Susan Hunter | Deakin University (original) (raw)

Papers by Susan Hunter

Background and Aims: Severity of postoperative pain is commonly evaluated using an 11-point numer... more Background and Aims: Severity of postoperative pain is commonly evaluated using an 11-point numerical rating scale (NRS). Clinically meaningful application of the NRS is challenging because there is ambiguity and ambivalence for both patients and clinicians in the identification and interpretation of the number used to represent pain intensity. The overall aim of this sequential, multiphasic, mixed methods study is to refine patient reporting of pain intensity through the development of an evidence-based approach to the clinical application of the 11-point NRS for the assessment of pain severity in the postoperative orthopaedic context. In Phase 1, interviews with postoperative patients were designed to explore the dimensions associated with six a priori domains of pain intensity ratings i.e. previous experience, expected pain, quality, functional impact, distress and urgency for treatment. The synthesis of the interview data are presented here.

Objectives: The objective of the study was to examine patients’ experiences of pain in Hospital i... more Objectives: The objective of the study was to examine patients’
experiences of pain in Hospital in the Home (HITH) programs and
identify the issues related to providing optimal pain management
for acute care patients in the home environment.
Methods: A descriptive survey of patients’ experience of pain and
pain management in 3 HITH programs in metropolitan Melbourne,
Australia (n=359). Data were collected by telephone
interview using a modified version of The American Pain Society’s
Patient Outcome Questionnaire. Patients were interviewed 48 to 72
hours after admission to the HITH program. Consecutive, adult,
acute care patients were invited to participate in the study. Patients
who had previously participated or had communication difficulties
unable to be overcome with the assistance of an interpreter were
excluded.
Results: Sixty-nine percent of patients interviewed experienced pain
at home and 86% of these patients had experienced pain in the 24
hours before the interview. Over half (56%) of the patients had
experienced moderate-to-severe worst pain in the previous 24 hours
and 33% reported moderate-to-severe pain as their average pain
experience. Two hundred thirty-two (93.2%) of the 250 patients
who experienced pain had pain in hospital before being transferred
to HITH. Of these patients, 52.2% (n=132) were prescribed
analgesics to take home with them; the remaining 118 patients
experiencing pain were not prescribed analgesics and either sourced
analgesics once home (n=81, 68.1%) or did not take any
analgesics (n=38, 31.9%).
Discussion: Treatment of pain at home was suboptimal with
patients experiencing moderate-to-severe pain and discomfort
during the treatment phase of their illness. Lack of appropriate
discharge planning strategies meant that patients went home
without adequate analgesia and use of nonprescribed pain
medication was common. The number of patients transferred
home without analgesics indicates a worrying underrecognition of
the need for analgesia in this care context and poses a risk to
patient safety that is no less significant because patients are
at home.

Objective: A study aimed at exploring the variation in conceptions of problem-based learning (PBL... more Objective: A study aimed at exploring the variation in conceptions of problem-based
learning (PBL) held by undergraduate nursing students and their approaches to study in PBL in a
pre-registration Bachelor of Nursing Course.
Method: Students were asked to respond to four open ended questions which focussed on their
experience of PBL in a particular subject. Data were analysed in two phases using a modified
phenomenographic analysis. In the first phase a set of categories of description were developed
from the student responses. In the second phase the individual responses were classified in terms
of the categories. The paper will describe the approach to the analysis, the categories identified, the
relationship between the categories and discuss the implications for further research and teaching.
Results: The findings indicated that there was a substantial variation in the conceptions and
approaches. The majority of students, however, held relatively unsophisticated conceptions of
problem based learning which were related to relatively unsophisticated approaches to learning.
Conclusion: Students participating in their first PBL subject generally reported unsophisticated
conceptions of and approaches to learning which were not linked to professional practice outcomes.
However, those completing the last PBL subject had recognised the link between participation in the
process and the development of knowledge and skills for professional practice.

