newslet ter volume 18 issue 3 - acpan · newslet ter volume 18 issue 3 . aspaan newsletter volume...

19
NE W SL E T TER VOLUME 18 ISSUE 3

Upload: others

Post on 02-Feb-2020

12 views

Category:

Documents


0 download

TRANSCRIPT

Page 1: NEWSLET TER VOLUME 18 ISSUE 3 - ACPAN · NEWSLET TER VOLUME 18 ISSUE 3 . ASPAAN NEWSLETTER VOLUME 18 ISSUE 3 2 Message from the Editor Welcome to this new edition of our newsletter

NEWSLET TER

VOLUME 18 ISSUE 3

Page 2: NEWSLET TER VOLUME 18 ISSUE 3 - ACPAN · NEWSLET TER VOLUME 18 ISSUE 3 . ASPAAN NEWSLETTER VOLUME 18 ISSUE 3 2 Message from the Editor Welcome to this new edition of our newsletter

A SPA A N NE W SL E T TER VO LU M E 18 I SSU E 3 2

Message from the Editor Welcome to this new edition of our newsletter. This edition is important for the

fact that it is the last before the National Conference. Speaking of which, have you

registered yet? It isn’t too late, jump on to the website now and secure your place.

Don’t forget also that we have the preconference cocktail evening on Friday 31st

October at 730pm. This free event also needs you to register for catering purposes.

All information can be found at the website.

Call for Poster Presentations on 31st October 2014 at the members cocktail party.

Submissions to [email protected].

Early Bird Registrations have been extended to 30th September.

Members $200 before September 30th, after $250.

Non-member $300 before 30th September, after $350

Welcome and thank you to Jerome Wang (Vic and National Committee) who has taken on the role of Webmaster

and will continue to work with our web partners, Beyond the Pixels in the maintenance and further enhancement

of the website. We welcome your feedback on the website or any other matter via email at

[email protected]

In the upcoming AGM to be held during the national conference, there will be several national committee roles

vacated. Please consider nominating for one of these roles. We are a group of volunteers that depend on our

members to continue to provide targeted education for our sector. If you don’t feel up to the national committee,

then consider helping out your state committee, especially those of you in Queensland,

South Australia and Northern Territory.

The Australian Society of Post Anaesthesia and Anaesthesia Nurses (ASPA AN) was convened to promote

the professional development of post anaesthesia and anaesthesia nurses through regular meetings, study days,

educational forums, and publication of newsletters. Membership is open to Registered Nurses or Enrolled Nurses

working in the specialties of Anaesthesia and Post Anaesthesia care, Associate membership is open to others

(eg: Representatives of Trade Companies and other Health Professionals) with a genuine interest in the field.

To join ASPA AN click here

How can you help us enhance Perianaesthesia Nursing?

• Become a member

• Be involved in your state branch or national committee

• Share your knowledge and ideas with the other members

by submitting an article or letter to our newsletter

• Take advantage of the education grants available to further

your knowledge and be published in our newsletter

• Present at state seminars and national conferences

• Promote peri-anaesthesia nursing as a fulfilling career.

Page 3: NEWSLET TER VOLUME 18 ISSUE 3 - ACPAN · NEWSLET TER VOLUME 18 ISSUE 3 . ASPAAN NEWSLETTER VOLUME 18 ISSUE 3 2 Message from the Editor Welcome to this new edition of our newsletter

A SPA A N NE W SL E T TER VO LU M E 18 I SSU E 3 3

Presidents Repor t The next two months bring with it a flurry of ASPAAN

activity with state seminars in Victoria and Tassie,

and of course the National conference which is in beautiful

Darling Harbour in Sydney!

Speaking of which... I would like to urge members to get in early to avoid

disappointment as the venue capacity is less than our National conferences

in Melbourne and tickets are selling fast.

Early-bird registration closes soon so have the chat at work and get to our website

to register for what promises to be an amazing conference at an amazing location!

Just a reminder that for ASPA AN members that have been with us for greater than

2 years, our grant process may help with meeting some of the costs associated with

getting to and attending the conference... Checkout our website for more detail.

Well that’s about it from me, please enjoy the read, get along to your state seminars,

and I look forward to seeing you in Sydney!

Jamie

Page 4: NEWSLET TER VOLUME 18 ISSUE 3 - ACPAN · NEWSLET TER VOLUME 18 ISSUE 3 . ASPAAN NEWSLETTER VOLUME 18 ISSUE 3 2 Message from the Editor Welcome to this new edition of our newsletter

A SPA A N NE W SL E T TER VO LU M E 18 I SSU E 3 4

National Conference

ASPAAN National and NSW Committees present:

NATIONAL CONFERENCE ‘BACK TO THE FUTURE’

Dockside Group Cockle Bay Wharf, Darling Harbour, Sydney, Saturday 1st November 2014 Click here to register for the conference

(make sure you are logged in to receive your member discount.)

PRE-CONFERENCE COCKTAIL EVENING… AT

THE STAR ROOM DARLING HARBOUR!

Date: Friday 31st October 2014

Time: 1930 – 2130

Poster presentations to be held during this time.

Please send in your poster abstracts to [email protected]

Click here to register

(make sure you are logged in to access this members only event.)

