ประสิทธิผลของการใช้แนวปฏิบัติทางคลินิกสำหรับการจัดการอาการปวดในผู้สูงอายุหลังผ่าตัดกระดูกสะโพก หอผู้ป่วยออร์โธปิดิกส์ โรงพยาบาลมหาราชนครเชียงใหม่

Abstract

After a hip operation elderly patients can suffer a great deal of pain. To manage such pain, scientific evidence is needed to acheive positive outcomes. This operational study aimed to determine the effectiveness of implementing clinical practice guidelines (CPGs) for pain management among elders with post hip operation, at the orthopaedics ward, Maharaj Nakorn Chiang Mai Hospital. Subjects consisted of 15 elders post hip operation who received usual nursing care between July and November 2013 and 13 elders post hip operation who received care based on the CPGs between January and April 2014. The instrument used was the CPGs for pain management among elders with post hip operation developed by Sanpunya (2009). The implementation of the CPGs model of the Registered Nurse Association of Ontario (2002) was used as a framework for this study. Data collection tools consisted of the numeric rating pain scale, frequencies and doses of analgesic, level of patient satisfaction, and level of provider satisfaction record form. Data were analyzed using chi-square and descriptive statistics. The results indicated that the number of elders in the CPGs group who had severe pain was significantly less than those who received usual nursing care (p<.05). The CPGs group also showed a higher level of satisfaction than the group receiving usual nursing care. Frequency of analgesic use in elders in both groups was not significantly different. In addition, most providers (75.86%) were satisfied with the CPGs to a high level. This study confirms that implementation of clinical practice guidelines for pain management reduces pain among elders post hip operation. It is recommended that the clinical practice guidelines be used continuously in the unit, and adjusted to fit the context.

After a hip operation elderly patients can suffer a great deal of pain. To manage such pain, scientific evidence is needed to acheive positive outcomes. This operational study aimed to determine the effectiveness of implementing clinical practice guidelines (CPGs) for pain management among elders with post hip operation, at the orthopaedics ward, Maharaj Nakorn Chiang Mai Hospital. Subjects consisted of 15 elders post hip operation who received usual nursing care between July and November 2013 and 13 elders post hip operation who received care based on the CPGs between January and April 2014. The instrument used was the CPGs for pain management among elders with post hip operation developed by Sanpunya (2009). The implementation of the CPGs model of the Registered Nurse Association of Ontario (2002) was used as a framework for this study. Data collection tools consisted of the numeric rating pain scale, frequencies and doses of analgesic, level of patient satisfaction, and level of provider satisfaction record form. Data were analyzed using chi-square and descriptive statistics. The results indicated that the number of elders in the CPGs group who had severe pain was significantly less than those who received usual nursing care (p<.05). The CPGs group also showed a higher level of satisfaction than the group receiving usual nursing care. Frequency of analgesic use in elders in both groups was not significantly different. In addition, most providers (75.86%) were satisfied with the CPGs to a high level. This study confirms that implementation of clinical practice guidelines for pain management reduces pain among elders post hip operation. It is recommended that the clinical practice guidelines be used continuously in the unit, and adjusted to fit the context.