Best practice guideline for nurses for the assessment and management of acute trauma-related pain in emergency centers

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dc.contributor.advisorJordan, P. J.en_ZA
dc.contributor.advisorVan der Heever, M. M.en_ZA
dc.contributor.authorMagerman, Yolande Nerissa
dc.contributor.otherStellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Nursing & Midwifery.en_ZA
dc.date.accessioned2023-02-23T06:24:54Z
dc.date.accessioned2023-05-18T07:01:54Z
dc.date.available2023-02-23T06:24:54Z
dc.date.available2023-05-18T07:01:54Z
dc.date.issued2023-03
dc.descriptionThesis (PhD)--Stellenbosch University, 2023. en_ZA
dc.description.abstractENGLISH SUMMARY: Background: Pain is a universal, common symptom experienced by patients admitted to the emergency center (EC). The global burden of pain includes trauma-related pain, which is a natural consequence of injury. Guidelines are necessary tools in evidence-based practice for the implementation of standardised nursing care with a common, efficient approach to patient care. The absence of a guideline for the assessment and management of acute trauma-related pain creates the opportunity for nurses to practice variantly and inconsistently leading to possible negative patient outcomes. Aim: The purpose of the study was to contextualise a best practice guideline for the assessment and management of acute trauma-related pain in emergency centers in the Western Cape, South Africa. Methods: The research was conducted in three phases. Phase one comprised of two quantitative studies: professional nurses in sub-study one, and the patients in sub-study two. Phase two consisted of a scoping review to identify, appraise, and summarise the content of the available best practice guidelines for the assessment and management of pain in adult patients within the emergency care settings. Phase three included the synthesis of the extracted recommendations and the drafting of the best practice guideline. Results: Data was collected from 118 professional nurses and 529 patients in the ECs of five hospitals in the Western Cape, South Africa. The findings indicated that approximately half of the nurses displayed adequate knowledge, while half have good knowledge and 4% have poor knowledge related to pain assessment and pain management. Attitudes and self-reported practices on pain assessment and management were congruent with the knowledge levels of nurses. Most of the nurses (n=63, 54%) did not consider their level of knowledge on the assessment and management of acute trauma-related pain to be up to date according to best practice nursing. Patient data findings indicated that the nurses did not consistently practise assessment and management of acute trauma-related pain in the ECs. The findings confirmed the need for base practices on the best available evidence. Six best practice guidelines on pain assessment and pain management were identified by means of the scoping review and 114 recommendations were extracted from them. The contextualised guideline was validated by nine external reviewers, who appraised the guideline using the AGREE II tool. An algorithm was developed as an evidence summary and supporting document for ease of reference for professional nurses in the EC. Conclusion: The need for a best practice guideline in the EC for professional nurses, as the end-users, was evident by the variation in practice, lack in knowledge, attitudes, and practices of nurses. A contextualised best practice guideline was developed as the end-product of this research study. Further research is recommended to implement and test the feasibility, appropriateness, meaningfulness, and effectiveness of the best practice guideline for professional nurses in the EC in a South African context.en_ZA
dc.description.abstractAFRIKAANSE OPSOMMING: Agtergrond: Pyn is ‘n universele, algemene simptoom wat ondervind word deur pasiente wat in die Ongevalle-Eenheid (OE) opgeneem word. Die globale probleem onder pyn, sluit in trauma-verwante pyn wat ‘n natuurlike oorsaak is. Riglyne is noodsaaklike instrumente in bewys gebaseerde praktyke vir die implementering van gestandaardiseerde verpleegsorg met ‘n effektiewe benadering vir die versorging van pasiente. Die afwesigheid van riglyne vir die assessering en behandeling van akute trauma-verwante pyn, skep die geleentheid vir verpleegsters om onbestendige en inkonsekwente behandeling toe te dien wat kan lei tot negatiewe uitkomste vir pasiente. Doel: Die doel van hierdie navorsingstudie is om ‘n praktyk met die beste riglyne vir die assessering en behandeling van akute trauma-verwante pyn in die Ongevalle-Eenhede (OEe) in die Wes-Kaap, Suid-Afrika te kontekstualiseer. Metodes: Die navorsing is in drie fases uitgevoer: Fase een bestaan uit twee kwantitatiewe studies wat professionele verpleegsters insluit as substudie een en pasiente as substudie twee. Fase twee bestaan uit ‘n omvang-resensie wat die beste beskikbare riglyne vir die assessering en behandeling van volwasse pasiente in die ongevalle-sorg eenhede te identifiseer, die waarde te bepaal en die inhoud op te som. Fase drie sluit in die sintese oor die uittreksel van aanbevelings en die opstel van die beste praktyk vir riglyne. Resultate: Data van 118 professionele verpleegsters en 529 pasiente in die OE van vyf hospitale in die Wes-Kaap, Suid-Afrika is ingesamel. Die bevindinge het aangedui dat ongeveer helfte van die verpleegsters voldoende kennis weerspieel, terwyl daar (helfte oor goeie kennis) en 4% nie oor genoegsame kennis wat verband hou met pyn-assessering en -behandeling beskik nie. Houdings-en selfgerapporteerde praktyke oor pyn-assessering en -behandeling is ooreenstemmend met betrekking tot die kennisvlakke van verpleegsters. Meeste van die verpleegsters (n=63, 54%) het nie hulle vlak van kennis in ag geneem oor die assessering en behandeling van akute trauma-verwante pyn wat op hoogte gebring moes word vir die beste verplegingspraktyk nie Data bevindinge van pasiente het aangedui dat die verpleegsters nie konsekwent pyn-assessering en -behandeling van akute trauma-verwante pyn in die OEe gepraktiseer het nie. Die bevindinge het bevestig dat daar ‘n behoefte is om praktyke op die beste beskikbare bewyse te baseer. Ses beste praktykriglyne oor pyn-assessering en -behandeling is geidentifiseer by wyse van die omvang-resensie en 114 aanbevelings is daaruit saamgevat. Die gekontekstualiseerde riglyne is gevalideer deur nege eksterne resensente wat die waardebepaling gedoen het, deur die gebruik van die AGREE II instrument. ‘n Algoritme was ontwikkel as ‘n opsomming en ondersteunende dokumente vir professionele verpleegsters in die OE wat as ‘n maklike verwysing is. Gevolgtrekking: Die behoefte vir die beste praktykriglyne in die OEe wat deur professionele verpleegsters as die eindverbruikers gebruik word, is voor die handliggend deur die variasiepraktyke, gebrek aan kennis, houdings in praktyke van verpleegsters. ‘n Gekontekstualiseerde beste praktykriglyn is ontwikkel as die eindproduk van hierdie navorsingstudie. Verdere navorsing word aanbeveel om die uitvoerbaarheid, gepastheid, betekenisvolheid en effektiwiteit van die beste praktykriglyne vir professionele verpleegsters in die OE in ‘n Suid-Afrikaanse konteks te implementeer en te toets.af_ZA
dc.description.versionDoctorate
dc.format.extentxxiii, 360 pages : illustrations (color), maps, includes annexures
dc.identifier.urihttp://hdl.handle.net/10019.1/127051
dc.language.isoen_ZAen_ZA
dc.publisherStellenbosch : Stellenbosch University
dc.rights.holderStellenbosch University
dc.subject.lcshPain -- Measurementen_ZA
dc.subject.lcshPain -- Treatmenten_ZA
dc.subject.lcshPain managementen_ZA
dc.subject.nameUCTD
dc.titleBest practice guideline for nurses for the assessment and management of acute trauma-related pain in emergency centersen_ZA
dc.typeThesisen_ZA
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