Relationship Between Quality of Care and Patient Care Outcomes for Postoperative Pain in Major Orthopedic Surgery: Analytical and Cross-Sectional Study

Abstract

The quality of care provided for the management of postoperative pain and patient outcomes are key criteria for healthcare institutions. This study aimed to determine the relationship between the quality of care provided for the alleviation of postoperative pain experienced among patients undergoing major orthopedic surgery and the patient care outcomes. The study was designed as an analytical and cross-sectional study. The rates of pain severity and sleep interference, activity interference, affective experiences, and adverse effects due to postoperative pain were higher in female patients than in male patients. A significant positive correlation was identified between the quality of postoperative pain care and the perception of care (p < .05). Implementing nursing interventions to improve pain management and increase the quality of care appears to be vital elements for reducing adverse effects caused by pain and increasing the satisfaction with postoperative pain care.

Keywords

nursing pain management care quality major orthopedic surgery

Get full access to this article

View all access options for this article.

References

Al-Shaer

Hill

P. D.

Anderson

M. A.

(2011). Nurses’ knowledge and attitudes regarding pain assessment and intervention. Medsurg Nursing: Official Journal of the Academy of Medical-Surgical Nurses, 20(1), 7–11.

Ayhan

Kursun

(2017). Experience of pain in patients undergoing abdominal surgery and nursing approaches to pain control. International Journal of Caring Sciences, 10(3), 1456.

Ballantyne

J. C.

Sullivan

M. D.

(2015). Intensity of chronic pain: The wrong metric? New England Journal of Medicine, 373(22), 2098–2099. https://doi.org/10.1056/NEJMp1507136

Barksdale

Backer

(2005). Health-related stressors experienced by patients who underwent total knee replacement seven days after being discharged home. Orthopaedic Nursing, 24(5), 336–342.

Bell

Duffy

(2009). Pain assessment and management in surgical nursing: A literature review. British Journal of Nursing, 18(3), 153–156. https://doi.org/10.12968/bjon.2009.18.3.39042

Booysen

Burger

J. R.

du Plessis

J. M.

Cockeran

(2020). Assessment of post-operative pain medication adherence after day case orthopaedic surgery: A prospective, cross-sectional study. International Journal of Orthopaedic and Trauma Nursing, 36, 100718. https://doi.org/10.1016/j.ijotn.2019.100718

Chassin

M. R.

Galvin

R. W.

(1998). The urgent need to improve health care quality. Institute of Medicine National Roundtable on Health Care Quality. The Journal of the American Medical Association, 280(11), 1000–1005. https://doi.org/10.1001/jama.280.11.1000

Darawad

M. W.

Al-Hussami

Saleh

A. M.

Al-Sutari

(2014). Jordanian patients’ satisfaction with pain management. Pain Management Nursing, 15(1), 116–125. https://doi.org/10.1016/j.pmn.2012.07.005

Donauer

Bomberg

Wagenpfeil

Volk

Meissner

Wolf

(2018). Regional vs. general anesthesia for total knee and hip replacement: An analysis of postoperative pain perception from the international PAIN OUT registry. Pain Practice, 18(8), 1036–1047. https://doi.org/10.1111/papr.12708

10.

Elsous

Mohsen

Mokayad

Ouda

Al-Sheikh

(2018). Post-operative pain after caesarean delivery: Initial assessment for quality improvement. International Journal of Caring Sciences, 11(1), 136–144.

11.

Fang

Liang

Hong

Sugiyama

Nozaki

Kobayashi

Sameshima

Namba

Asakawa

(2017). Psychometric evaluation of the Chinese version of the revised American Pain Society Patient Outcome Questionnaire concerning pain management in Chinese orthopedic patients. PLoS One, 12(5), e0178268. https://doi.org/10.1371/journal.pone.0178268

12.

Gaffney

C. J.

Pelt

C. E.

Gililland

J. M.

Peters

C. L.

(2017). Perioperative pain management in hip and knee arthroplasty. Orthopedic Clinics of North America, 48(4), 407–419. https://doi.org/10.1016/j.ocl.2017.05.001

13.

Gan

T. J.

Habib

A. S.

Miller

T. E.

White

Apfelbaum

J. L.

(2014). Incidence, patient satisfaction, and perceptions of post-surgical pain: Results from a US national survey. Current Medical Research and Opinion, 30(1), 149–160. https://doi.org/10.1185/03007995.2013.860019

14.

Gordon

D. B.

Polomano

R. C.

Pellino

T. A.

Turk

D. C.

McCracken

L. M.

Sherwood

Paice

J. A.

Wallace

M. S.

Strassels

S. A.

Farrar

J. T.

(2010). Revised American Pain Society Patient Outcome Questionnaire (APS-POQ-R) for quality improvement of pain management in hospitalized adults: Preliminary psychometric evaluation. The Journal of Pain, 11(11), 1172–1186. https://doi.org/10.1016/j.jpain.2010.02.012

15.

