Effects of preoperative teaching upon patients with differing modes of response to threatening stimuli

Adult burn patients experience pain during wound care despite pharmacological interventions. Additional nursing interventions are needed to improve pain management. A systematic review was undertaken in order to examine the implications of previous research for evidence based decisions concerning the use of non-pharmacological nursing interventions and for future research. Twenty-six studies met the inclusion criteria and were discussed. The majority of the included studies concerned behavioural nursing interventions and focussed on promotion of psychological comfort. Although 17 studies showed that the intervention had a positive effect on pain outcomes and no adverse effects of the reviewed interventions were reported, the best available evidence was found for active hypnosis, rapid induction analgesia and distraction relaxation. However, in order to reduce methodological limitations, further research is needed before well-founded evidence based decisions for nursing practice can be made. Aspects that seem important for future research, like the type of the intervention, theoretical framework, manner of giving instruction and guidance, cost, outcomes, measurement instruments and data collection points are considered.

This study examined the effectiveness of an innovative method of pain control, pleasant imagery, for the management of acute postsurgical pain in 32 individuals having elective surgery. In the experimental group, 16 preoperative subjects received procedural information and instruction regarding the use of pleasant imagery to control pain. In the control group, 16 subjects received procedural information only. Scores on a visual analogue scale and recorded doses of analgesics administered postoperatively provided measures of perceived pain and analgesic consumption, respectively. The t test for independent means showed that patients who used pleasant imagery perceived significantly less postsurgical pain and consumed significantly less pain medication than did the control group (p < .05). These findings suggest that nurses can enhance the management of postoperative pain by teaching patients to use pleasant imagery.

Although informational booklets are being used increasingly in Dutch hospitals, little is known of their effects and the conditions for optimal use. Various aspects of the use and effects of a specially developed information booklet were investigated in two surgical wards of a general hospital. The booklet gave information about ward procedures, operative routines, narcosis, and psychosocial care possibilities. Both before and after introduction of the booklet we gathered data on the satisfaction, knowledge, and emotional state of patients on the two wards and their perception of the care climate. Patients on the control ward received just the booklet. On the experimental ward staff nurses were trained in nondirective therapeutic skills, and measurements were repeated on both wards after this intervention. In a third manipulation on the experimental ward, some of the patients had a supportive and informative talk with a trained nurse. Although patients appreciated and read the booklet better than a general hospital leaflet, the results show that the booklet and other supporting measures had no effect on the patients' perception of their well-being.