MAKALAH KELOMPOK

ANALISIS ARTIKEL JURNAL

Pain Management in Patients with Long-bone Fracturesin a District Hospital in KwaZulu-
Natal, South Africa
Disusun untuk Memenuhi Tugas Praktik Stase Keperawatan Gawat Darurat

Disusun oleh:
Nur Firma Yunita (2020206030)
Rakhmadhan Alqadri Nurfaldin (2020206034)

PENDIDIKAN PROFESI NERS

FAKULTAS ILMU KESEHATAN
UNIVERSITAS ‘AISYIYAH
YOGYAKARTA
2021
 ANALISA JURNAL
A. Judul dan Tahun Jurnal :
Pain management in patients with long-bone fractures in a district hospital in KwaZulu-
Natal, South Africa (2015)
B. Nama Penulis :
Adeleye M. Awolola, Laura Campbell, dan Andrew Ross
C. Latar Belakang :
Studi ini meninjau keparahan nyeri dan penilaian yang diingat oleh pasien dengan
patah tulang panjang. Fokusnya adalah pada interval antara pasien masuk, dilakukannya
penilaian nyeri dan kolaborasi pemberian analgesik, karena penundaan analgesia untuk
nyeri akut dapat menyebabkan sindrom nyeri kronis yang kompleks.
D. Kesesuaian topik dengan masalah klinis/komunitas :
Afrika Selatan diperkiakan memiliki insiden tabrakan lalulintas yang terjadi setiap
empat detik. Sehingga insiden trauma yang diakibatkan menyebabkan banyak cedera,
termasuk patah tulang. Namun Unit Gawat Darurat di Afrika Selatan umumnya kurang
siap untuk pelayanan terutama pengelolaan nyeri. Studi ini dilakukan berdasarkan pada
pengamatan pasien di KwaZulu-Natal, Afrika Selatan yang dirujuk ke unit ortopedi dari
UGD tampaknya mengalami nyeri yang tidak terkendali.
Sebanyak 2/3 pasien menunggu hingga satu jam sebelum menerima analgesia
apapun, dan 1/3 diantaranya menerima analgesia yang tidak sesuai dalam kaitannya
dengan keparahan nyeri. Hal ini terutama mengkhawatirkan bahwa analgesia tidak
diberikan di UGD scara sesuai dan jelas.
E. Tujuan Penelitian :
Tujuannya adalah untuk mengeksplorasi ingatan pasien tentang keparahan nyeri dan
penilaian di unit gawat darurat (UGD) dan apakah analgesia yang diresepkan di UGD.
F. Metode :
Desain penelitian adalah eksplorasi cross-sectional study. Studi eksplorasi ini
mempertimbangkan aspek nyeri pada orang dewasa dengan fraktur tulang panjang yang
dirawat di UGD dan kemudian dirujuk ke unit ortopedi. Pengumpulan data berlangsung
di unit ortopedi di mana peserta diminta untuk mengingat keparahan nyeri mereka
(menggunakan skala analog visual) saat berada di UGD.
G. Hasil :
Sembilan puluh tiga pasien berpartisipasi, kebanyakan adalah laki-laki Afrika. Lebih
dari 60% mengingat keparahan nyeri mereka di UGD sebagai 5 atau lebih pada skala
persepsi analog visual. Tidak ada alat formal yang digunakan untuk menilai atau
mencatat nyeri di UGD, dan tidak ada hubungan antara keparahan nyeri yang diingat dan
jenis analgesia yang diresepkan.
H. Pembahasan :
Pada temuan peneliti pengkajian status nyeri pada partisipan mayoritas saat di UGD
dilakukan oleh dokter bukan perawat sehingga peran perawat untuk triase di ruang UGD
perlu lebih dieksplorasi kembali. Rentang waktu yang bervariasi dan cenderung dari
pasien masuk UGD, dilakukan pengkajian sampai dengan diberikannya analgesik serta
pemberian analgesik yang tidak sesuai dengan tingkat keparahan nyeri menjadi
perhartian. Hal ini menunjukkan bahwa tidak ada sistem standar untuk menilai nyeri dan
pemberian analgesik. Sehingga perlu adanya keseragaman dalam penilaian nyeri pasien
patah tulang serta durasi waktu didapatkannya obat analgesik.
Literatur mendukung bahwa jika perawat menjadi lebih terlibat, kesenjangan antara
admisi, penilaian dan pemberian analgesia dapat dipersingkat. Hal ini senada dengan
penelitian Dewhirst dkk, (2017) yang menyebutkan bahwa arahan medis untuk
pemberian analgesik yang diprakarsai perawat secara efektif meningkatkan ketepatan
waktu dan kualitas perawatan untuk pasien dengan nyeri akut. Varndell dkk (2018)
menyebutkan bahwa Tepat waktu dan manajemen nyeri akut yang efektif masih menjadi
salah satu tantangan terbesar bagi UGD di seluruh dunia.
I. Kesimpulan Penelitian :
Sebagian besar partisipan dinilai/dikaji nyerinya di UGD dan diberikan analgesia.
Namun ada perhartian bahwa penilaian status nyeri ini dilakukan oleh dokter dan peran
potensial perawat UGD dalam manajemen nyeri perlu eksplorasi lebih lanjut.
J. Rekomendasi :
Standar Operasional/protokol penilaian nyeri harus dikembangkan untuk dokter dan
perawat sebagai pedoman dalam menilai kondisi nyeri pasien dengan patah tulang
panjang dan meresepkan obat anti nyeri yang sesuai. Protokol ini juga dapat memberikan
kesempatan untuk evaluasi ulang dan penilaian pasien secara terus menerus dalam upaya
 untuk memastikan bahwa tidak ada kesempatan yang terlewatkan untuk memberikan
analgesia yang memadai. Perawat menjadi bagian penting dalam management nyeri
pasien di UGD sehingga peran perawat menjadi bagian vital yang dapat meningkatkan
keefektifan manajemen nyeri pasien. Penelitian lebih lanjut diperlukan di bidang penting
ini untuk memandu pelatihan dan praktik profesional perawatan kesehatan.