Page 5: NEWSLET TER VOLUME 18 ISSUE 3 - ACPAN · NEWSLET TER VOLUME 18 ISSUE 3 . ASPAAN NEWSLETTER VOLUME 18 ISSUE 3 2 Message from the Editor Welcome to this new edition of our newsletter

A SPA A N NE W SL E T TER VO LU M E 18 I SSU E 3 5

National Conference Program

WELCOME A D DR E SS

Jamie Mann-Farrar

ASPAAN National President

K E Y NOTE A D DRE SS

Dr William McMenimen

“Back to the future?”

Dr Janet Smith

Director of Anaesthetics

Concord Repatriation Hospital Sydney NSW

“Back to the future: trends, fads and failures in anaesthesia”

Lyell Brougham, RN

“A long, hard look at recovery - change is the process”

Dr Paula Foran, pHD, RN

“Back to the future? Developing PACU skills in ICU nurses

for the direct surgery transfer patient”

PANEL DISCUSSION

Jamie Mann Farrar, Dr Paula Foran, Lyell Brougham

A SPA AN ANNUAL GENER AL MEE TING

Courtney Player, RN & Catherine Fraietta, RN

“Save Our Sisters”

Jenny Sutton, RN

Calvary Mater Newcastle, NSW

“The role of religion for the surgical patient

in the operating theatre”

PR E SENTATION OF AWAR DS & PRIZE S

Pete Smith, CNS & John Gibbs, RN

Barwon Health, Vic

“Below 10000: Reducing noise in the operating suite,

a team safety initiative”

Mbene Letsamao, RN

“Is there Room in the Recovery Room ?”

A review of the literature of the Nurse Anaesthetist role in Australia.”

Page 6: NEWSLET TER VOLUME 18 ISSUE 3 - ACPAN · NEWSLET TER VOLUME 18 ISSUE 3 . ASPAAN NEWSLETTER VOLUME 18 ISSUE 3 2 Message from the Editor Welcome to this new edition of our newsletter

A SPA A N NE W SL E T TER VO LU M E 18 I SSU E 3 6

Commit tee Members NATIONAL COMMITTEE

NAME POSITION

Jamie Mann-Farrar President (TAS)

Suzanne Querruel Vice President & Conference Organiser

(NSW )

Meg Bumpstead Treasurer (VIC)

Anthea MacDonald Secretar y & Public Officer ( VIC)

Jerome Wang Technical Web Officer ( VIC)

Melanie Murray Newsletter Editor (WA)

Ken Hancock General Committee (TAS)

Positions Vacant Membership Officer

Merchandising & Marketing Officer

General Committee

STATE COMMITTEES

WA NSW/ACT

Paula Holland, President Suzanne Querruel, NSW President*

Sandy Presland, Treasurer Donna Hopley, Secretary & Treasurer

Melanie Murray, Secretary* Bernadette Huang

Jilda Levene Trevor Court

Shauna Fatovich Jane Nichols - ACT

Bronwyn Hegarty

Georgina Walker

VIC TAS

Angela Fraser, President Ken Hancock*

Rachael Ambatali Stephen Bagshaw

Jerome Wang* Elizabeth Cotton

Beth Schubel

QLD SA/ NT

Contact Contact: [email protected]

To view the Committee Members and the roles they perform click here.

If you or a friend is interested in education within the perianaesthesia environment,

contact [email protected] to express interest to your state committee or join

the National committee!

Page 7: NEWSLET TER VOLUME 18 ISSUE 3 - ACPAN · NEWSLET TER VOLUME 18 ISSUE 3 . ASPAAN NEWSLETTER VOLUME 18 ISSUE 3 2 Message from the Editor Welcome to this new edition of our newsletter

A SPA A N NE W SL E T TER VO LU M E 18 I SSU E 3 7

Commit tee Updates

WA

Meeting to discuss new options for seminar delivery.

NSW

Holding the national conference this year with the theme “Back to the Future”.

Register now via the website. The early bird date has been pushed back to the 14

September, so get in quick.

VIC

Seminar “Critical Minutes Be Prepared”

Saturday 23 August 2014: held at the Lecture Theatre

of St Vincent’s Hospital Melbourne.

TAS

Seminar “Renal study day – How well do you know your Kidney?”

Saturday 23rd August 2014: held at the Lecture Theatre of Hobart Private Hospital

Page 8: NEWSLET TER VOLUME 18 ISSUE 3 - ACPAN · NEWSLET TER VOLUME 18 ISSUE 3 . ASPAAN NEWSLETTER VOLUME 18 ISSUE 3 2 Message from the Editor Welcome to this new edition of our newsletter

A SPA A N NE W SL E T TER VO LU M E 18 I SSU E 3 8

State Seminar Reviews

VIC – “CRITICAL MINUTES” SEMINAR SUMMARY

The Victorian committee’s second free seminar for 2014, Critical Minutes: be prepared, was held at St Vincent’s Hospital in Melbourne on Saturday the 23

rd August. The seminar attracted interest from 100 nurses from across all aspects of the

perioperative field.

As well as a very interesting and pertinent cat video, Dr Suzi Nou’s talk on paediatric crises was a great start to the day leaving us with the acronym SOAP ME STABLE, which I’m sure, will assist us all in the future.

Dr Raja Rengasamy updated our knowledge of malignant hyperthermia; a crisis few of us have been involved with yet one that looms quite frighteningly in the background of all operating theatres.

