Comparison of nurse's and patient's understanding of the quality of pain management in patients undergoing coronary artery bypass graft surgery in the heart surgery department of Dr. Heshmat Rasht Hospital in 2019

Introduction and purpose: Effective management of pain after coronary artery transplantation is one of the major challenges for nurses, which requires understanding the patient's pain and implementing standard treatment measures. Therefore, the present study was conducted with the aim of comparing the perception of nurses and patients about the quality of pain management in patients undergoing coronary artery bypass surgery. Methodology: This comparative cross-sectional study was conducted on 108 patients undergoing coronary artery bypass graft surgery using the gradual sampling method and nurses caring for them in a ratio of 4:1 to patients at Dr. Heshmat Rasht's Educational-Therapeutic Center in 2009. The data were collected using a 3-part tool consisting of a demographic questionnaire, a standard tool for pain management after surgery, and a numerical tool for assessing patient satisfaction with pain relief and by observing file information and interviewing samples with specified characteristics, and were analyzed and compared with the help of ANOVA, Spearman, t-test, and Wilcoxon statistical tests under SPSS-version 16 software.

Findings: The results showed that the majority of the patients in the study were men (60.2%). with an age range of 50 to 60 years (38%) and all nurses were women with an average and standard deviation of age of 34.36±7.2 years. The mean and standard deviation of the nurses' understanding of the care provided related to pain was 4.37±0.49, and the highest mean (4.55±0.41) was seen in the area of ??communication. On the other hand, the average and standard deviation of patients' understanding of the care provided related to pain was 3.56±0.84, and the environment area had the highest average (3.9±0.93). In general, the average score of understanding of pain-related care and all its areas, except for the environment area (P < 0.001), as well as the average understanding of patient satisfaction with pain relief in nurses was significantly higher than that of patients (P < 0.028).

Conclusion: There is a significant difference between the understanding of the nurse and the patient regarding the provision of pain-related care, the need to pay attention to planning to improve the patient-nurse therapeutic relationship in order to achieve a better understanding of the patient. by the nurse and also highlights the standardization of care.  

Key words: pain. Patient satisfaction. Hospital nurses. Hospitalized patients. Coronary artery transplantation

Statement of the research problem:

Physical and mental comfort is one of the basic human needs, and maintaining and creating it, with the aim of increasing hope and reducing the suffering of patients, is one of the major challenges of nurses. But life is often associated with many factors that disrupt a person's comfort, such as anxiety, shortness of breath, nausea and pain (1). Meanwhile, pain, which is an individual and mental feeling of discomfort (2), is one of the most common complaints that cause discomfort and refer patients to health centers (3). Despite the fact that the true nature of pain remains unknown and its multi-dimensional nature, it appears in times of possible or real tissue damage and under the influence of factors such as inflammation, blood supply disorder, tumors, or surgery (4).

       Surgery, although it is a treatment method to relieve the patient's pain and discomfort, but it can also be considered as one of the important factors causing pain, so that most patients experience pain caused by surgical incisions in the post-operative stage. (2). Statistics also show that about 20 percent of patients undergoing surgery complain of mild pain, 20 to 40 percent of moderate pain, and 40 to 60 percent of them complain of severe pain (5). Coronary artery transplant surgery, which is one of the major and common surgeries in the world (6), is no exception to this rule. According to statistics, this surgery is performed annually on one person out of every thousand Americans (7). In Iran, coronary artery bypass surgery constitutes 60% of all open heart surgeries (8). In Gilan province, we are witnessing an increasing number of this type of surgery. The statistics collected for Gilan province by Mahmoudian show the employment of two heart surgeons and 435 cases of coronary artery transplant surgery in 2015 at Dr. Heshmat Rasht's super-specialized heart center (9). While the statistics compiled by the researcher showed the employment of 5 heart surgeons and 1474 cases of coronary artery transplant surgery in Dr. Heshmat Rasht Hospital in 2007, the 300% increase in coronary artery transplant surgery over two years in Gilan province can indicate the increasing trend of this surgery in this province.

It is noteworthy that Mahmoudian, in his research on patients undergoing coronary artery bypass surgery, showed the average pain intensity after coronary artery bypass surgery in the first 24 hours after being transferred from the ICU to the surgical department to be 5.7 in the range of 0 to 10 (9). It is derived from the basic concepts of nursing (10) and its effective management is a high priority in all nursing care standards (11). Pain after coronary artery bypass surgery is also one of the important nursing diagnoses, and its investigation and relief is one of the main goals of nursing (7). Because nurses spend the most time with patients and are responsible for examining pain, performing palliative measures such as delivering painkillers and evaluating the effects of these measures to ensure an acceptable level of pain relief (12). Also, nurses are responsible for providing a comfortable and appropriate environment for patients and training patients and families to perform palliative treatments at the appropriate time (13). In this context, Idemoto and Kersivik [1] write that pain relief and management is one of the most important considerations and cares for patients undergoing heart surgery and their families (14) which must be done with the desired quality in order to have a significant effect on the recurrence and intensity of the patient's pain (13) because post-operative pain has a great effect on various mental and physical aspects of patients and the resulting complications can also be effective in the economy of treatment, so the continuous evaluation of the quality of the pain treatment process is of particular importance. is A survey of patients about post-operative pain and their satisfaction is one of the major and important indicators of examining post-operative pain treatment processes (15). The American Pain Society [2] also advises care providers to pay attention to the assessment and recognition of pain as the fifth vital sign and has named the decade from 2001 to 2010 as the decade of pain control (16). In this context, the Joint Commission for Accreditation of Health Organizations [3] also stated that patients' pain should be regularly examined and treated from the time of admission to discharge (13). Because the effective and appropriate management of pain will improve the quality of life, facilitate rapid recovery and return to previous function, reduce morbidity and discharge the patient from the hospital earlier (18).

Today, the American Care Quality Committee has presented standards to improve the quality of pain management, which includes ensuring the identification of the patient's pain and its complete treatment, gathering necessary information about pain, easy and availability of pain management facilities and conditions in care clinics, pre-operative training Telling patients about pain, the possibility of patient participation in care, the quick response of the healthcare team to the patient's pain report, the implementation of policies and attention to safety in the use of anti-pain solutions, and the evaluation of the outcome of pain treatment are the means of quality improvement processes. This committee has considered it important to continuously evaluate the quality of the pain management process of patients (2). The Health Care Quality Research Center has also provided clinical attention related to pain management in the form of pain assessment using a scoring scale, rapid implementation of painkillers along with non-pharmacological methods such as proper positioning to reduce pain and provide comfort to patients (18). In the field of care related to pain management after surgery, Idol [4], by presenting the results of his previous studies that were conducted using a qualitative method, presented the dimensions of communication [5], environment [6], confidence [7] and activity [8] in the topic of pain management quality (19). Another point that has been noticed by researchers in the field of pain management quality is the patient's satisfaction with his pain relief. Because determining patient satisfaction is one of the standards that determine performance (20). In fact, patient satisfaction is the ultimate goal of the health care team, which is included in the quality improvement program in hospitals (21). Providing patient satisfaction is possible when he feels comfortable when his basic needs are met. Effective pain management will make the person satisfied with pain management (21). Japville [9] et al showed in their study that in hospitals where patients are more satisfied, the statistics related to length of hospitalization and patient mortality are lower than other hospitals (22).