K. Referensi :
Varndell, W., Fry, M., & Elliott, D. (2018). Quality and impact of nurse-initiated
analgesia in the emergency department: A systematic review. International
Emergency Nursing, 40(April), 46–53.
Dewhirst, S., Zhao, Y., MacKenzie, T., Cwinn, A., & Vaillancourt, C. (2017). Evaluating
a medical directive for nurse-initiated analgesia in the Emergency Department.
International Emergency Nursing, 35, 13–18.
Awolola, A. M., Campbell, L., & Ross, A. (2015). Pain management in patients with
long-bone fractures in a district hospital in KwaZulu-Natal, South Africa. African
journal of primary health care & family medicine, 7(1), 818.

Pain management in patients with long-bone fractures
in a district hospital in KwaZulu-Natal, South Africa
Authors:
Adeleye M. Awolola1
Laura Campbell1
Andrew Ross1
Affiliations:
1
Department of Family
Medicine, University of
KwaZulu-Natal, South Africa
Correspondence to:
Adeleye Awolola
Email:
awoleye2004@yahoo.co.uk
Postal address:
6A Knightsbridge, 141
Alexandra Road, Scottsville
3201, South Africa
Dates:
Received: 14 Jan. 2015
Accepted: 05 June 2015
Published: 02 Dec. 2015
How to cite this article:
Awolola AM, Campbell L,
Ross A. Pain management
in patients with long-bone
fractures in a district hospital
in KwaZulu-Natal, South
Africa. Afr J Prm Health Care
Fam Med. 2015;7(1), Art.
#818, 5 pages. http://dx.doi.
org/10.4102/phcfm.v7i1.818
Copyright:
© 2015. The Authors.
Licensee: AOSIS
OpenJournals. This work is
licensed under the Creative
Commons Attribution
License.
Read online:
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Page 1 of 5 Original Research
Background: This study reviewed pain severity and assessment as recalled by patients with long-
bone fractures. The focus was on the intervals between admission, pain assessment and analgesic
provision, as delay of analgesia for acute pain can result in complex chronic pain syndromes.
Aim: The aims were to explore patients’ recollection of pain severity and assessment in an
emergency department (ED) and whether analgesia prescribed in the ED correlated with pain
severity.
Setting: The study site was a district hospital ED in KwaZulu-Natal, South Africa.
Methods: This exploratory study considered aspects of pain in adults with long-bone fracture
who were admitted to an ED and later referred to an orthopaedic unit. Data collection took place
in the orthopaedic unit where participants were requested to recall their pain severity (using a
visual analogue scale) whilst in the ED.
Results: Ninety-three patients participated, most of whom were African males. Over 60%
recalled their pain severity in the ED as 5 or greater on a visual analogue perception scale. No
formal tool was used to assess or record pain in the ED, and there was no association between
recalled pain severity and type of analgesia prescribed.
Conclusion: The majority of patients were assessed for pain in the ED. Analgesia given to most
patients was inadequate for the degree of pain they experienced. A pain assessment protocol
should be developed for doctors and nurses to serve as a guideline in assessing patients with
long-bone fractures and prescribing appropriate analgesia.
Analyse de la gestion de la douleur chez les patients atteints de fractures des os longs dans
un hôpital de district dans le KwaZulu-Natal en Afrique du Sud.
Contexte : Cette étude a examiné la sévérité et l’évaluation de la douleur telles que rapportées a
posteriori par des patients atteints de fractures des os longs. L’accent était mis sur les intervalles
entre l’admission, l’évaluation de la douleur et l’administration d’analgésique, le retard de
l’analgésie en cas de douleur aiguë pouvant entrainer des syndromes complexes de douleur
chronique.
But : Les objectifs étaient d’analyser le souvenir de la sévérité et de l’évaluation de la douleur