Background: Evidence from clinical practice and the extant literature suggests that post-operativ... more Background: Evidence from clinical practice and the extant literature suggests that post-operative pain assessment
and treatment is often suboptimal. Poor pain management is likely to persist until pain management practices
become consistent with guidelines developed from the best available scientific evidence. This work will address the
priority in healthcare of improving the quality of pain management by standardising evidence-based care processes
through the incorporation of an algorithm derived from best evidence into clinical practice. In this paper, the
methodology for the creation and implementation of such an algorithm that will focus, in the first instance, on
patients who have undergone total hip or knee replacement is described.
Methods: In partnership with clinicians, and based on best available evidence, the aim of the Management
Algorithm for Post-operative Pain (MAPP) project is to develop, implement, and evaluate an algorithm designed to
support pain management decision-making for patients after orthopaedic surgery. The algorithm will provide
guidance for the prescription and administration of multimodal analgesics in the post-operative period, and the
treatment of breakthrough pain. The MAPP project is a multisite study with one coordinating hospital and two
supporting (rollout) hospitals. The design of this project is a pre-implementation-post-implementation evaluation
and will be conducted over three phases. The Promoting Action on Research Implementation in Health Services
(PARiHS) framework will be used to guide implementation. Outcome measurements will be taken 10 weeks
post-implementation of the MAPP. The primary outcomes are: proportion of patients prescribed multimodal
analgesics in accordance with the MAPP; and proportion of patients with moderate to severe pain intensity at
rest. These data will be compared to the pre-implementation analgesic prescribing practices and pain outcome
measures. A secondary outcome, the efficacy of the MAPP, will be measured by comparing pain intensity scores of
patients where the MAPP guidelines were or were not followed.
Discussion: The outcomes of this study have relevance for nursing and medical professionals as well as informing
health service evaluation. In establishing a framework for the sustainable implementation and evaluation of a
standardised approach to post-operative pain management, the findings have implications for clinicians and
patients within multiple surgical contexts.

Nursing ethics, Jan 1, 2000

Background and Aims: Severity of postoperative pain is commonly evaluated using an 11-point numer... more Background and Aims: Severity of postoperative pain is commonly evaluated using an 11-point numerical rating scale (NRS). Clinically meaningful application of the NRS is challenging because there is ambiguity and ambivalence for both patients and clinicians in the identification and interpretation of the number used to represent pain intensity. The overall aim of this sequential, multiphasic, mixed methods study is to refine patient reporting of pain intensity through the development of an evidence-based approach to the clinical application of the 11-point NRS for the assessment of pain severity in the postoperative orthopaedic context. In Phase 1, interviews with postoperative patients were designed to explore the dimensions associated with six a priori domains of pain intensity ratings i.e. previous experience, expected pain, quality, functional impact, distress and urgency for treatment. The synthesis of the interview data are presented here.

Objectives: The objective of the study was to examine patients’ experiences of pain in Hospital i... more Objectives: The objective of the study was to examine patients’
experiences of pain in Hospital in the Home (HITH) programs and
identify the issues related to providing optimal pain management
for acute care patients in the home environment.
Methods: A descriptive survey of patients’ experience of pain and
pain management in 3 HITH programs in metropolitan Melbourne,
Australia (n=359). Data were collected by telephone
interview using a modified version of The American Pain Society’s
Patient Outcome Questionnaire. Patients were interviewed 48 to 72
hours after admission to the HITH program. Consecutive, adult,
acute care patients were invited to participate in the study. Patients
who had previously participated or had communication difficulties
unable to be overcome with the assistance of an interpreter were
excluded.
Results: Sixty-nine percent of patients interviewed experienced pain
at home and 86% of these patients had experienced pain in the 24
hours before the interview. Over half (56%) of the patients had
experienced moderate-to-severe worst pain in the previous 24 hours
and 33% reported moderate-to-severe pain as their average pain
experience. Two hundred thirty-two (93.2%) of the 250 patients
who experienced pain had pain in hospital before being transferred
to HITH. Of these patients, 52.2% (n=132) were prescribed
analgesics to take home with them; the remaining 118 patients
experiencing pain were not prescribed analgesics and either sourced
analgesics once home (n=81, 68.1%) or did not take any
analgesics (n=38, 31.9%).
Discussion: Treatment of pain at home was suboptimal with
patients experiencing moderate-to-severe pain and discomfort
during the treatment phase of their illness. Lack of appropriate
discharge planning strategies meant that patients went home
without adequate analgesia and use of nonprescribed pain
medication was common. The number of patients transferred
home without analgesics indicates a worrying underrecognition of
the need for analgesia in this care context and poses a risk to
patient safety that is no less significant because patients are
at home.