Following morning tea, Eliza Wilson CNS and Pauline Fogarty NUM explained to us the process by which they were able to develop and instigate their Massive Blood Transfusion (MBT) protocol across all the Epworth Hospital campuses in Melbourne. Pauline explained that the most important aspect to the success of this protocol was the educational package that Eliza developed involving the use of a simulation lab at the Epworth Richmond Hospital.

Our final speaker for the day was Dr Gabe Snyder whose informative lecture on anaphylaxis will have all who attended ready when next this crisis raises its ugly head.

Of course the day could not have been as successful had it not been for the assistance afforded us by our sponsors – 3M, Pfizer, MSD and Ambu – all of whom we hope to see at future seminars.

On a final note I think the theme of the day was summed up well with a quote from Dr Suzi Nou’s talk – “it is poor practical application rather than lack of knowledge that leads to critical crisis”.

We look forward to seeing everyone back in March 2015 for – Before and After: the best surgical outcome.

Side note

We understand some people had issues registering with Miiytix for the Victorian

Seminar. For National Conference we expect all members to register using this

site - remember to be signed in to the ASPAAN website to get the member discount.

If it is your first time using Miiytix please remember to register for Miiytix separately

as the password and username on this site is not the same the ASPA AN site. Finally if

having any further issues please call the phone number on the screen.

TAS – “RENAL STUDY DAY – HOW WELL DO YOU KNOW

YOUR KIDNEY? SEMINAR SUMMARY

In conjunction with ASPA AN and the Hobart Private Hospital a half-day seminar was

held on the 23 August. The topics focused on anaesthetising renal patients and

chronic kidney disease (CKD). The study day was very well attended by nurses from

Hobart Private, Calvary, Hobart day surgery and one keen member from interstate.

The day was hailed as a great success with very positive feedback from all

attendees. Speakers included Dr Mark Hamilton, a surgeon specialising in renal

disease, in par ticular the formation of fistulas in patients requiring

long-term haemodialysis. Dr Hamilton frequents Northern Australia on a regular basis to provide his expertise

to the large indigenous population where there is an epidemic of CKD sufferers

waiting for haemodialysis. Dr Anna McDonald provided a very detailed analysis on the

challenges of anaesthetising the CKD patient while Joanne Wilkinson; a Clinical Nurse

specialist (CNS) discussed the difficulties faced by the renal patient and the issues

surrounding the long-term effect of haemodialysis. Ben Terr y gave a first-hand description of his life; first as a renal transplant recipient

and now a regular at the renal unit for haemodialysis. Despite Terry’s positive outlook

his very personal account of his life with a chronic illness reminded us all of the very real

difficulties that these patients face as well as their family and friends. We wish

to thank all our speakers for giving up their Saturday; it was very much appreciated

by all. We would also like to thank Liz livingstone from Fresenius Kabi for her support

and supplying a wonderful morning tea.

Page 9: NEWSLET TER VOLUME 18 ISSUE 3 - ACPAN · NEWSLET TER VOLUME 18 ISSUE 3 . ASPAAN NEWSLETTER VOLUME 18 ISSUE 3 2 Message from the Editor Welcome to this new edition of our newsletter

A SPA A N NE W SL E T TER VO LU M E 18 I SSU E 3 9

Page 10: NEWSLET TER VOLUME 18 ISSUE 3 - ACPAN · NEWSLET TER VOLUME 18 ISSUE 3 . ASPAAN NEWSLETTER VOLUME 18 ISSUE 3 2 Message from the Editor Welcome to this new edition of our newsletter

A SPA A N NE W SL E T TER VO LU M E 18 I SSU E 3 10

Events and Announcements ASPA AN GRANT INFORMATION

ASPA AN was formed with the idea of providing continuing education,

research and professional development opportunities for nurses in the

specialty of Anaesthesia and PACU Nursing.

Study days, combined group Seminars and conferences have all contributed

to furthering education and providing the networking opportunities so important in

this area. All of these events contribute to providing our patients with optimal care.

With all of this in mind, the committee is keen to encourage members to make use

of grants available through ASPA AN.

An Education and Research Fund has been established and the ASPA AN committee

extends to members an invitation to apply for these grants. We would like to see an

enthusiastic response to the research challenge. There must be a lot of questions out

there, and you may be able to solve some dilemmas or at least give us your educated

(and well researched) opinion. For further information about our education and

research grants, please go to http://www.aspaan.org.au and click on the grant link

found in the footer section.

PERI ANAESTHESIA JOB OPPORTUNITES

The website now includes a job page which will be free for Australian Hospitals

to advertise peri anaesthesia job opportunities.

To advertise on the website please email the ASPA AN National Secretary

info@ aspaan.org.au with the following details:

Job Title

• Position

• Company/Hospital

• Closing Date

• Name and contact details of contact for position

• url link to the full job advertisement and full job description.

Page 11: NEWSLET TER VOLUME 18 ISSUE 3 - ACPAN · NEWSLET TER VOLUME 18 ISSUE 3 . ASPAAN NEWSLETTER VOLUME 18 ISSUE 3 2 Message from the Editor Welcome to this new edition of our newsletter

A SPA A N NE W SL E T TER VO LU M E 18 I SSU E 3 11

Adver tising

ADVERTISING

ASPAAN is a non for profit organisation and our quarterly

newsletter is distributed to RN Clinicians, Educators, Hospitals

and to some businesses who are members of ASPAAN.