des patients dans un service d’urgence (SU), et si l’analgésie prescrite dans le SU correspondait
à la sévérité de la douleur.
Cadre : Le site d’étude était le SU d’un hôpital de district dans le KwaZulu-Natal en Afrique
du Sud.
Méthodes : Cette étude exploratoire a examiné les aspects de la douleur chez les adultes atteints
de fracture des os longs admis dans un SU et plus tard envoyés vers une unité orthopédique.
La collecte des données s’est faite au sein de l’unité orthopédique, où les participants ont été
invités à se remémorer la sévérité de la douleur (en utilisant une échelle visuelle analogique -
VAS) lors de leur passage au SU.
Résultats : Quatre-vingt treize patients ont participé, dont la plupart étaient des hommes
africains. Plus de 60% se sont rappelé d’une sévérité de la douleur au service d’urgence de 5 ou
plus sur une échelle de perception de type EVA. Aucun outil formel n’a été utilisé pour évaluer
ou enregistrer la douleur au SU, et il n’existait aucun lien entre le souvenir de la sévérité de la
douleur et le type d’analgésie prescrit.
Conclusion : La majorité des patients ont été évalués quant à la gestion de la douleur au
sein du SU. L’analgésie administrée à la plupart des patients était insuffisante par rapport
au degré de douleur qu’ils avaient subi. Un protocole d’évaluation de la douleur doit être
développé pour les médecins et les infirmières afin de servir de ligne directrice en termes
d’évaluation de l’état des patients atteints de fractures des os longs et de prescription d’une
analgésie appropriée.
http://www.phcfm.org doi:10.4102/phcfm.v7i1.818
 Page 2 of 5
Introduction
Internationally many patients with acute pain following
trauma do not receive any form of analgesia on admission
to a hospital emergency department (ED).1 As an example,
research carried out in the United States of America assessed
analgesia administered to patients with acute trauma in an
ED and reported that half received no analgesia at discharge.1
Two-thirds waited for up to one hour before receiving any
analgesia, and a third received inappropriate analgesia in
relation to pain severity. It is particularly concerning that
analgesia was not administered in the ED, even to patients
with clearly documented evidence of moderate to severe
pain.1
It is pertinent to review pain in patients with bone fractures
in South Africa, as the incidence of bone fractures is high.
It has been estimated that a road traffic collision occurs
every four seconds in South Africa, and the resultant trauma
leads to multiple injuries, including fractures.2 EDs in South
Africa are generally underprepared for their workload,
and improvements could be made, including management
of pain.3 This study grew from a concern that patients in
KwaZulu-Natal, South Africa who were referred to an
orthopaedic unit from an ED appeared to have unmanaged
pain.
With regard to pain following a fracture, a large study of
patients with extremities fractures reported that only 64%
received any analgesia, and analgesic management did not
form part of ED protocols.4 A paediatric ED study indicated
that only a third of children with acute, severe pain due to
long-bone fractures received any analgesia.5
Under-treatment of acute pain is of concern, because if pain
remains untreated a patient may develop a complex pattern
of chronic pain and disability.6 This chronic pain results from
‘central sensitisation’ where the nervous system develops a
process of ‘wind-up’ and becomes regulated to a persistent
state of high reactivity.6 This persistent state maintains pain,
even after the initial injury might be healed. Acute pain
following acute trauma such as bone fractures has been
demonstrated to induce central sensitisation.7 Although the
