Jordan (Hospital-A has APS, Hospital-B without APS). The case study utilised a combination of quantitative and qualitative methods. Adult patients who underwent elective major surgery (50 from each hospital) completed the Strategic and Clinical Quality Indicators in Postoperative Pain Management (SCQIPP) questionnaire 24 hours after surgery to examine the quality of POPM in both hospitals. A representative sample of nurses and junior doctors at the two hospitals (89 from hospital-A and 100 from hospital-B) completed the knowledge and attitudes regarding pain (KAP) questionnaire. Documentary evidence including hospital policies and notes of meetings was gathered to illuminate the findings derived from other sources. Finally, a purposeful sample of 25 clinicians (mixture of nurses, anaesthetists & surgeons; 12 from hospital-A and 13 from hospital-B) was interviewed to explore clinicians’ views on the APS and current POPM practice. Results: The total mean SCQIPP scores for hospital-A (57.28) and hospital-B (51.88) did not reach the ‘high quality of care’ threshold of 63 in either hospital. The findings from clinicians’ interviews suggest that the lack of patient involvement, the lack of regular pain assessment, and organisational challenges in both hospitals have prevented the total quality scores from reaching the international standard for ‘high quality of care’. Patients in hospital-A reported a significantly higher total SCQIPP scores, and in the subscales of communication and action, (P < 0.001) than hospital-B. There was no significant difference in the subscales of trust (P=0.927) and environment (P=0.344) or in the patient satisfaction scores (P=0.059). Patients in hospital-A also reported significantly lower pain intensity scores (P < 0.001). Patients in hospital-A used significantly more PCA (P=0.013) and epidural analgesia (P |