ASPA AN provides its members with seminars, study days, a national conference

and of course this newsletter. This is an ideal medium to market your products

to clinicians in the field of perianaesthesia nursing. Your help allows us to provide

these services to our members.

ASPA AN Advertising Fees:

• eNewsletter, full page, $400

• Website advertising, logo and link to your page

as a sponsor on our Jobs page $1000

• National Conference Program advertising: $800 one full page, colour

• National Conference showbag drop with your flyer, brochure, or product,

$500 or $1200 for both National Conference Program and showbag drop

Don’t forget, online right now are recent back issues of the newsletter which are

available to members for download and your advert (If in the newsletter) will always

be there! International advertisers, please send your expression of interest to

[email protected] for further details regarding your advertising.

For more information, please email [email protected]

Page 12: NEWSLET TER VOLUME 18 ISSUE 3 - ACPAN · NEWSLET TER VOLUME 18 ISSUE 3 . ASPAAN NEWSLETTER VOLUME 18 ISSUE 3 2 Message from the Editor Welcome to this new edition of our newsletter
Page 13: NEWSLET TER VOLUME 18 ISSUE 3 - ACPAN · NEWSLET TER VOLUME 18 ISSUE 3 . ASPAAN NEWSLETTER VOLUME 18 ISSUE 3 2 Message from the Editor Welcome to this new edition of our newsletter

13

Ar ticles of interest

ABSTRACTS

P OS T- DISCH ARGE N AUSE A AN D VOMITING:

M AN AGEMENT S TR ATEGIE S AN D OU TCOME S OV ER 7

DAY

Jan Odom-Forren, PhD, RN, CPAN, FA AN;

VallireHooper, PhD, RN, CPAN, FA AN; Debra K. Moser,

DNSc, RN, FA AN; Lynne A. Hall, DrPH, RN; Terry A.

Lennie, PhD, RN, FA AN; Joseph Holtman, PhD, MD;

Melissa Thomas, BSN, RN; Zohn Centimole, APRN,

CRNA, MS; Carrell Rush, MPH; Christian C. Apfel, PhD,

MD

Published online 24 February 2014.

Journal of PeriAnesthesia Nursing Volume 29, Issue 4,

Pages 275-284, August 2014

PURPOSE

The purpose of this study is to determine patient

management strategies and outcomes for self-care

of postdischarge nausea and vomiting (PDNV).

DESIGN

Prospective, comparative, descriptive,

and longitudinal study.

METHODS

The sample consisted of 248 patients aged 18 years

or older undergoing a procedure requiring general

anesthesia. Patients recorded incidence and severity

of nausea and vomiting, the impact of symptoms,

and actions taken to alleviate symptoms for 7 days

postdischarge.

FINDINGS

The prevalence of PDNV was 56.9%. The methods

used to relieve symptoms included antiemetic use

by a minority and nonpharmacologic techniques of

self-management by some. The effect of nausea on

QOL, patient functioning, and patient satisfaction

was significantly worse for those who experienced

postdischarge nausea on all days.

CONCLUSION

Patients with PDNV use minor self-care strategies

to manage symptoms. The presence of PDNV affects

overall quality of life, patient functioning, and patient

satisfaction.

PATIENT S’ PERCEP TION OF NOISE IN THE OPER ATING

ROOM — A DE SCRIP TI V E AN D AN ALY TIC CROSS -

SEC TIONAL S T U DY

Dorthe Hasfeldt, MSC, RNA; Helle Terkildsen Maindal,

PhD, MPH; Palle Toft, PhD, MD; Regner Birkelund, PhD,

MSC Published online 16 June 2014.

Journal of PeriAnesthesia Nursing PURPOSE

Noise is a general stressor that affects the

cardiovascular system, resulting in increased blood

pressure and heart rate, both of which can be

problematic for the patient preparing for anesthesia

and surgery. The purpose of this study was to

investigate the patient’s perception of noise in the OR

before anesthesia, the correlation between the actual

noise levels and the patient’s perception of noise,

and if there are particular patient subgroups that are

especially vulnerable to noise.

DESIGN

This cross-sectional study was performed within a

mixed descriptive and analytical design, including

120 patients (60 acute/60 elective) undergoing general

anesthesia for orthopaedic surgery.

METHODS

Data collection consisted of registration of

demographic variables and measurements of noise

levels in the OR combined with a questionnaire.

FINDINGS

Results showed that 10% of the patients perceived

noise levels in the OR as very high and experienced

the noise as annoying, disruptive, and stressful.

There was no correlation between the actual noise

levels to which patients were exposed and their

perception of noise. Acute patients perceived

significantly more noise than elective patients

(P <. 01), although they were actually exposed to less

noise. Of the acute patients, those undergoing major

surgery perceived more noise than patients undergoing

minor surgery (P < .01), although actually exposed to

less noise. There was a significant correlation between

patients’ sense of coherence (SOC) and their perception

of noise (P < .01). Most patients who perceived noise

levels as very high had a SOC below 50 (scale: 13-91).

CONCLUSIONS

Perianesthesia nurses need to maintain their focus on

keeping noise levels in the OR as low as possible.

