Academic journal article The Qualitative Report

Elderly Patients' Perception of Pain Management after Open and Reduction Internal Fixation Surgery

Academic journal article The Qualitative Report

Elderly Patients' Perception of Pain Management after Open and Reduction Internal Fixation Surgery

Article excerpt


Some older adults experience moderate to severe postoperative pain after they have undergone major surgery (Bremner, Webster, Katz, Watt-Watson, & McCartney, 2011; DeCrane et al., 2014; Moore, Derry, McQuay, & Wiffen, 2011), and often receive less attention for postoperative pain than younger individuals (Jensen-Dahm, Palm, Gasse, Dahl, & Waldemar, 2016; Rastegar, 2011). High levels of postoperative pain in older patients can cause increased anxiety, delirium, reduced ambulation, and higher chances of pulmonary complications (Jellish & O'Rourke, 2012; Ramirez, Roche, & Zimmern, 2014). Older adults not given attention for postoperative pain may experience prolonged hospital stays, reduced level of functioning after two months, and poorer ambulation half a year after discharge from the hospital (Jellish & O'Rourke, 2012; Ramirez et al., 2014).

Despite these negative outcomes, little research has examined perceptions of older adults who have undergone major surgery, particularly regarding pain after an operation and pain management practices. Research is lacking on pain and pain management in older adults who have experienced open reduction and internal fixation (ORIF) surgery for bone fractures in wrists or hips. This study sought to bridge the research gap regarding perceptions of elderly patients on pain and adaptation after open reduction and internal fixation surgery.


Pain management is an integral part of medical treatment teams in a variety of settings and with diverse populations (Nowakowski, Barningham, Buford, Laguerre, & Sumerau, 2017), though the concept of managing pain is esoteric. Pain is both a medical and a social issue. Traditionally viewed as either being indicative of a physical illness or a spiritual sickness, pain has been equated historically with a manifestation of social-spiritual justice, and was perceived as an indication of the willingness of an individual to endure personal sacrifice (Hudson, 2012).

Pain management is a definitive and distinct science in the medical treatment of patients (American Society of Anesthesiologists, 2012) and both physicians and nurses are crucial to help patients manage pain effectively. Physicians are vital for the diagnosis of potential causes of pain and identification of treatment. Nurses are charged with administering the prescribed treatment to alleviate the patient's pain. Unmanaged pain among elderly individuals leads to other complex medical issues such as cardiac, gastrointestinal, and psychological problems.

Theoretical Framework Background

There are approximately 30 active nursing theories, models, and frameworks. Each theory has four main concepts: (a) person, (b) health, (c) environment, and (d) nursing. Sister Calista Roy developed the adaptation model of nursing in 1976, and I selected this model as the guiding theoretical framework for this study. The adaptation model is herein referred to in this work as Roy's adaptation model. Roy combined Harry Henson's adaptation theory with Rapoport's definition of system to arrive at a theory where the person is viewed as an adaptive system. McEwen and Wills (2001) noted that people adapt to environmental stimuli in positive or negative ways. According to Roy's adaptation model, the way that individuals respond to stimuli, or adapt, significantly affects the integrity of their health. The four modes of adaptation featured in Roy's adaptation model of nursing are (a) physiological, (b) self-concept, (c) role function, and (d) interdependence (Roy & Andrews, 1999; Figure 1).

I chose this model to guide this study because it has steered my own practice since my early nursing education. This model considers the goal of nursing to be to support patients in the adaptation process. Within this theoretical framework, important assumptions guide the research process. Roy's adaptation models, both implicit and explicit, can frame a qualitative study of older patients' perceptions of post-operative pain. …

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