Hall-Lord

M. L.

Larsson

B. W.

(2006). Registered nurses’ and student nurses’ assessment of pain and distress related to specific patient and nurse characteristics. Nurse Education Today, 26(5), 377–387. https://doi.org/10.1016/j.nedt.2005.11.007

16.

Herranz-Rubia

(2007). The role of neonatal nursing in palliative care of the newborn. Enfermeria Clinica, 17(2), 96–100.

17.

Idvall

Hamrin

Sjöström

Unosson

(2002). Patient and nurse assessment of quality of care in postoperative pain management. Quality & Safety in Health Care, 11(4), 327–334. https://doi.org/10.1136/qhc.11.4.327

18.

Keskin

Sucu Dag

Gordon

D. B.

(2019). Reliability and validity of the Turkish version of the revised American Pain Society Patient Outcome Questionnaire in postoperative patients. Cyprus Journal of Medical Sciences, 4(3), 157–163. https://doi.org/10.5152/cjms.2019.1023

19.

Köse Tamer

Sucu Dağ

(2020). The assessment of pain and the quality of postoperative pain management in surgical patients. Sage Open, 10(2), 1–10. https://doi.org/10.1177/2158244020924377

20.

Magidy

Warrén-Stomberg

Bjerså

(2016). Assessment of post-operative pain management among acutely and electively admitted patients: a Swedish ward perspective. Journal of Evaluation in Clinical Practice, 22(2), 283–289.

21.

Mahama

Ninnoni

J. P. K.

(2019). Assessment and management of postoperative pain among nurses at a resource-constraint teaching hospital in Ghana. Nursing Research and Practice, 2019, 1–7. https://doi.org/10.1155/2019/9091467

22.

Mandell

M. S.

Smith

A. R.

Dew

M. A.

Gordon

D. B.

Holtzman

Howell

DiMartini

A. F.

Butt

Simpson

M. A.

Ladner

D. P.

Freise

C. E.

McCluskey

S. A.

Fisher

R. A.

Guarrera

J. V.

Olthoff

K. M.

Pomfret

E. A.

(2016). Early postoperative pain and its predictors in the adult to adult living donor liver transplantation cohort study (A2ALL). Transplantation, 100(11), 2362–2371.

23.

Martin

E. M.

Barkley

T. W.

Jr. (2016). Improving cultural competence in end-of-life pain management. Nursing, 46(1), 32–41; quiz 41. https://doi.org/10.1097/01.NURSE.0000475480.75266.9a

24.

Meissner

Huygen

Neugebauer

E. A. M.

Osterbrink

Benhamou

Betteridge

Coluzzi

De Andres

Fawcett

Fletcher

Kalso

Kehlet

Morlion

Montes Pérez

Pergolizzi

Schäfer

(2018). Management of acute pain in the postoperative setting: The importance of quality indicators. Current Medical Research and Opinion, 34(1), 187–196. https://doi.org/10.1080/03007995.2017.1391081

25.

Milutinović

Milovanović

Pjević

Martinov-Cvejin

Cigić

(2009). Assessment of quality of care in acute postoperative pain management. Vojnosanitetski Pregled, 66(2), 156–162.

26.

Moucha

C. S.

Weiser

M. C.

Levin

E. J.

(2016). Current strategies in anesthesia and analgesia for total knee arthroplasty. Journal of the American Academy of Orthopaedic Surgeons, 24(2), 60–73. https://doi.org/10.5435/JAAOS-D-14-00259

27.

Nandi

Schreiber

K. L.

Martel

M. O.

Cornelius

Campbell

C. M.

Haythornthwaite

J. A.

Smith

M. T.

Jr. Wright

Aglio

L. S.

Strichartz

Edwards

R. R.

(2019). Sex differences in negative affect and postoperative pain in patients undergoing total knee arthroplasty. Biology of Sex Differences, 10(1), 23. https://doi.org/10.1186/s13293-019-0237-7

28.

Niemi-Murola

Pöyhiä

Onkinen

Rhen

Mäkelä

Niemi

T. T.

(2007). Patient satisfaction with postoperative pain management: Effect of preoperative factors. Pain Management Nursing, 8(3), 122–129. https://doi.org/10.1016/j.pmn.2007.05.003

29.

Nightingale

(1992). Notes on nursing: What it is, and what it is not. Lippincott Williams & Wilkins.

30.

Öğüt

Sucu Dağ

(2019). Pain characteristics and pain interference among patients undergoing open cardiac surgery. Journal of PeriAnesthesia Nursing, 34(4), 757–766. https://doi.org/10.1016/j.jopan.2018.10.009

31.

Petersen

K. K.

Arendt-Nielsen

L. J. P.

(2016). Chronic postoperative pain after joint replacement. Pain, 24(3), 1–6.

32.

Phillips

Gift

Gelot

Duong

Tapp

(2013). Assessing the relationship between the level of pain control and patient satisfaction. Journal of Pain Research, 6, 683–689. https://doi.org/10.2147/JPR.S42262

33.