When caring for acute patients, patients undergoing

major surgery and patients with a low SOC

perianesthesia nurses should be particularly aware,

as these patients might be more vulnerable to noise.

Page 14: NEWSLET TER VOLUME 18 ISSUE 3 - ACPAN · NEWSLET TER VOLUME 18 ISSUE 3 . ASPAAN NEWSLETTER VOLUME 18 ISSUE 3 2 Message from the Editor Welcome to this new edition of our newsletter

14

Ar ticles of interest

PATIENT RISK A SSE SSMENT IN THE PACU:

AN E SSENTIAL ELEMENT IN CLINIC AL DECISION

M AK ING AN D PL ANNING C AR E

Pat Smedley

British Journal of Anaesthetic and Recovery Nursing

British Journal of Anaesthetic and Recovery Nursing/

Volume 13 / Issue 1-2 /February 2012, pp 21-29

Copyright © British Association of Anaesthetic

and Recovery Nursing 2012

Published online: 08 August 2012

ABSTRACT

Decision making in post-anaesthetic care practice is

an underresearched area. The patient undergoes rapid

and profound physiological change in the early stages

of recovery. The practitioner is required to assimilate

information about the patient, assess his clinical

status, plan proactive care and provide an immediate

reactive intervention depending on his/her condition.

Knowledge and understanding of the standard risks

of anaesthesia and surgery ensure that the practitioner

is able to prevent complications arising in the routine

recovery. This article investigates the role that risk

assessment plays in clinical decision making and

planning care in the post-anaesthetic care unit.

ANE S THE SIA AN D AL ZHEIMER ’S DISE A SE: TIME TO

WAK E UP!

David A. Scotta1, Brendan S. Silberta1 and Lisbeth A.

Evereda1

International Psychogeriatrics

International Psychogeriatrics / Volume 25 / Issue 03 /

March 2013, pp 341-344

Copyright © International Psychogeriatric

Association 2012

Published online: 02 November 2012

a1Centre for Anaesthesia and Cognitive Function,

Department of Anaesthesia, St. Vincent’s Hospital,

Melbourne, Australia Email: [email protected]

It has long been observed that some patients suffer

a significant cognitive impact following anesthesia

and surgery. This should not be surprising when

considering that not only is the target organ for

general anesthetic agents the brain itself but also

that the process of anesthesia is a form of deep,

pharmacologically induced coma rather than “sleep.”

The expectation that such a process should be fully

reversible with transient neurophysiological effects

contradicts our experience with repeated abuse of

other central nervous system depressants such as

glue, petrol, and alcohol. Of great concern is that,

while approximately 10% of populations in developed

countries undergo anesthesia and surgery of some

form each year, the proportion of the elderly making

up this group is much greater. In addition, it is the

elderly who are potentially at a greater risk of cognitive

impairment following such procedures because

many have decreased cognitive reserve, either due to

pre-existing mild cognitive impairment (MCI) or frank

dementia, which may be diagnosed or unknown.

The impact of anesthesia on these individuals is poorly

understood, as are the implications of the emerging

laboratory data that suggest an effect of anesthetic

agents on the pathological processes of Alzheimer’s

Disease (AD) itself.

E X PLORING PAIN M AN AGEMENT BAR RIER S IN PACU Original article by Jerome Wang – National Committee ABSTRACT

Postoperative pain management remains a challenge in

current clinical nursing practice. Through the discussion

of two vignettes this article will highlight major barriers

to effective pain management within the PACU (Post

Anaesthesia Care Unit). The practical awareness

of these barriers is essential to constantly improve

nursing practice, education and research.

INTRODUCTION

Pain is a subjective and unique personal experience1.

The most commonly recognised definition of pain is

“an unpleasant sensory and emotional experience

associated with actual or potential tissue damage,

or described in terms of such damage”2. Effective pain

management is essential to minimise patient’s distress

or suffering, reduce postoperative complications

and facilitate a rapid recovery3. Postoperative pain management is “perhaps the most

difficult and challenging arena for pain management”4

(p.441). Literature indicates that poor postoperative pain

control can cause significant physiological, emotional,

mental and economic consequences5. Achieving

good postoperative pain management still maintains

a challenge. For instance, in the U.S, each year over

80% of surgical patients report postoperative pain

among a hundred million operations6. Australian

data reveals that a significant number of postoperative

patients are still in pain after discharge, with 86% of

patients reporting pain after discharge and 41% of

those reporting moderate to severe pain7. Pain management barriers influence effective pain

management in the PACU. Identifying and recognising

common pain management barriers is a key step

toward optimal post-operative pain management.

These barriers can be categorised into three areas:

patient-related barriers, professional-related barriers

Page 15: NEWSLET TER VOLUME 18 ISSUE 3 - ACPAN · NEWSLET TER VOLUME 18 ISSUE 3 . ASPAAN NEWSLETTER VOLUME 18 ISSUE 3 2 Message from the Editor Welcome to this new edition of our newsletter

15

Ar ticles of interest

and organisation-related barriers8. Patient-related

barriers include patient’s knowledge, attitude, beliefs

and unique culture regarding the pain8. Professional-

related barriers include deficit knowledge, lack

of competency on pain assessment and personal

attitudes8. Organisation barriers may consist of policies,

increased workload, staffing shor tage and poor

time management8, 9.

