Transforming Practice With Scripted Messages: Improving Pain Management in Outpatient Surgical Patients
Lanell M. Bellury, PhD, RN, AOCNS, OCN
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Purpose: Outpatient surgeries are increasingly common because of patient convenience, lower cost, and reduced stress but most patients experience pain postoperatively requiring nursing attention to pain management (Mitchell, 2015; Subramanian et al., 2014). Scripting, recommended for consistent, targeted communication with patients, has limited evidence to support its use (Alaouf et al., 2015; Monterroso et al., 2013). The purpose of this study was to explore the effect of providing scripted messages related to pain management in the outpatient surgical setting on self-reported pain control and patient satisfaction in outpatient surgical patients. Additionally, the feasibility of practice change research in clinical settings was examined. The findings may assist others interested in the conduct of clinical research and adds to the body of knowledge around the effectiveness of scripted messages delivered by nurses.
Methods: A retrospective record review pre and post a practice change intervention evaluated implementation of a pain management scripted message delivered at two time points (preoperatively and postoperatively). Intention to treat analysis was used to compare patient reports of pain control and patient satisfaction with care 48 hours post-discharge from outpatient surgical procedures. Feasibility of data collection and measurement issues were also explored.
Results: 231 records (98 pre-intervention; 133 post-intervention) were analyzed. The sample included 144 (62%) male and 156 (68%) married with mean age 57.6 (SD=16.1) years. The large majority (90%) received general anesthesia and the most common surgical procedures were urologic (24%), colorectal (17%), and laparoscopy (13%). A Mann-Whitney U test indicated patient reported pain control was statistically significantly greater for the post intervention group (Mean rank=62.66) than for the pre-intervention group (Mean Rank = 51.95), U=1258, p=0.015. A large number of missing data related to the standard of care post-op phone calls (54% missing) and receipt of the intervention (47% receiving the script at time two).
Conclusion: While it is encouraging that even the small dose of scripting had a significant effect on postoperative pain control, the feasibility issues related to data collection and intervention fidelity will require considerable resources to surmount. Practice change is a complex process requiring sensitivity to work and patient flow especially in specialty care units. Overcoming resistance to change when evidence is not robust is challenging and may be especially difficult related to scripting, which is often perceived as a mandated intrusion into the nurse-patient relationship.
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