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Outcomes of a nurse-initiated intravenous analgesic protocol for abdominal pain in an emergency department: a quasi-experimental study
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
2011 (English)In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 48, no 1, 13-23 p.Article in journal (Refereed) Published
Abstract [en]

Background: Abdominal pain is one of the most frequent reasons for seeking care in an emergency department. Surveys have shown that patients are not satisfied with the pain management they receive. Reasons for giving inadequate pain management may include poor knowledge about pain assessment, myths concerning pain, lack of communication between the patient and healthcare professional, and organizational limitations.

Objectives: The aim of the study was to investigate the outcome of nursing assessment, pain assessment and nurse-initiated intravenous opioid analgesic compared to standard procedure for patients seeking emergency care for abdominal pain. Outcome measures were: a) pain intensity, b) frequency of received analgesic, c) time to analgesic, d) transit time, and e) patients’ perceptions of the quality of care in pain management.

Design: A quasi-experimental design with ABA phases was used.

Setting: The study was conducted in an emergency department at a Swedish university hospital.

Participants: Patients with abdominal pain seeking care in the emergency department were invited to participate. A total of 50, 100 and 50 patients, respectively, were included for the three phases of the study. The inclusion criteria were: ongoing abdominal pain not lasting for more than 2 days, ≥18 years of age and oriented to person, place and time. Exclusion criteria were: abdominal pain due to trauma, in need of immediate care and pain intensity scored as 9-10.

Methods: The patients’ perceptions of the quality of care in pain management in the emergency department were evaluated by means of a patient questionnaire carried out in the three study phases. The intervention phase included education, nursing assessment protocol and a range order for analgesic.

Results: The nursing assessment and the nurse-initiated intravenous opioid analgesic resulted in significant improvement in frequency of receiving analgesic and a reduction in time to analgesic. Patients perceived lower pain intensity and improved quality of care in pain management.

Conclusions: The intervention improved the pain management in the emergency department. A structured nursing assessment could also affect the patients’ perceptions of the quality of care in pain management in the emergency department.

Place, publisher, year, edition, pages
2011. Vol. 48, no 1, 13-23 p.
Keyword [en]
Abdominal pain, analgesic, emergency department, nursing assessment, intervention study, range order
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Caring Sciences in Medical Sciences
Identifiers
URN: urn:nbn:se:uu:diva-110254DOI: 10.1016/j.ijnurstu.2010.06.003ISI: 000286703400003PubMedID: 20598691OAI: oai:DiVA.org:uu-110254DiVA: diva2:275584
Available from: 2009-11-06 Created: 2009-11-06 Last updated: 2017-12-12Bibliographically approved
In thesis
1. Identifying and Improving Quality of Care at an Emergency Department: Patient and healthcare professional perspectives
Open this publication in new window or tab >>Identifying and Improving Quality of Care at an Emergency Department: Patient and healthcare professional perspectives
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Patients in the emergency department are not always satisfied with the care received and the nursing care in the emergency department is sometimes described as instrumental and non-holistic. Structured quality improvement work and evidence-based practice are needed. Aim: The overall aim was to emphasize general patients in the emergency department to enhance the knowledge on how they perceive the quality of care and how the care could be improved through collaboration with the healthcare professionals. Methods: Four studies, with quantitative and qualitative designs, were conducted in a Swedish emergency department. Two hundred patients answered a questionnaire, after which 22 healthcare professionals comprising five focus groups were interviewed, and finally 200 patients were included in an intervention study. Results: The following five areas for improvement were identified: “information, respect and empathy”, “pain relief”, “nutrition”, “waiting time” and “general atmosphere”. Of these areas, the healthcare professionals prioritized “information, respect and empathy”, “waiting time” and “pain relief” to be highlighted in the quality improvement work. Although goals and suggestions for changes were stated, barriers to quality improvement at different levels in the health care were detected. The results of the intervention study showed that structured nursing assessment of the patients’ abdominal status and nurse-initiated intravenous opioid analgesic could increase frequency of analgesic and reduce time to analgesic in the emergency department. Patients perceived lower pain intensity and improved quality of care in pain management. Conclusions: An uncomplicated nursing intervention, related to pain management, based on the results from a patient questionnaire and interviews with healthcare professionals, can improve the care process and pain management in the emergency department, as well as patients’ perceptions of the quality of care in pain management. To succeed with continuous quality improvement work, barriers to change should be addressed.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2009. 76 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 499
Keyword
nursing, emergency department, quality improvement, evidence-based care, patient perspectives, healthcare professional perspectives, pain management, intervention, implementation
National Category
Nursing
Research subject
Caring Sciences in Medical Sciences
Identifiers
urn:nbn:se:uu:diva-110260 (URN)978-91-554-7657-1 (ISBN)
Public defence
2009-12-18, Grönwallsalen, Akademiska sjukhuset, Ing 70, Akademiska sjukhuset, Uppsala, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2009-11-27 Created: 2009-11-06 Last updated: 2010-11-09Bibliographically approved

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Muntlin, ÅsaCarlsson, MarianneSäfwenberg, UrbanGunningberg, Lena

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