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N324 Hospital Rooms and Pain

NURS324 Team 13 Research Presentation; Mixed-Methods quasi-experimental research proposal investigating the role of hospital room environment on pain experience.

Chris Lacombe

on 7 April 2011

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Transcript of N324 Hospital Rooms and Pain

Post-Operative Pain Control Kalyn Bolland, Krupa Isaac, Hyosung Jung, Christopher Lacombe, Chanel Pare- Bingley, Mathusha Shanmugarajah & Danielle Zens. NURS 324 Team 14 Background Importance Previous Studies Knowledge Gaps Purpose of Study Quantitative Arm: To describe the relationship between post- operative pain and room occupancy. Qualitative Arm: To develop a theoretical framework to describe this phenomenon, if it exists. Proposed Design A pilot study using a mixed methods comparative design. Sample
Selection Convenience sample: patients with appendicitis requiring surgery
Appendectomy patients selected to ensure large sample size and to control for uniform patient experience
Single site: Kingston General Hospital (KGH)
Inclusion: all patients 18 years or older
Room assignments not experimentally assigned
Informed written consent, ethical review approval Appendectomy Surgery Quantitative
Arm Immediately after surgery

Assessment, recording of pain q2h by nursing staff using a self-reported numerical pain 0-10 scale

Access medication administration record (MAR) to assess pain medication (including narcotic) usage, both scheduled and PRN Continues until discharge 24 hours post-operative Qualitative
Arm 1-on-1 interview, will discuss pain experience using McGill Pain Questionnaire and narrative interview Patient discharged. Demographic
Data Obtained Age, sex, ethnicity, education, household income,
comorbidities, and previous medical history. Data Analysis Quantitative Results Operational Construct Definitions Pain: Single Occupancy Room: Multiple Occupancy Room: A private hospital room for inpatients with only one bed; may include rooms designed for infectious disease isolation. A semi- private or ward room consisting of at least two beds. Pain Medication: Qualitative Results Comparison of self-reported pain numerical values. Statistical analysis of variance (ANOVA)

controlling for demographic values
and post-operative recovery time. Comparison of pain medication usage. Narrative analysis of common themes
from Interview
Pain descriptors
from McGill Pain Questionnaire Creation of theoretical framework explaining the relationship of these factors. Patients in multiple occupancy rooms experience more environmental and social stimulation, decreasing attention to pain. Patients in multiple occupancy rooms will report less pain and use less pain medication. Anticipated Implications Hospital Design Patient Perceptions Room preference may be altered for patient satisfaction and recovery reasons, in addition to financial constraints. Nursing Interventions May provide evidence for increasing social interaction and distraction for single occupancy room patients. Potential Funding Sources Conceptual Framework Room Occupancy Staff Perceptions Patient Satisfaction Environmental Stimulation Infection Control Care Provided Contact Precautions Mental Health, Social Interaction Pain Any administered pharmacologic treatment for pain management, including NSAID and opioid analgesics. An unpleasant sensory and emotional experience associated with real or potential tissue damage. Postoperative pain control effects healing time and complications Given the choice, most patients prefer single rooms, but this may effect their pain experience. People that are distracted and stimulated are less likely to pay attention to internal cues, including pain, since people can only pay attention to a maximum amount of information. This is similar to the gate theory of pain. Isolation from contact precautions result in decreased overall mental health, increased depression, anxiety, anger. Excess noise and distraction are associated with increased anxiety and pain` Nurses prefer caring for patients in single rooms: exam privacy, family visits, diet mixups. Physicians spend more time and communicate more effectively with patients in single rooms Single rooms offer more privacy, family interaction, but may have less social interaction and environmental stimulation. Both increased and decreased narcotic use between single and multi-room patients has been demonstrated. Works Cited Abad, C., Fearday, A., Sadfar, N. (2010). Adverse effects of isolation in hospitalised patients: A systematic review. Journal of Hospital Infection, 26, 97-102.

Al- Omran, M., Mamdani, M. M., McLeod, R. S. (2003). Epidemiologic features of acute appendicitis in Ontario, Canada. Canadian Journal of Surgery, 46(4), 263- 268.

Chaudhury, H., Mahmood, A., Valente, M. (2005). Advantages and disadvantages of single-versus multiple-occupancy rooms in acute care environments: A review and analysis of the literature. Environment and Behavior, 37(6), 760-786.

Chaudhury, H. Mahmood, A., Valente, M. (2006). Nurses’ perception of single-occupancy versus multioccupancy rooms in acute care environments: An exploratory comparative assessment. Applied Nursing Research, 19, 118-125.

Dolce, J. F., Doleys, D. M., Raczynski, J. M., Crocker, M. F. (1985). Narcotic utilization for back pain patients housed in private and semi-private rooms. Addictive Behaviors, 10, 91-95.

Green, C. R., Anderson, K. O., Baker, T. A., Campbell, L. C., Decker, S., Fillingim, R., . . . Vallerand, A. H. (2003). The unequal burden of pain: Confronting racial and ethnic disparities in pain. Pain Medicine, 4(3), 277-294.

Pennebaker, J. W. (1994.) Psychological bases of symptom reporting: Perceptual and emotional aspects of chemical sensitivity. Toxicology and Industrial Health, 10(4/5), 497-511.

Stephens, J. Laskin, B., Pena, B., Wong, J. (2003).The burden of acute postoperative pain and the potential role of the COX-2-specific inhibitors. Rheumatology, 42(Suppl. 3), iii40-iii-52.

Teltsch, D. Y., Hanley, J., Loo, V., Goldberg, P., Gurashaney, A., Buckeridge, D. L. (2011). Infection acquisition following intensive care unit room privitization. Archives of Internal Medicine, 171(1), 32-38.

van de Glind, I., van Dulmen, S., Goossensen, A. (2008). Physician-patient communication in single-bedded versus four-bedded hospital rooms. Patient Education and Counseling, 73, 215-219.
In Adult Appendectomy Patients in Single Vs Multiple Occupancy Rooms. A preliminary mixed-methods comparative study of pain experience and management. Expected Results Expected Results Potential Limitations Pilot study:

Specific to appendectomy pain

Non experimental design:

Confounding: Canadian Institute of Health Research (CIHR)
Canadian Health Services Research Foundation (CHSRF)
International Association for the Study of Pain
Kingston General Hospital Quality Assurance
Queen's University Conferences Second Annual International Nursing Intervention Research Symposium

Joint Annual Scientific Meeting of British and Canadian Pain Societies, Edinburgh, Scotland. Canadian Journal of Nursing Research (CJNR)

Pain Management Nursing (PMN) Publications Small sample size
Single site
Single geographic area Patient personalities and room preference Better care in single-occupancy rooms
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