Date of Award

2023

Degree Name

Doctor of Philosophy (College of Nursing)

Degree Name

Doctor of Philosophy (School of Nursing and Midwifery)

First Supervisor

Gail Ross-Adjie

Second Supervisor

Leanne Monterosso

Third Supervisor

Caroline Bulsara

Abstract

Although pain is the most common reason for patients to present to emergency departments (EDs), conventional methods of pain management in EDs are suboptimal. Patient controlled analgesia (PCA), commonly used for post operative pain relief, was proposed as a modality of pain management in ED. PCA enables the patient to self-administer intravenous analgesia, has been rigorously evaluated in acute care settings and is widely used in many clinical areas. It is not routinely used in EDs. The literature review found critical gaps in the existing evidence of PCA use in EDs justifying this research. A three-phase sequential mixed methods study was conducted in the ED setting to identify clinicians’ perceptions of PCA and determine the feasibility of this mode of analgesic delivery. In Phase 1, semi-structured interviews with clinicians (n = 20) revealed five main themes about PCA use in EDs: suitability and choosing the right patient; time; safety concerns and side effects; anticipating the patient’s perspective (staff perception); and facilitating PCA use in ED. Phase 2 used these findings to develop and administer a survey to ED doctors (n = 141) and nurses (n = 299) across Australia and New Zealand to obtain a wide view of perceptions about PCA use in EDs. Findings revealed the majority of respondents were either somewhat likely or extremely likely to prescribe or recommend PCA use in EDs if clear policy and protocols are applied. In the final phase, a pilot randomised controlled trial (RCT) evaluated the feasibility, acceptability and practicality of using PCA in EDs. Participants (n = 13) were randomly allocated to the PCA group or control group (who received usual care). This trial protocol demonstrated feasibility of recruitment and acceptability of treatment by nursing and medical staff, however, did not achieve acceptability of intervention by nursing and medical staff and adherence to study protocol by nursing staff. The study protocol used in this trial requires amendment for any future larger scale and fully powered RCTs; especially to increase the amount of staff education provided pre-trial and to reduce the amount of time a participant spends in the study. Future research should also address the costs, practical barriers and facilitators. This study provided a holistic perspective, novel insights, comprehensive evidence and the foundations for a future large-scale RCT.

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