In outpatient surgery, a patient’s pain is treated immediately after surgery, and patients are sent home. However, the pain control after discharge may be more important than the initial treatment at the bedside, says Elaine A. Yellen, RN, PhD, assistant professor at Texas A&M University - Corpus Christi.
"We need to do a lot of discharge education for them about how to control pain at home," she says. "They may have a lot more trouble once they are at home by themselves."
Yellen recently published research from an ambulatory surgical unit that indicated communication is one of several nurse-sensitive variables that influence pain satisfaction.1
"We often get in such a rush to go out the door, but they have to be encouraged to ask questions," she says. "We need to be making sure they don’t have any more concerns or questions. Try to ask if there is anything else we can get for them."
Waiting time also is an issue for outpatient surgery patients, Yellen says. "Sometimes it’s difficult to decrease the waiting time, but at least tell them why they’re waiting and how long they might expect to wait," she advises.
Yellen’s study was conducted at a 300-bed urban hospital in south Texas. A sample of 132 participants was drawn during a six-week period. After surgery, one group completed a patient satisfaction instrument,2 while others completed an ambulatory surgery survey from Press Ganey Associates in South Bend, IN.
Yellen’s research indicated that pain control is a key nurse-sensitive variable affecting patient satisfaction. She also determined these variables apply:
• Age.
Nurses need to have a heightened sensitivity to pain, Yellen suggests. Older people may not complain as much about pain as younger persons, she explains. "Sometimes, we have to make suggestions for them, to assist them in how they should be treating their pain," Yellen says. "They might not know." Additionally, clinicians don’t know how pain medications will affect older patients, she says. "Sometimes, they are more sensitive; and sometimes, they are less sensitive," Yellen says. Most drug research has been performed on young or middle-age people, she points out.
• Gender.
Yellen’s research indicates that men weren’t as satisfied with their pain control as women. "I don’t want to generalize, but often nurses are women, and we’re asking men about pain," she points out. "We have to be sensitive that there’s a gender issue." For example, accept men’s expressions of pain, and be aware of any biases you might have, adds Yellen. "We have to make sure we’re not stereotyping and possibly projecting our own impressions of how they should act."
• Culture.
The Corpus Christi area has a 50% Hispanic population, Yellen says. Her research indicated that the Hispanic patients were not as satisfied with their care as Caucasian patients, she says. "Even our hospitals systems are not culturally sensitive," Yellen maintains.
The language barrier may be one factor, she says. "We need to invite them to express their pain to us, whether we need an interpreter or sometimes a family member to help us."
Even with an interpreter, however, it can be difficult for that person to interpret pain as well as the language, she points out. "We need to remain open to expressions of pain, and try to be sensitive to how other cultures express themselves, too," Yellen adds.
For example, some members of the Hispanic culture are deeply religious and, as part of their belief system, may think they should be stoic about suffering, she says. "While suffering might be part of their religious thinking, I think they should also be relieved of their pain."
References
1. Yellen E. The influence of nurse-sensitive variables. AORN J 2003; 78:783-793.
2. Risser NL. Development of an instrument to measure patient satisfaction with nurses and nursing care in primary care settings. Nurs Res 1975; 24:45-52.
