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Barriers to and Faciliators for Post Op Pain Management

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Unrelieved post-operative pain is one of the leading clinical challenges in the health care field. Despite vast research and numerous analgesic approaches in the management of pain, members of the health care profession continue to struggle in controlling or minimizing it in post-operative patients. Statistics indicate that about 43 million patients in the United States experience acute postoperative pain, with pain intensities of moderate to severe reported by 80% of these patients (Apfelbaum, J. et al, 2003).

Nursing research describes post-operative pain management as a fundamental component of nursing process.

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Although nurses do play a crucial role in pain management, the extent of involvement is often limited in Iranian nursing practice. This study demonstrates the lack of involvement by Iranian nurses and identifies the barriers and facilitators in the control of post-operative pain (Rejeh et al, 2008). While this study is specifically about Iranian nursing practice, it is a worthwhile study as the U. S. also struggles with the management of pain for patients post-operatively.

The only means of post-operative pain control in Iranian surgical units is pharmacological in nature. Due to their unpopularity, alternative methods of pain relief are rarely used in Iran. Iranian nurses express a lack of ability to use their training, knowledge, and skills to act in patients’ best interest in decreasing or eliminating pain. This is a common feeling among nurses in the U. S. as well. While non-pharmacological pain relief therapies are increasing in popularity, health care professionals and patients’ understanding of these methods are not well researched and therefore not used regularly.

The purpose of this study was to illustrate the barriers and facilitators to post-operative pain management from the perspective of Iranian nurses. This study was qualitative with twenty-six participants who had a mean of 10. 6 years of nursing experience. It was determined that nurses having two or more years of acute care post-operative nursing experience was necessary as the researchers found that some nurses with five or more years’ experience were “desensitized” to patients’ pain. Twenty-two of the participants had their bachelors of science in nursing (BSN) and four participants had their masters of science in nursing (MSN).

The researchers briefed the participants on the purpose and outline of the study as well as the voluntary nature of their involvement. Informed, written consent was given to participants and their signature was required at each stage of the study. Semi-structured serial interviews provided the data, which was then, analyzed using the content analysis method. Each participant interview lasted 60-120 minutes and consisted of a set of core open-ended questions, allowing the participant to explain their own perspectives and experiences.

The series of questions asked included, ‘‘please share with me how you care for your patient in pain’; ‘please share examples of times when your efforts to manage a patient’s pain were successful’; and ‘please share examples of times when your efforts to manage a patient’s pain were unsuccessful’ (Rejeh et al, 2008). Following the analysis, the participants received a complete transcript of their personal coded interviews along with a summary of the resulting themes to determine if the codes and themes coincided with their experiences.

Numerous themes surfaced in this study to describe the factors that impeded or facilitated post-operative pain management. It proved necessary to group the themes into two main categories. The first theme was barriers to pain management after surgery with subgroups such as powerlessness, policies and rules of organization, physicians leading practice, time constraints, limited communication with patient and/or physician, and interruption of activities relating to pain.

The second theme was comprised of elements that promote post-operative pain management. These elements are the nurse–patient relationship, nurses’ responsibility, the physician as a colleague, and nurses’ knowledge and skills (Rejeh, 2008). The results of this study were not surprising as the management of patients’ pain post-operatively has been an issue medical personnel have been trying to resolve for years with limited success. Collaborative, respectful, and professional relationships between physicians and nurses would help minimize this issue.

Developing this type of professional relationship is an issue in Iran where physicians carry strong authority and physician leading is the standard practice. Providing nurses with an appropriate nurse to patient ratio would assist them in fostering a trusting, collaborative relationship with their patients allowing them to know what methods of pain relief are most effective for each individual patient. Additionally, each nurse needs to possess the knowledge and skills necessary to determine what the most effective pain relief would be and when and how to implement their use.

While there is a multitude of research demonstrating the lack of pain control for patients post-operatively and the reasons why this occurs, there is a lack of research on how to remedy the situation successfully. Researchers and medical personnel know how and why post-operative pain remains an issue, but the solutions to the barriers seem insurmountable given the state of Iran’s medical practice and the current state of the U. S. ’s health care reform. All physicians and nurses know that pain management following surgery is an essential practice component, but the effective and sustained implementation of those measures remain elusive.


Apfelbaum, J. , Chen, C. , Mehta, S. , Gan, T. (2003). Postoperative Pain Experience: Results From a National Survey Suggest Postoperative Pain Continues to be Undermanaged. Anesth Analg, 97(2), 534–540. Retrieved December 2, 2012, from http://journals. lww. com/ornursejournal/Fulltext/2011/11000/New_thinking_about_postoperative_pain_management. 8. aspx#P11 Bicek, E. (2004). Nurses’ Attitudes, Knowledge, and Use of Nonpharmalogical Pain Management Techniques And Therapies. Honors Projects. Paper 12.

Retrieved December 2, 2012, from http://digitalcommons. iwu. edu/nursing_honproj/12 Rejeh, N. N. , Ahmadi, F. F. , Mohammadi, E. E. , Anoosheh, M. M. , & Kazemnejad, A. A. (2008). Barriers to And Facilitators of Post-Operative Pain Management in Iranian Nursing: a Qualitative Research Study. International Nursing Review, 55(4), 468-475. Retrieved December 2, 2012, from http://ehis. ebscohost. com. library. gcu. edu:2048/ehost/pdfviewer/pdfviewer? sid=f992456e-4001-4729-b8cd-6f2710a56e5f%40sessionmgr12&vid=5&hid=4

Cite this Barriers to and Faciliators for Post Op Pain Management

Barriers to and Faciliators for Post Op Pain Management. (2017, Jan 20). Retrieved from https://graduateway.com/barriers-to-and-faciliators-for-post-op-pain-management/

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