time between fracture pain and central sensitisation has not
been determined, it would seem necessary to treat any acute
pain as soon as possible. Most importantly, prompt and
appropriate pain management is essential as a fundamental
human right.8
An extensive literature search found no literature on pain
management of patients with long-bone fracture in a South
African ED setting, and hence this study will add to the
information available on this important topic. The aim of
this study was to assess patients’ perceptions of pain severity
following a long-bone fracture and to review their perceptions
of how this pain was assessed in an ED. Associations between
recalled pain severity and analgesia that was prescribed were
explored. An ED presents a unique opportunity for prompt
and appropriate management of any acute pain.
http://www.phcfm.org
Original Research
Research methods and design
The design was an exploratory cross-sectional study, and
the setting was a district hospital (DH) in KwaZulu-Natal
which serves a large community of over 220 000 people.
Approximately 50 patients with long-bone fractures are
reviewed every month in the ED. For the purpose of this
study long-bone fractures were considered to be fractures
of the humerus, ulna, radius, femur, tibia and fibula. All
patients with long-bone fractures are assessed and stabilised
in the ED, and only those requiring admission with multiple
open, severely displaced and severely painful fractures are
referred onwards for specialist care in an orthopaedic unit.
Approximately 40 patients with long-bone fractures are
referred from the ED to the orthopaedic unit each month.
This study population was chosen because pain in this group
of patients is usually severe, and there is a need for prompt,
appropriate management in the ED to prevent long-term
complications.
As this was an exploratory study, a sample size of 100
was chosen as expedient. Inclusion criteria included adult
patients with acute long-bone fractures who were referred
from an ED to the orthopaedic unit. The following patients
were excluded: those with associated pain which may
not be related to long-bone fracture (for example, bone
cancer), those who presented to the ED more than one
week post-fracture, and those who were unable to give
consent.
Every third patient admitted to the orthopaedic unit who
met the inclusion criteria was recruited over the study
period. Data were collected using two methods: an interview
between the patient and the researcher, which was carried
out in the orthopaedic unit, and a hospital chart review.
The interviews took place at various times after admission
to the orthopaedic unit, and patients were requested to
recall their stay in the ED. They were asked to recall the
following: their maximum pain severity in the ED, whether
someone assessed their pain in the ED, and their estimations
of intervals between admission and pain assessment and
analgesia administration.
Pain management is recognised as a fundamental human
right, and at the time of interview the researcher (A.M.A.),
who is a medical doctor, assessed pain using a visual
analogue scale (VAS) in the orthopaedic unit and immediately
prescribed appropriate analgesia if required.
Participants were requested to score the severity of their
recalled pain in the ED on the VAS. The VAS was considered
to be easy to use in a clinical setting and has been validated
in diverse cultural and linguistic settings.9 The VAS has been
found to be useful in measuring pain in bone fractures in a
range of injuries, including spinal fractures.10
Data on analgesia prescribed in the ED were obtained from
patients and patient chart review. Data were captured on
a Microsoft Excel spreadsheet and analysed descriptively.
doi:10.4102/phcfm.v7i1.818
 Page 3 of 5 Original Research