The following case vignettes are a compilation

of various case examples drawn from clinical

experience. Patients represented here are not

identified in any way.

CASE VIGNETTE ONE

Ms. Jane (pseudonym), 45 years of age, arrives to

the PACU in the busy evening hour after a right

rotator cuff repair under general anaesthesia. She has

mild sleep apnoea and 10-year smoking history. Prior

to the anaesthesia she refused to accept any shoulder

nerve block. During the operation, Ms. Jane received

200mcg Fentanyl, 8 mg morphine, 40mg paracoxib

intravenously additional to 20ml 0.75% Naropin locally.

The anaesthetist concerns about Ms. Jane’s sleep

apnoea and requests the PACU nurse, who is a new

graduate nurse, to “cautiously” give the pain medicine.

Upon emerging from anaesthesia, Ms. Jane starts

to moan and cry, with a pain score of “10”. 100mcg

Fentanyl is gradually given and followed with 10mg

morphine as ordered. Besides the initial analgesia,

she still rates the pain with score of “9” even

though her breathing is becoming shallow. Her BP

is 180/100mmHg, respiratory rate is 8 and oxygen

saturation is 91% on 6L oxygen mask. Besides offering

psychosocial support and encouraging her with deep

breathing, the PACU nurse repositions Ms. Jane’s arm

with pillow and applies the ice pack to her shoulder

side instead of seeking further opioids order. The PACU

nurse suspects that Ms. Jane may have addictive issue

and explains to her again that no more pain medicine

could be given because of her current respiratory

status. Ms. Jane is still moaning and becoming

agitated. A senior nurse comes to help the graduate

nurse to deal with the agitation issue and she observes

that Ms. Jane seems reluctantly to take a deep breath

due to the pain it causes. Upon further discussion with

the anaesthetist, a multimodal analgesia approach is

adopted and Tramadol and Clonidine are given. After

receiving 150mg Tramadol and 100mg Clonidine, Ms.

Jane’s pain is gradually reduced to a tolerable level,

respiratory rate is increased to 11 with 97% Oxygen

Saturation and BP is down to 142/70. Finally,

Ms. Jane is successfully discharged from the PACU.

DISCUSSION FOR VIGNETTE ONE

In this case, Ms. Jane’s postoperative pain brings a

challenge to manage due to her history of sleep

apnoea and long-term smoking. It has been

consistently shown that smokers have increased

requirements for opioids perioperatively, resulting

from either an increase in metabolism of the

substrates or alteration of the pain threshold10.

Respiratory depression is also a well-known side effect

of opioids11 and for this reason clinical nursing staff

are especially cautious about administering opioids to

sleep apnoea patients. In addition, cigarette smoking

decreases mucociliary clearance of the lungs, reduces

forced expiratory volume and impairs oxygen delivery

by shifting the oxygen–hemoglobin dissociation curve

to the left that decreases oxygen availability

to the tissues12, 13. Initially the graduate nurse had to give opioids

gradually based on the “cautious” order from the

anaesthetist and did not give second thought on pain

management through use of further opioids or other

multimodal analgesia. It was not until an expert nurse

noticed that the insufficient pain management as the

root cause of inhibited breathing efforts based on

her experience and the cues of assessment. Dihle,

Bjolseth and Helseth14 (2006) suggest that insufficient

knowledge of pain management, inadequate

assessment and evaluation of pain, and various

attitudes towards pain may contribute to the

suboptimal pain relief.

Knowledge plays an important role in effective clinical

decision-making for pain management. Inadequate

knowledge about pain management principles among

clinical nursing staff is a significant barrier to pain

management. Several studies show that there is a

relationship between educational intervention and

improved pain management8. As a result, a nursing

education program needs to emphasise crucial parts

of clinical decision-making applying on complex pain

management issues15.

On the other hand, personal attitudes and beliefs must

be left aside when assessing and managing patients’

pain. The nurse should be able to deliver evidence-

based pain management care with competency in order

to meet the patients’ need9. Good pain management

skills include regular pain assessment that is acted upon

with appropriate drug administration. PACU nurses

need to realise their own biases and prejudices to

avoid unconsciously misguiding toward own

practice16,17. Pain management is a two-way process.

Trusting the patient and finding the cues on

patient’s body or behaviour are the first steps in

building a therapeutic relationship to enable

effective pain management.

Page 16: NEWSLET TER VOLUME 18 ISSUE 3 - ACPAN · NEWSLET TER VOLUME 18 ISSUE 3 . ASPAAN NEWSLETTER VOLUME 18 ISSUE 3 2 Message from the Editor Welcome to this new edition of our newsletter

16

Ar ticles of interest

Furthermore, increased workload and lack of

experienced PACU staff could directly cause lack

of sufficient time on pain management. Evidence

shows that nurses have prioritised caring for the

physical issues of the patient higher than caring

for the pain management of a patient because

of the strained caring time8. In Ms. Jane’s case,

a less experienced graduate nurse had to care

for a complex pain management patient initially

without expert help in the climate of staff shortage.

Finally, inadequate pain management education

and training for clinical nursing staff can be another

key organisational-barrier on pain management8.

