1. EVIDENCED BASED PRACTICE & ALTERNATIVE PAIN MANAGEMENT: IMPLEMENTING A NEW RESOURCE PRESENTED BY: ERIN HOFFMAN, LAURA SWICKY, SARA STONE, MARSHA DAVIS, LAURA DADDOW, KELLY MANDELL

2. Agenda Current postoperative pain management techniques. What evidence reveals about non-pharmacological pain management efforts. Implementation of adjuvant pain therapy.

3. Postoperative Pain “Pain is most severe immediately after the operation when the effect of the anesthetic analgesia ends.” “Postoperative pain is managed usually by administering parenteral opioids.” ~ Vaajoki, Anne et al.

4. Current Pain Management Therapy Preoperative patient education. Procedure, recovery, pain expectations & management. Literature provided in welcome packet, describing non- pharmacological pain management & comfort items / actions. Various relaxation options. Cost associated. Pharmacological options are the focus.

5. The Evidence on Music “Music is an example of an external and distracting stimulus with cognitive and emotional features that can induce an analgesic effect, influencing better moods and emotions.” - Villareal, Vaajoki (2010) Music causes changes in physiology (i.e. reduction in heart and respiratory rate,) behavior (i.e. enhances sense of relaxation and emotions (i.e. reduce anxiety, improves mood) – Kemper “Familiarity may be key in the influence of the cognitive and emotional mechanisms of music induced analgesia, music decreased pain more than sounds of nature-- therefore, cognitive and emotional factors of familiar music may have more to do with the pain decrease than music itself”. - Villareal, Vaajoki (2010)

6. The Evidence on Music, cont. “In terms of feeling well and healing it is important that the music is the kind the patient likes and suits their moods.” – Leardi “Music should be offered as a non-pharmalogical method adjuvant to pharmalogical methods in pain management after surgery because of it’s potential benefit, but it should be tailored to the preferences and moods of the individual patient.” - Villareal, Vaajoki (2010)

7. The Evidence on Distraction / Movies “Pain intensity has been shown to be lowered through distraction, more so than the patient’s acceptance of their situation and the pain itself. Acceptance of the pain has been shown to increase tolerance of the pain, but in the acute care setting, it may be more important for healing to have less intense pain, as opposed to the same amount of pain, but a higher tolerance of it. Distraction aims to shift the attentional focus away from painful stimulation and thereby to lessen the intensity. In a chronic pain situation, acceptance of the pain may make more sense than distraction, because an increase in pain tolerance might be preferred.” - Kohl

8. The Evidence on Distraction / Movies, cont. A different article revealed: The top four non-pharmacological pain interventions recognized by patients, their families, and nurses, for their usefulness, relevance, and feasibility, were music therapy, distraction, simple massage, and the presence of family members. An argument against distraction as therapy noted in the article is that it could distract the nurses, as well. A solution to this is that when an assessment or medication administration is necessary, a movie could be paused, music could be turned down, or a puzzle book could simply be put aside. However, a testimonial in the article from a pt read that watching something on the television was the only thing that took his mind off of the pain.

9. Suggestions for Non-Pharmacology Pain Management Massage Decreases stress in the acute care setting, which could decrease pain. Some patients may prefer massage, while others may not. Cold & Hot Therapy Ice has been shown to decrease pain post-operatively. Holistic & Spiritual Care

10. Patient Testimonials “I think a video library would be great! Not only could it provide a nice distraction, but it could also improve the experience & satisfaction of patients and their families.” “Having movies on hand would be a great way to pass the time. It can be difficult to focus on anything besides why you are here.” “I don’t know if it would solve pain, but it would be a nice addition and surprise.” - All quotes from personal interviews with patients & families of those recovering from surgery on this floor.

11. Discussing Pain Management vs. Doing Something About it. Evidence shows that distraction pain therapy is more successful when patients are able to choose something familiar. Daytime TV is unfamiliar to most. Our Goal Make a difference & help the patients, families and staff of this Unit. Decrease pain level of patients. Decrease the need for & frequency of call lights, increasing staff productivity. Increase patient and family satisfaction.

12. Our Gift 15 Movies available for patient checkout. Movie list & check out form for tracking. Only the beginning… Box for continued donations. Suggested Placement - the floor or staff break room.

13. Suggestions for Success Provide remote w/ DVD to minimize falls. Include DVD list in welcome bag. Increasing paitient awareness & usage. DVD List management. Staff member volunteer. Maintain electronic copies of movie for ease in making updates. Grow the library!!

14. Thank you for coming! Questions?