Date of Award

Fall 9-28-2018

Degree Type

Doctoral Nursing Capstone Project

Degree Name

Doctor of Nursing Practice (DNP)

School

Leadership and Advanced Nursing Practice

Committee Chair

Dr. Marjorie Everson

Committee Chair Department

Nursing

Committee Member 2

Dr. Michong Rayborn

Committee Member 2 Department

Nursing

Committee Member 3

Dr. Cathy Hughes

Committee Member 3 Department

Nursing

Abstract

Postoperative pain management is a necessary component of the care of every surgical patient. Epidural analgesia is a widely used method to provide excellent postoperative pain relief and enhance postoperative recovery (Sawhney, 2012). Epidural analgesia is associated with fewer side effects than alternative pain management techniques; however, when epidural catheters are managed improperly, or pain is inadequately assessed, epidural analgesia fails to provide adequate pain relief (Deni et al., 2016). More than 80% of surgical patients experience moderate to severe postoperative pain, and 28 to 50% of these patients have a pain score greater than 6 out of 10 at any given time (Chou et al., 2016; Duncan & Haigh, 2013; Nagelhout & Plaus, 2014). Epidural analgesia needs improvement because it has been linked to a failure rate of 30% in clinical practice (Duncan & Haigh, 2013). The purpose of this DNP project was to perform an epidural policy analysis at a hospital in Mississippi.

Questionnaires were collected from critical care nurses and anesthesia providers. Seventy-five percent of critical care nurses and anesthesia providers were not aware that epidural analgesia has a 30% failure rate. Also, 50% of nurses and 95% of anesthesia providers believed that having up-to-date, accessible policies outlining epidural care, and management can improve postoperative epidural analgesia. One hundred percent of nurses and 95% of anesthesia providers believed their institution’s epidural policy demonstrates areas for improvement. Lastly, 75% of nurses and 95% of anesthesia providers felt that the hospital would benefit from an updated epidural policy.

Postoperative pain management is a necessary component of the care of every surgical patient. Epidural analgesia is a widely used method to provide excellent postoperative pain relief and enhance postoperative recovery (Sawhney, 2012). Epidural analgesia is associated with fewer side effects than alternative pain management techniques; however, when epidural catheters are managed improperly, or pain is inadequately assessed, epidural analgesia fails to provide adequate pain relief (Deni et al., 2016). More than 80% of surgical patients experience moderate to severe postoperative pain, and 28 to 50% of these patients have a pain score greater than 6 out of 10 at any given time (Chou et al., 2016; Duncan & Haigh, 2013; Nagelhout & Plaus, 2014). Epidural analgesia needs improvement because it has been linked to a failure rate of 30% in clinical practice (Duncan & Haigh, 2013). The purpose of this DNP project was to perform an epidural policy analysis at a hospital in Mississippi.

Questionnaires were collected from critical care nurses and anesthesia providers. Seventy-five percent of critical care nurses and anesthesia providers were not aware that epidural analgesia has a 30% failure rate. Also, 50% of nurses and 95% of anesthesia providers believed that having up-to-date, accessible policies outlining epidural care, and management can improve postoperative epidural analgesia. One hundred percent of nurses and 95% of anesthesia providers believed their institution’s epidural policy demonstrates areas for improvement. Lastly, 75% of nurses and 95% of anesthesia providers felt that the hospital would benefit from an updated epidural policy.

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