Associations between recalled pain severity and analgesia 80 75

prescribed in the ED were explored using the Chi-square test 70
and analysis of variance (ANOVA). 60

Percentage (%)
50
Ethical considerations 40
30
Permission to conduct the study was obtained from the
20
Research Ethics Committee at the University of KwaZulu- 10.7 9.5
10
Natal (Ref. BE 023/13), the Provincial Department of Health 2.4 2.4
0
and hospital managers. <1 hr 1-2 hrs 2-3 hrs 3-4 hrs >4 hrs
Hours

Results FIGURE 3: Perceived intervals between emergency department admission and

pain assessment.
Two hundred and seventy-five patients were admitted to the
orthopaedic unit over an eight-month period from January
to August 2014, and 93 patients were interviewed as part 70
of this study. Ages of the participants ranged from 18 to 60 57.6

Percentage (%) of total

over 60 years, and over half (56.0%) were in the 30–50-years

number of patients
50
age group. The majority were male (84.0%) and most were
40
black African (94.0%), with 3.0% of participants being white
and 3.0% from other racial groups. The age distribution is 30
22.4
represented diagrammatically in Figure 1. 20
14.1
10
4.7
Half of the fractures occurred in the leg (51.6%). Some 1.2
0
patients had more than one type of fracture; for instance, <30 min 30-60 min 60-90 min 90-120 min >120 min
31.2% had both tibia and fibula fractures. The fracture sites Perceived intervals between pain assessment and
administration of analgesia in minutes
are represented in Figure 2.
FIGURE 4: Perceptions of interval between pain assessment and administration
Most participants (62.4%) were interviewed by the of analgesia.
researcher more than 48 hours following admission to the
ED. The majority (96.0%) perceived that they had some no formal pain evaluation scale used. Two per cent of the
form of pain assessment in the ED, and these participants participants recalled that they were not asked about pain
recalled being only verbally questioned about pain with intensity. Most (82.0%) recalled receiving an initial pain
assessment from a doctor only and 18.0% received an
initial pain assessment from a nurse only. The perceived
28.0
Percentage (%) of total

25.8 intervals between ED admission and pain assessment are

number of patients

summarised in Figure 3.
18.3

11.8 Participants’ reports concerning the interval between pain

7.5 8.6 assessment and administration of analgesia are illustrated in
Figure 4.
18-20 21-30 31-40 41-50 51-60 60>
Age (Years) A chart record review of the time spent in the ED revealed
that half of the analgesia prescribed was administered
FIGURE 1: Age distribution of participants.
orally (46.0%) and half via injection (54.0%). The analgesia
varied from a weak class to a strong class (as described by
50 the World Health Organization).11 Some patients received
46.3
45 more than one class of analgesia. Some patients (4.3%)
Percentage (%) of total

40 37.6 reported receiving analgesia but information on the specific

number of patients

35 type was not recorded in the patient’s chart (information

30
not available). Some patients (33.3%) received opioid-like
25
agents such as tramadol and/or paracetamol with codeine
20 18.3
15 14 (classified by the researcher as ‘other analgesia’ in Figure 5).
11.8
10 8.6 Paracetamol was administered orally whilst nonsteroidal
5 anti-inflammatory agents (NSAIDs) were administered
0 either orally or via intramuscular (IM) injections. Opioids
Humerus Radius Ulna Femur Tibia Fibula
used for analgesia were given via IM or intravenous
Type of long bong fracture
injection. The types of analgesia recorded during ED stay
FIGURE 2: Site of long-bone fracture. are shown in Figure 5.