CASE VIGNETTE TWO

Mr. Lin (pseudonym), 32 years old immigrant from

China with limited English capacity, arrives in the PACU

after an open reduction and internal fixation (ORIF)

procedure on his left arm under general anaesthesia.

He is a regular community soccer player and his arm

was fractured during an intense game. He received

10mg Morphine, 5mg Oxynorm and 40mg Paracoxib

during the procedure. The surgeon also added 20ml

local anaesthetic to the site before the closure.

Identifying and recognising pain

management barriers in PACU

would facilitate clinical nursing

practice in effective

postoperative pain management,

tolerate certain pain without a painkiller. The PACU

nurse tells Mr. Lin that postoperative pain management

is an extremely important step towards a quick

recovery and minimising postoperative complications.

It is important to control the pain at its early stage.

After careful reassessment of the pain, 100 mcg

Fentanyl is then gradually given intravenously. Finally,

a relieved smile is appeared on Mr. Lin’s face and he

reports that his pain is much improved.

DISCUSSION FOR VIGNETTE TWO

In above case, the postoperative pain management

issue for Mr. Lin specifically reflects cer tain barriers

on effective communication, patient’s beliefs, values

and cultural attitude toward pain. Pain management

is greatly affected by cultural factors of pain at is

has psychological, social, spiritual and physical

dimensions16. Culture is the conditioning influence

in forming the individual’s patterns of responding

to and expressing pain18. Effective communication

between the nurse and patient for a comprehensive

pain assessment leads to successful pain management.

Language can be a major barrier to effective pain

assessment and management where English is not the

first language for those patients in English speaking

countries. Without competent interpretation available

for the patient who lacks of proficiency in English, it is

impossible to adequately assess pain and educate the

patient on the pain management16, 19.

Although a nurse may be equipped with good

knowledge of disease processes and pharmacological

methods for pain management, he/she may still lack

insight into the patient’s culture. This can be a barrier 18

further enhance nursing to pain intervention . The pain not only represents

education on advanced pain

In the PACU, Mr. Lin is quiet and alert without being

bothered by the busy evening environment. His oxygen

saturation is 98% on room air, but BP is up to 158/82

mmHg and pulse is 99. The PACU nurse suspects that

the patient may have pain but Mr. Lin seems to deny it

by slightly shaking his head with hesitation.

No hypertensive history was recorded and no

increasing BP medicine was ever used intra-operatively.

Upon applying sling and repositioning Mr. Lin’s arm

with a pillow, the PACU nurse notices that Mr. Lin frowns,

and his forehead has some sweat. In order to better

communicate with Mr. Lin, a clinical staff member who

speaks Mandarin is called in as a temporary interpreter.

The interpreter tells the PACU nurse that

Mr. Lin does have pain and it is getting worse now.

Initially, he tried not to bother nursing staff when

they were so busy as he thought he might be able to

a physiological response to a painful stimulus but

also includes behavioural and emotional elements as

determined by cultural values and beliefs20. Certain

cultural groups may feel ashamed to publically display

pain or only have behaviour cues such as grimacing

to express a pain because they believe that it would

be disrespectful to ask for pain relief19.

According to Carteret , patients’ culturally based

responses to pain are often divided into two categories:

stoic and emotive. Stoic patients seldom reveal their

pain and tend to “grin and bear it.” Patients from Asian

cultures like Mr. Lin may often express stoicism under

surgical pain such as keep low profile and reluctant

to speak out his pain, which directly relates to strong

cultural values about self-conduct21.

Pain is a bio-psycho-social experience and culture plays

an important part in determining how we interpret and

express pain. Providing culturally sensitive nursing care,

and identifying and addressing barriers to effective

Page 17: NEWSLET TER VOLUME 18 ISSUE 3 - ACPAN · NEWSLET TER VOLUME 18 ISSUE 3 . ASPAAN NEWSLETTER VOLUME 18 ISSUE 3 2 Message from the Editor Welcome to this new edition of our newsletter

17

Ar ticles of interest communication can avoid insufficiency

and inequality on the pain management19.

SIGNIFICANCE TO NURSING

Identifying and recognising pain management barriers

in PACU would facilitate clinical nursing practice in

effective postoperative pain management, further

enhance nursing education on advanced pain

management topics and promote future nursing pain

management research by exploring and overcoming

the barriers effectively.

IMPLICATIONS FOR FUTURE PRACTICE

Postoperative pain management continues to

be a challenging field and it should be a

clinical priority task for all healthcare

professionals. The pain response is not

restricted to a physiological reaction to noxious

stimuli or tissue injury, but also encompasses

emotional and behavioural responses as well.

Through above presented two cases study,

major postoperative pain management barriers in PACU

are identified and analysed. In order to achieve an

effective postoperative pain management, it is crucial

to recognise and remove the existing barriers that

directly impact on nursing practice. Nurses must not

only have advanced pain management education and

training, but also need to equip with high competency

assessment skills and high-level clinical decision-

making knowledge when facing complex postoperative

pain management scenarios. In addition, it is critical

to implement culturally sensitive pain management

to provide optimal care for the patient, and integrate

daily postoperative pain management into evidence-

based policies and guidelines, standards of practice,

continuing education and quality improvement programs.

