| Postoperative pain relief is one of the most important concerns for patients undergoing cardiac surgery and is one of the most clinically challenging problems for nurses. It is widely recognized that postoperative pain can negatively impact cardiac surgery outcomes, yet recent surveys report only modest success in pain management as patients continue to describe poorly controlled pain and studies report pain as underestimated, undermedicated, and underrelieved. Research in basic and clinical science has advanced the knowledge of pain management following cardiac surgery. However, the emergence of fast-track cardiac surgery programs, which includes tracheal extubation within 6 hours of surgery, early ambulation, a shortened intensive care length of stay and hospital discharge within 3 to 5 days presents a challenge to conventional methods of pain management.;The problem of pain management after cardiac surgery was examined from three perspectives (1) the relationships of patients' preoperative health-related quality of life, pain management, and postoperative outcomes, (2) nurses' clinical decision-making Pain Management after Cardiac Surgery regarding pain management during weaning from mechanical ventilation, and (3) the evaluation of a new pain management modality. The studies presented in this dissertation used a variety of theoretical models and research methodologies to allow for synthesis and a broader contribution to nursing science. Each study is presented as an individual manuscript to be prepared and submitted for publication. Collectively, the manuscripts represent a cohesive body of research, with each topic informing the other.;This body of research extends the understanding of the relationships of patients' perceptions of health-related quality of life and postoperative pain management and early recovery clinical outcomes. It also illuminates nurses' clinical decision-making processes in a unique clinical setting that require nurses to effectively manage pain while simultaneously facilitating early extubation in fast track programs. Finally the evaluation of a new pain management modality, the use of a continuous local anesthetic infusion at the sternotomy did not reduce patients' postoperative pain intensity or improve other clinical outcomes. |
