Pain and anxiety management in the postoperative gastro-surgical setting

BACKGROUND: Despite increasing knowledge and technological advances, patients continue to experience pain and anxiety in the postoperative setting. AIM OF THE STUDY: The aim of this study was to examine how nurses managed patients' pain and anxiety within the gastro-surgical hospital setting. METHODS: An observational design was selected to examine nurses' management of postoperative patients' pain and anxiety. Six nurses who were involved in direct patient care in one of two gastro-surgical wards in a public teaching hospital in Melbourne, Australia, were randomly selected to participate. The observation period comprised a fixed 2-hour segment, and each nurse was observed on three different occasions. FINDINGS: Patient assessment was a major concern for participants, which was influenced by the modes of assessment used, patients' medical condition and operation procedure, and their self-reports of pain or anxiety. Communication with health care professionals and policy and protocol concerns also affected nurses' pain and anxiety management decisions. Formal communication through the multidisciplinary ward round tended to be somewhat fragmented, as the medical consultant did not seek out the bedside nurse. Nurses had good knowledge of unit policies and protocols and, while attempting to enforce them, spent considerable time encouraging medical colleagues to abide by these guidelines. Finally, nurses made complex clinical judgements which extended beyond the administration of analgesics or antianxiety drugs. STUDY LIMITATIONS: It is possible that nurses demonstrated a raised awareness of how they managed patients' pain and anxiety during observation periods. CONCLUSIONS: The study confirmed the importance of examining the complexities of the clinical context in determining how nurses manage pain and anxiety in the postoperative setting.