Perceptions of health professionals for postoperative pain

Agron Bytyqi, BSc, Ma, Teacher of Nursing at R.H. Prizren Acute pain is a significant problem in the postoperative setting. Patients report a lack of information about pain-control measures and ineffective pain control. Health professionals continue to rely on pharmacologic measures and tend to under-administer analgesics. Postoperative pain encompasses a complex phenomenon that involves physical, psychologic, social, cultural, and environmental factors that interconnect and affect how the pain is perceived, managed, and evaluated (IASP, 2003). Pain is a personal experience for patients and health professionals and is influenced by the context in which it occurs. After surgery, pain is a common experience for patients in the surgical ward due to tissues trauma. It is unethical to let the patient to suffer from pain without adequate efforts to provide high quality treatment. Health professionals always should believe in assessing the patient for his pain. Pain is treated in best way before it reach severe levels. The ethical responsibility for pain management, which health professionals must have, is a crucial part in handling the patient suffering from pain. Postoperative pain management should be based on a system of well-organized health care which emphasizes that continuing professional education is consistent with the proper techniques of pain management. The aims of this study are: Assessment of the health professionals perceptions about postoperative pain management; Recognition and analysis of interventions for postoperative pain management; Comparison of results of the perception of health professionals and the outcome of interventions for postoperative pain management; Creating opportunities for improving health education and continuing medical care to patients with pain; To investigate their routine work, to describe the level of their knowledge and improve old ways of working for better quality care to patients with pain. The research method was quantitative, was made statistical analysis of data from assessments, opinions and attitudes of participants and their generation in the numerical value provided by their observation based on prepared questionnare. The target group were doctors and nurses of surgical branches with different experience in the Regional Hospital of Prizren. First was noted deficiency in the source of information that health professionals have received, in the curricula of the faculty of medicine was not put special emphasis to pain management, and less that in secondary schools, while most nurses (95%) were with secondary school. In this institution. Liked in others in the country level there is no accreditation program for postoperative pain management. Results showed that pain assessment most of professionals do it through objective data and that through oral reporting (65%) than from the subjective data (35%) and documentation of postoperative pain using assessment tools have reported that only 20% of participants do it, while according to literature these forms of evaluation should be routin for each patient, according to American Pain Society, the pain should be considered as the fifth vital sign and according to Bonica et al., 2000 scales of assessment with numbers and analog should be used as common tools and standards. By non-pharmacological treatment, other techniques that are used to manage postoperative pain mostly was reported appropriate position 60% while the other as cooling/heating, massage/relaxation, recreation and the environment are least techniques used (3%), while according to Lewis et al, 2005 such strategies should be included among working with postoperative patients because helps in managing postoperative pain, increase comfort, promote sleep and improve quality of life. While pharmacological treatment compared to non-pharmacological treatment is dominant in routine activities of health professionals in the management of postoperative pain, in 70% of cases was given analgesia while less than 25% was used other techniques. Schedule of analgesics use for initial postoperative period was according to statutory schedule at 70% of participants, and 30% have administer the drug when the patient has asked for it, this practice is consistent with literature where according to Mac Lellan, 1997 and Manias, 2003 description

and administration of analgesics in the initial postoperative stage should be done in a routine manner and not as required. Documentation of postoperative pain, in addition to general medical and nursing documentation is a problem in itself, since in the plan of health care lacks adequate documentation for assessing and evidentation of pain and lack of pain assessment tools. 80% of participants have point out that they dond do documentation of postoperative pain. This is contrary to studies of Merboth & Barnason, 2000 and Chanvej et al, 2004 where the documentation of postoperative pain should be part of the chart for recording vital signs, and by American Pain Society documentation should include all assessments and measures of management axcept patient answers. To improve the quality of health services related to postoperative pain management we recommend: - To complete health documentation (medical and nurse documentation) for each patient with an
administrative directive from the Ministry of Health,

To undertake professional continuing education for medical and nursing staff including postoperative pain management with relevant specification of assessment, treatment and documentation, To prepare and issued guidelines and protocols for pain care at postoperative patients, Strengthening of continuing education programs, increasing the volume and quality of curriculum for specific training in the management of postoperative pain, Development and implementation of educational programs within the stationary healthcare institutions with special emphasis on effective management of postoperative pain.

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