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Expert nurses’ decision-making regarding intravenous patient controlled analgesia McLeod, Barbara Elaine


Little is known about how expert nurses make decisions regarding IV PCA therapy and the factors and/or barriers affecting those decisions. The purpose of this research was to examine how expert nurses manage acute postoperative pain using the modality of IV PCA, and the processes nurses use to make decisions about IV PCA therapy in day-to-day clinical practice. The qualitative method of noncategorical, interpretive description guided the study. Seven participants were recruited via a process of nomination. Data collection included a modified think-aloud technique and post-think aloud interviews. Data were transcribed verbatim and analysis involved data inductively produced from the interviews and think aloud statements. A reflexive journal was used to provide insight into decisions made by the researcher and the rationale for making those decisions. The study generated six conclusive statements. (1) Nurses make a distinction between having IV PCA expertise and being an expert nurse in IV PCA therapy. (2) Nursing knowledge related to pain management and IV PCA, clinical judgment, and clinical reasoning are intimately interconnected and contribute to nurses' decision-making and pain management outcomes. (3) Three types of decisions are used (a) immediately intervene, (b) wait and watch with potential intervention at a later time, and (c) to do nothing. (4) Personal and institutional factors influence all of these decisions. (5) Pain management outcomes resulting from the nurses' decisions in regard to IV PCA were usually less than optimal. (6) Nurses do not consistently implement physicians' standing prn orders within the specified time frames to optimally manage acute postoperative pain using IV PCA. Implications of this research focus largely on the need for development and commitment to pain management standards of care (both generic and for IV PCA) and ongoing education around pain management. Further research is indicated to monitor and evaluate the outcomes of IV PCA.

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