http://www.phcfm.org doi:10.4102/phcfm.v7i1.818

92.5
Percentage
55.0
11.8
4.3
Paracetamol NSAID Opioid Info not
available
Analgesia
FIGURE 5: Types of analgesia recorded during emergency department stay.
TABLE 1: Recalled pain score on the visual analogue scale.
Recalled pain score reported on VAS % respondents
1 4.3
2 7.5
3 10.8
4 10.8
5 32.3
6 10.8
7 11.6
8 7.3
9 2.2
10 2.2
Most of the participants (64.0%) recalled their pain as being
at level 5 or greater. The range of recalled VAS pain scores is
summarised in Table 1.
ANOVA showed no association between type of analgesia
provided in the ED and participants’ recalled pain score on
the VAS (F = 1.001, and p = 0.396).
Discussion
The aim of the study was to explore participants’ recall
of pain they experienced whilst in the ED and to assess
intervals between admission, assessment and receipt of
analgesia. Importantly the study also considered whether
ED analgesia correlated with pain severity. Participants had
severe or complex fractures, and review of pain assessment
and treatment is vital as a lack of early pain management
intervention can lead to complications such as chronic pain
syndromes.
Results indicated that more males that females were referred
to the orthopaedic unit and participants reported significant
levels of pain whilst in the ED. Participants were mainly
reviewed by doctors in the ED and the intervals between
admission, assessment and receipt of analgesia varied between
participants. This suggests that no standardised systems were
in place for assessment of pain and delivery of analgesia.
The study methods were primarily descriptive, however
analysis using ANOVA was found to be useful to hone in
on the lack of correlation between reported pain severity
and type/World Health Organization class of analgesia
prescribed. Each of the findings will be discussed in more
detail below.
http://www.phcfm.org
Page 4 of 5 Original Research
More men were admitted than women. Although chronic
pain syndromes tend to be more common in women, it is
important not to neglect the prompt management of acute
pain in men.6 Most participants were in the age group
30–50 years, and a relatively young population may have
33.3
a higher predisposition to central sensitisation resulting
in chronic pain.12 Further study could consider other
demographic features which could predispose to central
Other
sensitisation, including not being employed, low educational
status and smoking.6
In this study the majority of participants were assessed
for pain by a doctor rather than by a nurse. This is an
interesting finding, as in South Africa there are generally
more nurses than doctors available in an ED setting. South
African literature advocates that nurses should become
more involved with triage of patients in EDs.13 The potential
assessment of pain by nurses requires further exploration in
this context.
Although most participants recalled that their pain was
assessed within an hour of admission to the ED, the time
between assessment and analgesia availability varied
and was prolonged (over two hours) in some instances.
This finding has major implications in terms of human
rights issues, and can also potentially induce chronic pain
syndrome. The literature supports that if nurses became
more involved, gaps between admission, assessment and
analgesia administration may be shortened.14
It was of concern that no tool was used to measure or record
pain in the ED. This is similar to findings of a Tanzanian
study on pain in an ED setting.15 The introduction of a nurse-
initiated triage of pain could potentially improve assessment
of pain, using a standardised, validated pain assessment
tool. Such an assessment tool could be supported by a pain
assessment protocol to serve as a guideline in prescribing
appropriate analgesia.
Despite patients rating their pain score as 5 or more, the
two most commonly prescribed analgesics were oral
paracetamol and an NSAID, which according to the World
Health Organization are not adequate for moderate to severe
pain.11 This finding is similar to that of another ED-based
study, which showed that an NSAID was the commonest
analgesia used for patients with fractures, and was usually
administered as a once-off IM dose.15 Reasons why relatively
mild analgesia was prescribed despite patients reporting
moderate to severe pain, and how effective mild analgesia is
in this setting require further investigation.
Limitations of the study
A limitation to this study is that the recall of data was used.
Patients were asked to recall events such as severity of pain,
who assessed the pain, and the interval between admission,
assessment and analgesic administration, and their recall may
have been impaired or distorted as they were in an acutely
stressful situation. An alternative data collection method
doi:10.4102/phcfm.v7i1.818
 Page 5 of 5
using a point prevalence of pain in an ED or continuous
assessment of patients from admission to discharge may
permit the gathering of more reliable data.
Conclusion and recommendations
It was encouraging that the majority of patients were assessed
for pain and given analgesia in the ED. However, it was of
concern that the majority was assessed by doctors, and the
potential role of the ED nurse in pain management requires
further exploration. As an example, ensuring cooperation
and collaboration between nurses and doctors may require
attention; a complication may arise if a nurse assesses a pain
as significant and a doctor prescribes a mild analgesia.
There appeared to be no standardised methods to assess
and record pain, and analgesia prescriptions did not seem
to be appropriate for the severity of the pain. In addition,
there were prolonged periods between pain assessment and
analgesia provision.
A pain assessment protocol should be developed for doctors
and nurses to serve as a guideline in assessing patients with
long-bone fractures and prescribing appropriate analgesia.
This protocol could also provide an opportunity for
continuous re-evaluation and assessment of patients in a bid
to ensure that no opportunity is missed to provide adequate
analgesia. Further research is required in this important area
to guide the training and practice of healthcare professionals.
Acknowledgements
The authors would like to thank the management of
Northdale Hospital, Pietermaritzburg for providing us with
an opportunity to conduct the study there. Special thanks go
to the staff in the ED and the orthopaedic departments for
their assistance.
Competing interests
The authors declare that they have no financial or personal
relationship(s) that may have inappropriately influenced
them in writing this article.
http://www.phcfm.org
Original Research
Authors’ contributions
A.M.A. (University of KwaZulu-Natal) was responsible
for protocol development, data collection and analysis,
and writing up the manuscript, whilst L.C. (University of
KwaZulu-Natal) was involved in conceptualisation of the
research, data review and writing up the manuscript and
A.R. (University of KwaZulu-Natal) assisted with data
review and writing up the manuscript.
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 ANALISA JURNAL
Pain Management in Patients with Long-bone Fracturesin a
District Hospital in KwaZulu-Natal, South Africa

