A Correlation Study on Patients Satisfaction with their Pain Management and Comfort Level after Open Heart Surgery in selected Hospital at Mangaluru

Miss. Lijiya Jose, Dr. (Mrs). Larisa Martha Sams

Laxmi Memorial College of Nursing, A.J Towers, Balmatta, Mangalore- 575 002

*Corresponding Author Email: lijiyajose3@gmail.com

ABSTRACT

AIM: The aim of this study is to find out the correlation between patient satisfaction with their pain management and comfort level after open heart surgery.

BACKGROUND: Cardiovascular disease has become the leading cause of morbidity and mortality in India during the last 3 decades. Hundreds of millions of people around the world undergo surgery every year one of which is cardiac surgery. One of the major complaints of patients after surgery is postoperative pain. Patients' satisfaction is considered an important outcome criterion to health services. Logically, patient satisfaction is an important measure when the quality of nursing care is assessed. All health care professionals .including nurses, have a responsibility to advocate for optimal comfort of patients and to intervene based on the situation and setting in order to protect the best interests of the patient.

METHOD: The study consists of total 25 patients who had undergone open heart surgery.

DESIGN: A descriptive correlative study was used. The sample consisted of 25 patients after open heart surgery patient’s selected using purposive random sampling technique. Patient’s satisfaction with their pain management was assessed by using Pain Satisfaction Survey from immediately after surgery, at first post operative ambulation, and at the time of discharge. And the patients level of comfort after open heart surgery was assessed by using General Comfort Scale at the time of discharge.

RESULTS: The mean scores of immediately after surgery (73.03±4.52) was more than mean pain scores of first ambulation(53.59±3.91) and at discharge(35.11±3.71).All patients were satisfied with their pain management and majority of subjects had good comfort (84%) at discharge. There is a significant association between patient satisfaction with their pain management during immediately after surgery, first post operative ambulation and at discharge since ( F(₂,₇₂₎=3.1, ≤0.05).

CONCLUSION: Findings of the study concluded that all patients were satisfied with their pain management and majority of subjects had good comfort at discharge and there was a significant association between patient satisfaction with their pain management after open heart surgery.

KEYWORDS: Patient Satisfaction, Pain Management, Comfort, Open Heart Surgery

INTRODUCTION:

Today, cardiac diseases are the out of the most common causes of mortality worldwide. They would be the main cause of death worldwide in 2020, according to a prediction made by the World Health Organization (WHO)¹.

Increasing the frequency of cardiac surgeries and increased knowledge regarding pain and pain management, patients experience considerable pain during the postoperative period and pain management remains inadequate after the cardiac surgery.²

Inadequately managed pain can lead to adverse physical and psychological patient outcomes for individual patients and their families. Postsurgical complications related to inadequate pain management negatively affect the patient’s welfare and the hospital performance because of extended lengths of stay and readmissions, both of which increase the cost of care.³

A Prospective study was conducted on the incidence of chronic post-sternotomy pain after cardiac surgery among 369 patients. Coronary artery by-pass grafting (CABG) including internal thoracic artery grafting (ITAG), CABG without ITAG and valve replacement without CABG patients were selected. Visual analogue scale (VAS, 0-100 mm) showed that 41 patients (13%) reported maximum pain intensity > or =30 mm (moderate pain), and 14 of these patients (4%) scored > or =54 mm (severe pain). Study concluded that there was no statistically significant difference in pain incidence and pain intensity when comparing the patients subjected to different surgical procedures.⁴

There are many different causes of post‑operative pain after cardiac surgery. Numerous sources of pain have been identified, such as incisions, trauma, immobility, chest tubes left in after surgery, invasive equipment, and nursing and medical interventions.^5,6 The impact of inadequate pain relief is well known and can result in delayed mobilisation and related complications as well as psychological distress and anxiety .⁷

Assessment of pain is a critical step to providing good pain management. In a sample of physicians and nurses, Anderson and colleagues found lack of pain assessment was one of the most problematic barriers to achieving good pain control.⁸ The assessment parameters should be explicitly directed by hospital or unit policies and procedures.^9,10 To meet the patients’ needs, pain should be reassessed after each intervention to evaluate the effect and determine whether modification is needed. The time frame for reassessment also should be directed by hospital or unit policies and procedures.¹¹

Patients' satisfaction is considered an important outcome criterion to health services. This professed utility rests on a number of implicit assumptions regarding the nature and meaning of expressions of satisfaction.¹² Logically, patient satisfaction is an important measure when the quality of nursing care is assessed. A dissatisfied patient is not psychologically or socially well and thus the goal of nursing has not been attained .¹³

Inadequate management of pain is common and may result in clinical and psychological changes that increase morbidity, mortality, and costs and decrease the quality of life.¹⁴ The American Society for Pain Management in Nursing (ASPMN) states that appropriate pain management is a primary nursing duty for any patient experiencing pain. It is also stated that “pain management ”and “comfort management” are terms that can be used interchangeably.¹⁵

Comfort is defined as the convenience to facilitate daily life and it is a concept central to nursing care.¹⁶ All health care professionals (HCPs), including nurses, have a responsibility to advocate for optimal comfort of patients and to intervene based on the situation and setting in order to protect the best interests of the patient ¹⁵

This study examining open heart surgery patients’ satisfaction with their pain management and comfort level these results may help nurses anticipate and address patient pain more effectively in the early post‑operative period following open heart surgery.

OBJECTIVES OF THE STUDY:

1. To measure the patient satisfaction on their pain management post open heart surgery using Patient Satisfaction Survey tool by American Pain Society (APS).

