Action Study On The Nursing Management Protocol Of Patient Controlled Intravenous Analgesia In Postoperative Patients With Major Abdominal Surgery

ObjectiveThe specific aims of this study were to review and analyze management status quo ofpatient-controlled intravenous analgesia(PCIA) in postoperative patients with majorabdominal surgery; to explore the experiences of medical staffs and patients whoparticipated and perceived PCIA; to explore effective nursing protocol of PCIA forpostoperative abdominal pain management; to establish evaluation index system of nursingquality of postoperative PCIA and to discuss the effects of the protocol.MethodsWithin the frame of action study, the study was divided into five stages. In the firststage, problems such as inadequate pain control due to lack of clear division and qualityevaluation were identified. In the second stage, literature review and clinical investigationwere conducted to analyze current status of PCIA management and to figure outinfluencing factors and possible solutions. Based on previous results, the managementprotocol of PCA was put forward by experts consultation in the third stage which proposedthe nurses supervised by the anesthesiologist as the principal participants of PCIAmanagement. In the fourth stage, the practical plan was formulated according to themanagement protocol. The plan was then implemented in a3A hospital. After study groupcollected problems by observation and interview, gathered advice from participants andcombined it with researcher’s reflection, normalized propulsion of PCIA care managementprotocol and management text were formulated by two rounds of summaries. Meanwhile,the evaluation index system of nursing quality of PCIA was established by Delphi method.In the fifth stage, according to the results of qualitative interview with patients undergoingPCIA therapy intervened by this management protocol and the analysis on PCIA nursingquality using evaluation index system, effects of the management protocol on nursingquality were discussed.Results1. PCIA is widely used for postoperative patients with major abdominal surgery.However, patients aren’t really satisfied with the effect and quality of PCIA. Relevantinfluencing factors include lack of pain management team and protocol, inconsistentunderstanding on pain between nurses and patients, inadequate knowledge and skills of medical staffs for PCIA, and lack of enough attention to patients’ ability of self-care forPCIA, etc.2. Through exploring the experiences of medical staffs and patients perceiving inPCIA, methods to solve the problem of PCIA management were defined, including toenhance perioperative pain management training of medical staffs for post-operativeanalgesia, to implement PCIA health education to improve patients’ ability of self-care,and to establish post-operative analgesia service team proposing nurses as the principalparticipants, who are supervised by anesthesiologists.3. According to knowledge-attitude-belief-practice (KABP) model and Orem’sself-care theory, the management protocol which proposed nurses as the principalparticipants was constructed and revised by experts consultation. After two rounds ofaction, the PCIA managing team was constructed, supervised by anesthesiologists,participated by surgeons, interacted by nurse anesthetists and nurses in the ward. The PCIAcare management protocols for nurse anesthetists and nurses in the ward were establishedrespectively.4. Series of management text of PCIA care management were developed, includingillustrating card for PCIA health education, PCIA care record chart, and practicalpocketbook of Nurse manual for post-operative PCIA care management.5. The PCIA nursing quality evaluation system was established after three rounds ofexperts consultation by Delphi method. The system was composed by essential quality,process quality as well as endpoint quality, which includes three grades with3items of thefirst grade,13items of the second grade,38items of the third grade. Meanwhile, theweights of various index were also set.6. The action team intervened in114patients’ PCIA care management. It showed thatpatients’ needs for PCIA health education were met, patients’ ability of self-care for PCIAwas improved, patients were more active to complain pain (CHR≥4)(P<0.05),unnecessarily withdrawal of PCA pump was reduced (P<0.05), satisfactions for analgesiacare and side-effect treatment of PCIA were improved (P<0.05), surgeons’ accreditationfor pain nursing was also improved, understanding and collaboration between nurseanesthetists and nurses in the ward in PCIA management were enlightened. Conclusions1. As comprehensive health care providers, nurses are principal pain controlparticipants. Quality of PCIA affects patients’ postoperative recovery and the quality oflife directly.2. The PCIA managing team under supervision of anesthesiologists, participated byward physicians, with nurse anesthetists and nurses in the ward being proposed as principalpartners, was a feasible approach to change current status of inadequate analgesia andunsatisfied service.3. The PCIA nursing quality evaluation index system provides a scientific tools toevaluate the quality of PCIA. It can also improve the system of PCIA, rationalize themanagement process and standardize nurses’ PCIA care.4. Card for PCIA health education, PCIA care record chart and nurse manual forpost-operative PCIA care management are the practical management text for PCIA caremanagement.5. This action study on PCIA nursing management would provide guidance forstandardizing the perioperative pain management and promote the popularization of APSin China.