Disusun oleh:
Nur Firma Yunita (2020206030)
Rakhmadhan Alqadri N. (2020206034)

UNIVERSITAS ‘AISYIYAH YOGYAKARTA

2021
• Judul dan Tahun Jurnal :
Pain management in patients with long-bone
fractures in a district hospital in KwaZulu-
Natal, South Africa (2015)
• Nama Penulis :
Adeleye M. Awolola, Laura Campbell, dan
Andrew Ross
 Latar Belakang
Studi ini meninjau keparahan nyeri dan
penilaian yang diingat oleh pasien dengan
patah tulang panjang. Fokusnya adalah pada
interval antara pasien masuk, dilakukannya
penilaian nyeri dan kolaborasi pemberian
analgesik, karena penundaan analgesia untuk
nyeri akut dapat menyebabkan sindrom nyeri
kronis yang kompleks.
 Kesesuaian topik dengan masalah
klinis/komunitas

Diperkirakan tabrakan lalu lintas jalan terjadi setiap empat

detik di Afrika Selatan,sehingga insiden trauma yang
diakibatkan menyebabkan banyak cedera, termasuk
patah tulang. Namun Unit Gawat Darurat di Afrika
Selatan umumnya kurang siap untuk pelayanan
terutama pengelolaan nyeri. Studi ini dilakukan
berdasarkan pada pengamatan pasien di KwaZulu-
Natal, Afrika Selatan yang dirujuk ke unit ortopedi dari
UGD tampaknya mengalami nyeri yang tidak terkendali
 Kesesuaian topik dengan masalah
klinis/komunitas

