Outcomes of a nursing intervention to improve post-operative pain control at night

Postoperative pain is often poorly managed, and the control of such pain specifically at night has been neglected. This study aimed to evaluate the effectiveness of a nursing intervention designed to improve pain control through enhanced night-time nurse-patient communications.
The design of the study was a before and after trial with a control ward for comparison. Two orthopaedic wards were matched in terms of organisational factors, grades of nursing staff, patient type and throughput, types of surgery, anaesthetic staff and analgesic prescribing.
The intervention was comprised of a patient information package and the development of a structured night-time pain assessment which was introduced randomly to one of the two wards following baseline data collection.
A total of 417 patients from the four groups (two wards pre- and post-intervention) were interviewed on the second postoperative morning about their pain (verbal rating scales), anxiety (HAD scale), and other factors during the previous night. Information about analgesic provision and other nursing input was taken from the appropriate documentation as well as directly from patients.
The intervention was associated with significantly lower reported pain scores. There was an increased frequency of pain assessment but there was no change in the type or frequency of analgesic provision. The main predictors of lower pain scores were: presence of the intervention, lower anxiety scores, and trauma rather than elective surgery. The authors recommend that structured pain assessment should be introduced to wards where patients are likely to suffer pain during the night, and greater attention should be paid to the amelioration of anxiety.