Objective: The purpose of this study was to test the effect of a pain communication intervention on elders' ability to communicate their pain and obtain pain relief after surgery.
Intervention and Outcome Variables: The intervention was based upon Communication Accommodation Theory (CAT) that describes specific communication skills helpful in managing a conversation. It was predicted that elders taught pain communication skills and basic pain management information would experience less postoperative pain than elders taught only pain management information or elders taught no additional information.
Design: A posttest-only experimental design was used to compare three groups: (a) elders receiving standard preoperative teaching, and viewing the pain management film and the pain communication film; (b) elders receiving standard preoperative teaching and viewing the pain management film; and (c) elders receiving only the standard preoperative teaching.
Sample: Forty-one elders undergoing a single total knee replacement at two different hospitals were randomly assigned to one of the three conditions. All of the elders had attended a preoperative total joint replacement class (standard preoperative teaching) provided by the hospital, as part of their preparation for surgery.
Methods: The two films were professionally developed for the study, reviewed by an expert in pain management for elders, and tested with a focus group of elders prior to use. CAT guided development of the pain communication film. Content for the pain management film was based on prior work by Ferrell, Rhiner & Ferrell (1993). Elders in the two film conditions also received a colorful tri-folded handout summarizing the content of the film(s) they viewed. Average daily postoperative pain was measured with the Short Form McGill Pain Questionnaire on postoperative day 1, and 2, and 1 and 7 days after discharge by a research assistant blind to the condition. Two pain dimensions were measured, pain intensity (100 mm VAS) and sensory dimensions of pain (0 - 33 scale).
Findings: Significant group differences emerged for the first postoperative day, F(4,74)=2.96, p < .025. Post hoc analysis with the Scheffe' test revealed that elders in the treatment group reported significantly less sensory pain than elders in the control condition with film, M=3.6 (SD=2.48) and M=8.7 (SD=7.19), respectively, F(2, 38)=4.21, p < .023. The VAS pain intensity scores were M=47.0 (SD=29.24), M=41.1 (SD=23.16) and M=31.7 (SD=18.60) for the control no film, control with film and treatment group, respectively.
Conclusions: A significant difference in the sensory dimension of pain emerged between elders in the treatment group and elders in the control condition with film. The pain intensity differences, although not statistically significant, suggest a clinically significant difference between the treatment and control groups, with treatment group elders reporting a pain intensity in the mild range and elders in the two control groups reporting a slightly higher pain intensity in the moderate range. The sensory and pain intensity results together suggest that teaching elders specific pain communication skills along with basic pain information before surgery might result in greater pain relief during the early postoperative period when pain tends to be most intense.
Implications: Further refinement of the film intervention is currently under way, so that greater pain relief might be obtained beyond the first postoperative day. Nurses can assist elders to use pain communication skills, for example by teaching them to describe the pain sensation in their own words, use a pain intensity rating scale, prioritize the pain topic when pain is a problem, and ask for clarification when they do not understand their pain management. Elders who effectively communicate their pain may be more likely to obtain greater postoperative pain relief.
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