Piotrkowska

Jarzynkowski

Mędrzycka-Dąbrowska

Terech-Skóra

Kobylarz

Książek

(2020). Assessment of the quality of nursing care of postoperative pain in patients undergoing vascular procedures. Journal of PeriAnesthesia Nursing, 35(5), 484–490. https://doi.org/10.1016/j.jopan.2020.03.010

34.

Pizzo

Clark

Carter-Pokras

Christopher

Farrar

J. T.

Follett

K. A.

(2011). Relieving pain in America: A blueprint for transforming prevention, care, education, and research. IOM.

35.

Rothaug

Zaslansky

Schwenkglenks

Komann

Allvin

Backström

Brill

Buchholz

Engel

Fletcher

Fodor

Funk

Gerbershagen

H. J.

Gordon

D. B.

Konrad

Kopf

Leykin

Pogatzki-Zahn

Puig

M., . . .

Meissner

(2013). Patients’ perception of postoperative pain management: Validation of the International Pain Outcomes (IPO) Questionnaire. The Journal of Pain, 14(11), 1361–1370. https://doi.org/10.1016/j.jpain.2013.05.016

36.

Schwenkglenks

Gerbershagen

H. J.

Taylor

R. S.

Pogatzki-Zahn

Komann

Rothaug

Volk

Yahiaoui-Doktor

Zaslansky

Brill

Ullrich

Gordon

D. B.

Meissner

(2014). Correlates of satisfaction with pain treatment in the acute postoperative period: Results from the international PAIN OUT registry. Pain, 155(7), 1401–1411. https://doi.org/10.1016/j.pain.2014.04.021

37.

Sjøveian

A. K. H.

Leegaard

(2017). Hip and knee arthroplasty: Patient’s experiences of pain and rehabilitation after discharge from hospital. International Journal of Orthopaedic and Trauma Nursing, 27, 28–35. https://doi.org/10.1016/j.ijotn.2017.07.001

38.

Wang

D.-X.

(2018). Improve postoperative sleep: What can we do? Current Opinion in Anaesthesiology, 31(1), 83–88.

39.

Tabachnick

B. G.

Fidell

L. S.

(2013). Using multivariate statistics (6th ed.). Pearson.

40.

Tocher

Rodgers

Smith

M. A.

Watt

Dickson

(2012). Pain management and satisfaction in postsurgical patients. Journal of Clinical Nursing, 21(23–24), 3361–3371. https://doi.org/10.1111/j.1365-2702.2012.04253.x

41.

Vatansever

N. A.

Akansel

(2014). Validation study of the strategic and clinical quality indicators in postoperative pain management questionnaire in Turkish surgery patients. Pain Management Nursing, 15(4), 871–880. https://doi.org/10.1016/j.pmn.2014.01.003

42.

Vilīte

Strīķe

Rutka

Leibuss

(2019). Pain management in intensive care unit patients after cardiac surgery with sternotomy approach. Acta Medica Lituanica, 26(1), 51–63. https://doi.org/10.6001/actamedica.v26i1.3956

43.

Wang

Sherwood

Gong

Liu

(2013). Psychometric evaluation of the revised American Pain Society Patient Outcome Questionnaire (APS-POQ-R) in postoperative patients. Laboratory and Clinical Investigation, 20(4), 285–290.

44.

Wang

Sherwood

G. D.

Gong

Ren

Liu

(2017). Reliability and validity of the Chinese version of the revised American Pain Society Patient Outcome Questionnaire in postoperative patients. Pain Management Nursing, 18(2), 110–120. https://doi.org/10.1016/j.pmn.2017.01.002

45.

Zarzycka

Bartoń

Mazur

Turowski

(2019). Socio-demographic and medical factors associated with patients’ satisfaction with nursing care and their perception of pain. Annals of Agricultural and Environmental Medicine, 26(2), 298–303. https://doi.org/10.26444/aaem/90385

46.

Zaslansky

Rothaug

Chapman

C. R.

Bäckström

Brill

Fletcher

Fodor

Gordon

D. B.

Komann

Konrad

Leykin

Pogatski-Zahn

Puig

M. M.

Rawal

Ullrich

Volk

Meissner

(2015). PAIN OUT: The making of an international acute pain registry. European Journal of Pain, 19(4), 490–502. https://doi.org/10.1002/ejp.571

47.

Zheng

Schnabel

Yahiaoui-Doktor

Meissner

Van Aken

Zahn

Pogatzki-Zahn

(2017). Age and preoperative pain are major confounders for sex differences in postoperative pain outcome: A prospective database analysis. PLoS One, 12(6), e0178659. https://doi.org/10.1371/journal.pone.0178659

48.

Zhu

N. N.

P. P.

Lei

T. T.

Sun

Chan

S. W.

(2017). Postoperative pain self-management behavior in patients who underwent total knee or hip arthroplasty. AORN Journal, 105(4), 355–364. https://doi.org/10.1016/j.aorn.2017.02.001