2. To measure the patient comfort level after open heart surgery using General Comfort Scale

MATERIALS AND METHODS:

A descriptive study was used. The sample consisted of 25 patients after open heart surgery patient’s selected using purposive random sampling technique. Patient’s satisfaction with their pain management was assessed by using Pain Satisfaction Survey from immediately after surgery, at first post operative ambulation, and at the time of discharge. And the patients level of comfort after open heart surgery was assessed by using General Comfort Scale at the time of discharge. The data was collected and complied for data analysis.

RESULTS:

Section A: Description of the sample characteristics

Highest percentage (44%) of patients were within the age group of ≥60years, none of them were less than 40 years of age. Most of the participants (84%) were males. Majority (64%) of the subjects had primary education and least (4%) were illiterate and graduates. All of the subjects (100%) were married. Majority (88%) of the subjects had not undergone surgery. Majority (56%) of the subjects had hypertension and (44%) had diabetes.

Section B : Measure the patient satisfaction with pain management and comfort level after open heart surgery

Figure 1: Bar diagram showing the percentage of pain scores of patients in beginning, at ambulance and at discharge after open heart surgery.

Data in the figure 1 shows that the mean scores of immediately after surgery (73.03±4.52) was more than mean pain scores of first ambulation (53.59±3.91) and at discharge (35.11±3.71).

Table 1: Range, mean, median, Standard deviation of patient satisfaction with their pain management. N=25

Observation

Range (%)

Median (%)

Mean ± Standard deviation

Not Satisfied(<50%)

Satisfied(>50%)

62-100

86.56±6.50

Data in the table 1 shows that all patients were satisfied with their pain management

Table 2 : Distribution of frequency and percentage of patient comfort level at discharge N=25

Category	Frequency (f)	Percentage (%)
No Comfort (90-100)	-	-
Moderate Comfort (100-110)	4	16
Good Comfort (110-120)	21	84

Data in the table 2 shows that majority of subjects had good comfort (84%) at discharge

Section C: Association of patient satisfaction with their pain management after open heart surgery

H_0- There is no significant association between patient satisfaction with their pain management after open heart surgery.

Observations	Mean	Source of variation	Degree of freedom	Sum of squares	Mean square	F ratio	p value
Immediately after surgery	83.2	Between groups	2	3.3	1.7	3.7^*	.03*
First post operative ambulation	87.2	Within groups	72	32.5	.5
At discharge	88.0	Total	74	35.8	2.2

F(₂,₇₂₎=3.1 p≤0.05

Data in table 3 shows that there is a significant association between patient satisfaction with their pain management during immediately after surgery, first post operative ambulation and at discharge since ( F(₂,₇₂₎=3.1, ≤0.05). Hence the null hypothesis is rejected and research hypothesis accepted.

DISCUSSION:

Sample characteristics:

Highest percentage (44%) of patients were within the age group of ≥60years, none were less than 40 years of age. Most of the participants (84%) were males. All the subjects were married. Majority (56%) of the subjects had hypertension and (44%) had diabetes. A similar study conducted regarding patient satisfaction with their pain management and comfort level after open heart surgery in Turkey showed that the mean age was 58.4 years and majority(61.5%) of subjects were males. Most of the subjects (92.3%) were married and highest percentage (32%) of subjects who had hypertension (23%) had diabetes.¹⁷

Description of the patient satisfaction with pain management and comfort level after open heart surgery:

The findings of the study showed that the mean pain scores of immediately after surgery (73.03±4.52) was more than mean pain scores of first ambulation (53.59±3.91) and at discharge(35.11±3.71). All patients were satisfied with their pain management and majority of subjects had good comfort (84%) at discharge. A similar study conducted regarding patient satisfaction with their pain management and comfort level after open heart surgery in Turkey showed that the mean pain scores immediately after surgery(7.07+2.6) was more than the mean pain scores of first post-operative ambulation(6.71+2.7), and at discharge(4.57+2.3), majority (80.8%) of the patients were satisfied with pain management and the mean score of comfort level at discharge was 3.16+0.2.¹⁷Similar findings were found in another study regarding study of patient pain management after heart surgery showed that the mean pain level 1 and 4 hours after extubation, and before and one hour after transferring to wards was 5.05±2.5, 4.09±2.0, 3.52±1.8, 2.36±1.89 respectively. And in this study 80% reported satisfaction with their post-surgery pain management.¹⁸

Association of patient satisfaction with their pain management after open heart surgery:

In the present study there was a significant association between patient satisfaction with their pain management during immediately after surgery, first post operative ambulation and at discharge. The present study findings are also supported by the study regarding patient satisfaction with their pain management and comfort level after open heart surgery in Turkey that showed the pain intensity gradually decreased as patients neared hospital discharge and their overall satisfaction with the nurses' pain management was high.¹⁷Another study regarding quality improvement survey to assess pain management in cardiac surgery patients who showed that the overall management and individualized care in the intensive care units probably made the patients satisfied with the pain management.¹⁹

CONCLUSION:

The following conclusions were drawn from the study:

1. The mean scores of immediately after surgery was more than mean pain scores of first ambulation and at discharge.

2. All patients were satisfied with their pain management and majority of subjects had good comfort at discharge.

3. There is a significant association between patient satisfaction with their pain management during immediately after surgery, first post operative ambulation and at discharge .

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Received on 14.07.2015 Modified on 27.07.2015

Int. J. Nur. Edu. and Research 3(4): Oct.-Dec., 2015; Page 419-422

DOI: 10.5958/2454-2660.2015.00033.2