Barriers and Facilitators to the Prevention of Chronic Pain in the Subacute Phase After Cardiac Surgery

Abstract

Background: Although a transitional approach promoting continuity of care is warranted to prevent chronic post-surgical pain (CPSP) and opioid misuse, there is limited research examining interventions targeting the subacute phase after cardiac surgery. Contextual multi-level factors may explain this scarcity.

Aims: The purpose of this study was to explore the potential implementation of a nursing intervention to prevent CPSP in the subacute phase by describing nurses' viewpoints of current barriers and facilitators.

Design: A descriptive qualitative study was conducted using secondary data analysis.

Settings: A Web-based survey was used along with in-person interviews.

Participants: 75 perioperative nurses.

Methods: Qualitative data from individual interviews (n=10) and open-ended responses to a survey (n=65) regarding the intervention's acceptability were used. Content analysis was conducted using a deductive approach.

Results: The introduction of nurses from various clinical settings to a new intervention allowed reflection on current practice and represented a shift toward a preventive approach. The main barrier expressed was the lack of communication and continuity of care between clinical settings. Several policy implications were outlined such as increasing the involvement of rehabilitation programs and strengthening collaboration between pain specialists and primary care providers.

Conclusions: Based on perceptions of nurses involved at different stages of the continuum, the findings provide a preliminary picture of clinical challenges and potential avenues for the prevention of CPSP in the subacute phase after cardiac surgery. An expanded pain management nursing role in primary care would allow earlier interventions and contribute to the prevention of CPSP for a tremendous number of patients undergoing surgeries.