Nurses' adoption of a patient-controlled analgesia approach.

The value of a patient-controlled analgesia (PCA) approach has been demonstrated in the literature. A ground of nurses responsible for implementing a PCA approach in their agencies reported varying levels of success. It was not known how nurses' values, goals, and experiences influenced their innovation adoption behavior, nor was it understood how an organization's contextual factors affected nurses' adoption of the PCA approach. The purpose of this study was to increase the understanding of the factors that influence nurses t adoption of PCA. A total of 13 coinvestigators responsible for the implementation of PCA in their agencies formed a participatory action research group. A phenomenological approach, using staff nurse focus groups, was chosen by the coinvestigators to gather data from their respective agencies. The concept of innovation adoption provided the framework for the study

The existence of technology does not ensure that it will be adopted or incorporated into practice (Coyle & Sokop, 1990). The advantages of patient-controlled analgesia (PCA) have been identified extensively in the literature (Keeri-Szanto & Heaman, 1972; Lange, Dahn, & Jacobs, 1988; Ryder, i991; Wasylak, Abbott, English, & Jeans, 1990); however, nurse educators responsible for the implementation of PCA in their own agencies felt that staff nurses frequently did not embrace this method of pain control. Effective integration of PCA into nurses' practice requires nurses to accept the concept of pain as a subjective, unique, and personal experience. Ferrell, McCaffrey, and Grant (1991) demonstrated that nurses' clinical decision making relating to pain management relied mainly on observational and behavioral assessments when deciding whether or not to treat pain. Only 45% of the nurses regarded patient perception of pain as the most influential factor. Clearly, many nurses do not believe pain is a subjective, personal experience with great interpatient variability.

Romano's (1990) review of the literature on diffusion of technology indicated that rate of diffusion and adoption was affected by the users' perceptions as to relative advantage, compatibility with existing values and experiences, complexity, ability to be tested, and visibility of results. Although the relative advantage of PCA (for nurses and patients) had been identified, little was known about the compatibility of a PCA approach with nurses' values and experiences or about the innovation's complexity.

Definition of Terms

Pain is defined as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage" (International Association for the Study of Pain, i979, p. 7). Pain is also defined as "whatever the patient says it is and existing whenever the patient says it does" (McCaffery & Beebe, 1989). For the purpose of this study, pain (as just defined) included acute pain, which is sudden and severe and subsides as healing occurs, and chronic pain, which lasts more than 6 months.

The PCA approach is a method of maintaining a desired level of constant pain control. PCA includes but is not limited to pain management with a computerized intravenous infusion pump. The approach is based on a philosophy of the patients controlling the amount and timing of analgesia required to manage their pain and may include any or all of the following: use of pharmacological therapies (oral, injected, and inhaled medications), use of computerized intravenous infusion pumps, and use of nonpharmacological techniques such as self-hypnosis, imagery, and relaxation. For the purposes of this study, nonpharmacological techniques were not included.

Implementation of the E>CA approach is defined as the entire range of activities from the process by which the decision to make a change (i.e., adopt the PCA approach) is made until that change is fully accepted, adopted, and incorporated into routine nursing practice. Implementation occurs at both the macro (agency) and micro (nurse/patient) levels.

Purpose

The purpose of the study was to determine purses' needs to bring about effective and efficient implementation of a PCA approach. The study was designed to address the following questions. How has the introduction of a PCA approach changed nurses' perceptions of pain management and decision making related to pain management? What initial and ongoing learning opportunities do nurses perceive as increasing their confidence and satisfaction with a PCA approach? What are the values, goals, and experiences of nurses implementing a PCA approach? How are they affected by the organizational system and intraorganizational processes? What are the diffusion processes and predictors of adoption of a PC:A approach among nurses?

METHOD

Sample

A total of 11 health care agencies (on 13 sites) in which a PCA approach had been initiated participated in the study. A focus group from each agency was used as the unit of …