Sebanyak 2/3 pasien menunggu hingga satu jam

sebelum menerima analgesia apapun, dan 1/3
diantaranya menerima analgesia yang tidak sesuai
dalam kaitannya dengan keparahan nyeri. Hal ini
terutama mengkhawatirkan bahwa analgesia tidak
diberikan di UGD scara sesuai dan jelas.
 Tujuan penelitian
Tujuannya adalah untuk mengeksplorasi ingatan
pasien tentang keparahan nyeri dan penilaian
di unit gawat darurat (UGD) dan apakah
analgesia yang diresepkan di UGD.
 Metode
Desain penelitian adalah eksplorasi cross-sectional study. Studi
eksplorasi ini mempertimbangkan aspek nyeri pada orang
dewasa dengan fraktur tulang panjang yang dirawat di UGD
dan kemudian dirujuk ke unit ortopedi. Pengumpulan data
berlangsung di unit ortopedi di mana peserta diminta untuk
mengingat keparahan nyeri mereka (menggunakan skala
analog visual) saat berada di UGD.
 Hasil Penelitian
Sembilan puluh tiga pasien berpartisipasi, kebanyakan adalah
laki-laki Afrika. Lebih dari 60% mengingat keparahan nyeri
mereka di UGD sebagai 5 atau lebih pada skala persepsi
analog visual. Tidak ada alat formal yang digunakan untuk
menilai atau mencatat nyeri di UGD, dan tidak ada hubungan
antara keparahan nyeri yang diingat dan jenis analgesia yang
diresepkan.
 Pembahasan
Menurut temuan peneliti dan pernyataan partisipan
pengkajian nyeri di KwaZulu-Natal, Afrika Selatan
pertama kali dilakukan oleh dokter. Sedangkan peran
perawat dalam manajemen nyeri patah tulang masih
perlu dieksplorasi kembali. Waktu yang lama sejak
pasien dianamnesa tentang nyerinya sampai dengan
mendapatkan obat antinyeri membutuhkan waktu
yang lama.
Literatur mendukung bahwa jika perawat menjadi lebih terlibat,
kesenjangan antara admisi, penilaian dan pemberian
analgesia dapat dipersingkat. Hal ini senada dengan
penelitian Dewhirst dkk, (2017) yang menyebutkan bahwa
arahan medis untuk pemberian analgesik yang diprakarsai
perawat secara efektif meningkatkan ketepatan waktu dan
kualitas perawatan untuk pasien dengan nyeri akut. Varndell
dkk (2018) menyebutkan bahwa Tepat waktu dan manajemen
nyeri akut yang efektif masih menjadi salah satu tantangan
terbesar bagi UGD di seluruh dunia
 Kesimpulan penelitian
Sebagian besar partisipan dinilai/dikaji nyerinya
di UGD dan diberikan analgesia. Namun ada
perhartian bahwa penilaian status nyeri ini
dilakukan oleh dokter dan peran potensial
perawat UGD dalam manajemen nyeri perlu
eksplorasi lebih lanjut.
 Rekomendasi hasil
Pengkajian yang dilakukan dikembangkan dan
diseragamkan agar dapat menjadi pedoman
dalam menilai kondisi pasien patah tulang dan
dalam memberikan obat analgesik sesuai
dengan tingkat keparahan nyeri dan dengan
waktu yang lebih efektif.
 Rekomendasi hasil
Dengan hasil ini sebagai penguat bahwa
perawat menjadi bagian penting dalam
management nyeri pasien di UGD sehingga
peran perawat menjadi bagian vital yang
dapat meningkatkan keefektifan manajemen
nyeri pasien.
 referensi
Varndell, W., Fry, M., & Elliott, D. (2018). Quality and impact of nurse-
initiated analgesia in the emergency department: A systematic review.
International Emergency Nursing, 40(April), 46–53.
Dewhirst, S., Zhao, Y., MacKenzie, T., Cwinn, A., & Vaillancourt, C. (2017).
Evaluating a medical directive for nurse-initiated analgesia in the
Emergency Department. International Emergency Nursing, 35, 13–18.
Awolola, A. M., Campbell, L., & Ross, A. (2015). Pain management in patients
with long-bone fractures in a district hospital in KwaZulu-Natal, South
Africa. African journal of primary health care & family medicine, 7(1), 818.