Objective: A study aimed at exploring the variation in conceptions of problem-based learning (PBL... more Objective: A study aimed at exploring the variation in conceptions of problem-based
learning (PBL) held by undergraduate nursing students and their approaches to study in PBL in a
pre-registration Bachelor of Nursing Course.
Method: Students were asked to respond to four open ended questions which focussed on their
experience of PBL in a particular subject. Data were analysed in two phases using a modified
phenomenographic analysis. In the first phase a set of categories of description were developed
from the student responses. In the second phase the individual responses were classified in terms
of the categories. The paper will describe the approach to the analysis, the categories identified, the
relationship between the categories and discuss the implications for further research and teaching.
Results: The findings indicated that there was a substantial variation in the conceptions and
approaches. The majority of students, however, held relatively unsophisticated conceptions of
problem based learning which were related to relatively unsophisticated approaches to learning.
Conclusion: Students participating in their first PBL subject generally reported unsophisticated
conceptions of and approaches to learning which were not linked to professional practice outcomes.
However, those completing the last PBL subject had recognised the link between participation in the
process and the development of knowledge and skills for professional practice.

Background: Evidence from clinical practice and the extant literature suggests that post-operativ... more Background: Evidence from clinical practice and the extant literature suggests that post-operative pain assessment
and treatment is often suboptimal. Poor pain management is likely to persist until pain management practices
become consistent with guidelines developed from the best available scientific evidence. This work will address the
priority in healthcare of improving the quality of pain management by standardising evidence-based care processes
through the incorporation of an algorithm derived from best evidence into clinical practice. In this paper, the
methodology for the creation and implementation of such an algorithm that will focus, in the first instance, on
patients who have undergone total hip or knee replacement is described.
Methods: In partnership with clinicians, and based on best available evidence, the aim of the Management
Algorithm for Post-operative Pain (MAPP) project is to develop, implement, and evaluate an algorithm designed to
support pain management decision-making for patients after orthopaedic surgery. The algorithm will provide
guidance for the prescription and administration of multimodal analgesics in the post-operative period, and the
treatment of breakthrough pain. The MAPP project is a multisite study with one coordinating hospital and two
supporting (rollout) hospitals. The design of this project is a pre-implementation-post-implementation evaluation
and will be conducted over three phases. The Promoting Action on Research Implementation in Health Services
(PARiHS) framework will be used to guide implementation. Outcome measurements will be taken 10 weeks
post-implementation of the MAPP. The primary outcomes are: proportion of patients prescribed multimodal
analgesics in accordance with the MAPP; and proportion of patients with moderate to severe pain intensity at
rest. These data will be compared to the pre-implementation analgesic prescribing practices and pain outcome
measures. A secondary outcome, the efficacy of the MAPP, will be measured by comparing pain intensity scores of
patients where the MAPP guidelines were or were not followed.
Discussion: The outcomes of this study have relevance for nursing and medical professionals as well as informing
health service evaluation. In establishing a framework for the sustainable implementation and evaluation of a
standardised approach to post-operative pain management, the findings have implications for clinicians and
patients within multiple surgical contexts.

Nursing ethics, Jan 1, 2000