In Lumbar Fusion Patients, How Does Establishing a Comfort Function Goal Preoperatively Impact Postoperative Pain Scores?

The purpose of this feasibility study was to determine the impact of establishing a comfort function goal preoperatively on postoperative pain scores and opiate requirements in lumbar fusion patients. A comfort function goal is defined as the pain score identified by the patient describing the level...

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Publicado en:Pain Management Nursing Vol. 16; no. 6; pp. 841 - 846
Autores principales: Hennessy, Winnie, Wagner, Elizabeth, Dumas, Bonnie P., Handley, Patricia
Formato: research Journal Article
Publicado: W B Saunders Dec2015
Acceso en línea:Ver este registro en EBSCOhost
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      dt: Dec2015
      vid: 16
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      pub: W B Saunders
      place: Philadelphia, Pennsylvania
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        10.1016/j.pmn.2015.06.007
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        atl: In Lumbar Fusion Patients, How Does Establishing a Comfort Function Goal Preoperatively Impact Postoperative Pain Scores?
      aug:
        au:
          Hennessy, Winnie
          Wagner, Elizabeth
          Dumas, Bonnie P.
          Handley, Patricia
        affil: Roper Saint Francis Healthcare, Charleston, South Carolina
      sug:
        subj:
          Postoperative Pain
          Goal-Setting
          Lumbar Vertebrae Surgery
          Spinal Fusion
          Preoperative Education
          Analgesics, Opioid Administration and Dosage
          Human
          Prospective Studies
          Experimental Studies
          Record Review
          Medical Records
          Control Group
          Pilot Studies
          Hospitals Southeastern United States
          Southeastern United States
          Pain Measurement
      ab: The purpose of this feasibility study was to determine the impact of establishing a comfort function goal preoperatively on postoperative pain scores and opiate requirements in lumbar fusion patients. A comfort function goal is defined as the pain score identified by the patient describing the level of pain tolerance to participate in healing activities such as deep breathing, ambulation and participation in activities of daily living. The design was prospective, nonrandomized, intervention group (n = 30) compared with retrospective chart review as control group (n = 30). Sample included patients scheduled for routine lumbar fusion in an urban southeastern hospital. The study intervention established a comfort function goal during a routine preoperative patient education class. No significant difference in pain score or opiate requirement was found for these data. However, a fundamental clinical question arose surrounding opiate requirements and dosing management. In our hospital, the norm for postoperative pain management is to categorize pain scores as mild (1-3), moderate (4-6), and severe (7-10) pain. Physician orders commonly use this differential to order opiate dose ranges. In this sample, the mean pain score for the intervention group at home is 5.8 and the mean comfort function goal is 4.9. Based on normative categories of pain scores, if a patient's baseline of tolerable pain is 4.9, this has potential impact on clinician responses to managing pain, as 4.9-5.8 is, for this patient, perhaps a mild range of pain, not moderate. If a patient reports a pain score of 7, and their norm is 5.8, the delta is only 1.2. Does this imply that the patient is experiencing mild or severe pain? Does the nurse deliver a dose of pain medication that is in the mild or severe dose range?
      pubtype: Academic Journal
      doctype:
        research
        Journal Article
      ougenre: Article
    language: English
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