ACKNOWLEDGEMENT

A special thank to A/Prof. Karen-Leigh Edward and

Researcher fellow Ms. Cally Mills for their expertise

guidance, diligent reviews and valuable suggestions

on the paper. Thanks Ms. Annette Silinzieds from

Education Department who offered valuable nursing

research workshop.

REFERENCES

1. Briggs, E. (2010). Understanding the experience

and physiology of pain. Nursing Standard Vol. 25,

No. 3, pp.35-39.

2. International Association for the Study of

Pain (IASP). (2011). IASP pain terminology.

http://www. iasp-

pain.org/AM/Template.cfm?Section=Pain_

Definitions&Template=/CM/HTMLDisplay.

cfm&ContentID=1728#Pain

3. Mackintosh, C. (2007). Assessment and management of patients with post-operative pain. Nursing Standard

Vol. 22, No. 5, pp. 49

4. Drain, C. B. and Odom-Forren, J. (2009).

Perianesthesia nursing: A critical care approach

(5th ed.). St Louis: Saunders Elsevier.

5. Polomano, R.C., Dunwoody, C.J., Krenzischek,

D.A., and Rathmell, J.P. (2008). Perspective on pain

management in the 21st centur y. Pain

Management Nursing: Official Journal of the

American Society of Pain Management Nurses Vol.

9, Suppl. 1, S4–S14.

6. International Association for the Study of Pain

(IASPa). (2011). Global year against acute pain.

http:// www.iasp-

pain.org/Content/NavigationMenu/

GlobalYearAgainstPain/GlobalYearAgainstAcute

Pain/ default.htm

7. Kable, A., Gibberd, R. and Spigelman, A. (2004).

Complications after discharge for surgical patients.

ANZ J Surg Vol. 74, pp. 92-97.

8. Duignan, M., and Dunn, V. (2009). Perceived

barriers to pain management. Emergency Nurse

Vol. 16, No. 9, pp.31-35.

9. Bell, L., and Duffy, A. (2009). Pain assessment

and management in surgical nursing: A

literature review. British Journal of Nursing Vol.

18, No. 3, pp. 153-156.

10. Sweeney, B., and Grayling, M. (2009).

Smoking and anaesthesia: The

pharmacological implications. Anaesthesia

Vol. 64, No. 2, pp. 179-186.

11. Middleton, C. (2004). Barriers to the provision

of effective pain management. Nursing Times

Vol. 100, No. 3, pp. 42-45.

12. Warner, D. O. (2007), Tobacco control for

anesthesiologists. Journal of Anaesthesia

Vol.21, pp.200-211. Doi: 10.1007/s00540-006-

0483-9.

13. Tønnesen, H., Nielsen, P.R., Lauritzen, J. B., and

Møller, A.M. (2009). Smoking and alcohol

intervention before surgery: Evidence for best

practice Vol. 102, No. 3, pp.297-306.

Doi:10.1093/bja/aen401.

14. Dihle, A., Bjølseth, G., and Helseth, S. (2006). The

gap between saying and doing in postoperative

pain management. Journal of Clinical Nursing Vol.

15, No. 4, pp. 469-479. Doi:10.1111/j.1365-

2702.2006.01272.x

15. Rejeh, N., Ahmadi, F., Mohammadi, E.,

Kazemnejad, A., & Anoosheh, M. (2009).

Nurses’ experiences and perceptions of

influencing barriers to postoperative pain

management. Scandinavian Journal of Caring

Sciences Vol. 23, No. 2, pp. 274-281. Doi: 10.1111/j.1471-6712.2008.00619.x

Page 18: NEWSLET TER VOLUME 18 ISSUE 3 - ACPAN · NEWSLET TER VOLUME 18 ISSUE 3 . ASPAAN NEWSLETTER VOLUME 18 ISSUE 3 2 Message from the Editor Welcome to this new edition of our newsletter

18

Ar ticles of interest

16. Narayan, M. (2010). Culture’s effects on pain

assessment and management: cultural patterns

influence nurses’ and their patients’ responses to

pain. American Journal of Nursing Vol. 110, No. 4,

pp. 38-49.

doi:10.1097/01.NAJ.0000370157.33223.6d

17. Samaraee, A, A., Rhind, G., Saleh, U. and

Bhattacharya, V. (2010). Factors contributing to poor

post-operative abdominal pain management in adult

patients: a review. The Surgeon Vol. 8, pp. 1 5 1 – 1

5 8.

18. Spencer, C., and Burke, P. (2011). The impact of

culture on pain management. Med-Surg Matters

Vol. 20, No. 4, pp. 1.

19. Briggs, E. (2008). Cultural perspectives on pain

management. Journal of Perioperative Practice Vol.

18, No. 11, pp. 466-471.

20. Lovering, S. (2006). Cultural Attitudes and Beliefs

About Pain. J Transcult Nurs Vol. 17, pp. 389. Doi:

10.1177/1043659606291546

21. Carteret, M. (2011). Culture aspects of pain

management. http://www.dimensionsofculture.

com/2010/11/cultural-aspects-of-pain-

management.

Page 19: NEWSLET TER VOLUME 18 ISSUE 3 - ACPAN · NEWSLET TER VOLUME 18 ISSUE 3 . ASPAAN NEWSLETTER VOLUME 18 ISSUE 3 2 Message from the Editor Welcome to this new edition of our newsletter

VISIT US AT W W W.ASPA AN.ORG.AU