Patient controlled analgesia and the assessment and control of pain in a coronary care unit

  • Karen Smith

    Student thesis: Doctoral Thesis


    Coronary Heart Disease (CHD) is one of the major causes of morbidity and mortality in Scotland. One of the most frequently reported symptoms of CHD is chest pain which is often of sudden onset and severe in nature. The control of pain presents a challenge to nursing and medical staff as patients experience ongoing pain. This study sought to investigate the assessment and treatment of cardiac pain in a coronary care unit (CCU).

    Adequate assessment of pain is a fundamental step in its management. Within this study the process of communication with patients who had cardiac pain was assessed by measuring the duration, frequency and content of verbal communication between nurses and patients. Following attendance at an educational programme the staffs' behaviour was reassessed to evaluate any change. No significant difference was observed in the duration or frequency of interaction, but a change was observed in the quality of communication which occurred during pain assessment and the subsequent administration of opiates in CCU.

    Having attempted to improve the practice of nursing staff, a comparison of patient controlled analgesia (PCA) versus nurse administered analgesia for pain following myocardial infarction was performed for 48 hours. A significant reduction in pain intensity was reported in the PCA group. The PCA group also used significantly more analgesics particularly in the second 24 hour period. The use of PCA clearly demonstrated the problem of ongoing pain following myocardial infarction. An exploration of the levels of urinary catechoalmine secretion as an objective measure of pain was found to show no relationship to pain experience. The patients' views on the management of their pain and opinions of PCA was also explored. The results suggested that PCA removed the obstacles associated with the administration of analgesia in the conventional regime. It was readily accepted by both patients and staff in CCU and could be easily offered as a treatment option in the management of cardiac pain. This study has generated areas for further investigation which include the influence of alternative education strategies on pain management and the evaluation of PCA with other client groups, and in different clinical settings.
    Date of AwardMay 1996
    Original languageEnglish

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