A Middle Range Theory:

Chronotherapeutic Intervention for

Postsurgical PainTheory developed by Susan E.

Auvil-Novak

By Candice Kiskadden

Overview ObjectivesO Discuss the theory of Chronotherapeutic

Intervention for postsurgical pain (CIPP)O Describe purpose and major concepts of CIPPO List contexts for use of the CIPP theoryO Discuss nursing implications of CIPPO Characterize the evidence of empirical

testing of CIPPO Outline current research articles using CIPPO Communicate application to author’s practice

Theory of Chronotherapeutic Intervention for Postsurgical Pain

O CIPP theory states pain management is time dependent

O “Chronotherapeutic” approaches to pain

O Derived from theory, literature review, and studies

O Used three separate studiesO Analgesic utilization is a feedback

loop for pain reception

Who is Susan E. Auvil-Novak?

O Authored four publications related to nursing

O Publication focus was on time aspects

Susan E. Auvil-Novak, Ph.D, RN

Analysis and Evaluation

CIPP Theory

Purpose and Major Concepts

O Prescriptive Mid-range Nursing Theory

O Focused on postoperative pain perception

O Pain is chronologically rhythmicO Different pain interventions needed

at different levels through cycleO Maximize pain control and minimize

adverse effects

Context for UseO Theory has evidenced-based practice

references to past studiesO Clinical evidence supports theory of CIPP

pharmacologic administrationO Can be applied to different types of pain stimuliO Uses model of Individual Biologic Time StructureO Use of CIPP pain management enhances

postoperative outcomesO Can be used for populations unable to verbally

communicate: children, neonates

Nursing ImplicationsO Recent studies support congruency with

CIPP TheoryO Patient controlled analgesics currently

utilized postoperativelyO Theory is socially relevant and can be

applied transculturallyO Increases the nursing evidence-based

practice for pain controlO Heathcare professionals can provide better

pain control with less adverse effects

Evidence of Empirical Testing

O Empirical validation of gynecologic oncology patients

O Compounding evidence supported the theory in three separate studies

O Testing has proved the theory to be accurate and valid

O CIPP has been cited in many other scholarly publications

Research Utilizing CIPP

O Henly, S. J., Kallas, K. D., Klatt, C. M., & Swenson, K. K. (2003). The notion of time in symptom experiences. Nursing Research, 52(6), 410-417.

O Sherwood, G. D., McNeill, J. A., Starck, P. L., & Disnard, G. (2003). Changing acute pain management outcomes in surgical patients. AORN Journal, 77(2), 374-395.

Henly, Kallas, Klatt, & Swenson

O Appropriately uses CIPP Theory to build new SET theory

O Uses theory to build on nursing practice

O Uses CIPP theory as empirical study to illustrate critical points

O Does not continue to develop CIPP theory

O Relevant to current evidence-based nursing practices

Sherwood, McNeill, Starck, & Disnard

O Appropriately uses CIPP theory to increase research knowledge

O Supports hypothesis of postoperative pain management

O Contributes to chronotherapeutic approach of pain assessment

O Contends that CIPP theory enhances postoperative outcomes and precipitate recovery

Practice ApplicationO No direct application to Operating

Room nursingO Preoperative assessment can include

CIPP for greater pain managementO Effective for immediately

postoperativeO OR nurses and CRNAs can influence

prescriber for order of CIPP

ReferencesAuvil-Novak , S. E. (1997). A middle-range theory of chronotherapeutic intervention for postsurgcial pain. Nursing Research, 46(2), 66-71. Retrieved from http://www.nursingcenter.com/lnc/JournalArticle?Article_ID=102327

Henly, S. J., Kallas, K. D., Klatt, C. M., & Swenson, K. K. (2003). The notion of time in symptom experiences. Nursing Research, 52(6), 410-417. Retrieved from http://www.nursingcenter.com/lnc/journalarticle?Article_ID=443674

McEwan, M., & Wills, E. M. (2011). Theoretical Basis for Nursing (3rd ed.). Philadelphia, PA: Lippincott Williams & Wilkins.

Sherwood, G. D., McNeill, J. A., Starck, P. L., & Disnard, G. (2003). Changing acute pain management outcomes in surgical patients. AORN Journal, 77(2), 374-395. Retrieved from http://www.aornjournal.org/article/S0001-2092(06)61206-4/fulltext