Authors (including presenting author) :
Cheung SN(1), Kwok LH(1), Wong MF(1),Chan K(2)
Affiliation :
(1)Surgery Department, Ruttonjee & Tang Shiu Kin Hospitals (2)The School of Nursing of the Hong Kong Polytechnic University
Keyword 1: :
pain management
Keyword 2: :
Enhanced Recovery After Surgery
Keyword 3: :
colorect operation
Introduction :
Early Recovery After Surgery (ERAS) is a multidisciplinary protocol designed to improve patient outcomes and reduce hospital stays by optimizing preoperative conditions and minimizing complications (Ljungqvist et al., 2020). Effective pain management is essential for recovery, especially in colorectal surgery(Dionysopoulos & Katsaragakis, 2019; Simpson et al., 2019). However, our surgical department's induction program for junior staff lacks comprehensive pain management and ERAS related training. From January to December 2024, 43 patients underwent elective colorectal surgeries under ERAS, with 5 using Patient-Controlled Anesthesia (PCA) and 38 using Epidural Anesthesia (EA) for pain relief in our hospital.
Objectives :
The program aims to improve postoperative pain management under ERAS to facilitate recovery. This will involve lectures and simulation training on pain assessment, epidural anesthesia (EA), and Patient-Controlled Anesthesia (PCA) complication management, followed by supervised practice with real cases. The program aims to improve postoperative pain management under ERAS to facilitate recovery. This will involve lectures and simulation training on pain assessment, epidural anesthesia (EA), and Patient-Controlled Anesthesia (PCA) complication management, followed by supervised practice with real cases.
Methodology :
Development of training program based on ADDIE model The enhancement program was developed using the ADDIE model, which includes five phases: Analysis, Design, Development, Implementation, and Evaluation(Branson et al., 1975; DeSimone et al., 2002). This cyclical model helps identify gaps, select educational methods, create materials, implement programs, and evaluate effectiveness. In the Analysis phase, it was found that junior staff lack confidence in managing pain for patients in the ERAS program, highlighting the need for enhanced training in postoperative pain managementD4,D5,D6,D7;L1. The Design phase involved a literature review that indicated a Combination of lectures and supervised simulations is the best approach, based on Kolb's Learning Cycle(kolb, 1984). During the Develop phase, teaching materials will be created based on departmental guidelines, covering pain assessment, medication, non-pharmacological methods, and emergency handlingD4. Educational materials will be validated by a panel composed of Advanced Practice Nurses and the ward managerD4,D5;L2. In the Implementation phase, theoretical classes will precede simulations in a controlled environment, followed by practical assessments using a performance checklist. Participants’ knowledge will be evaluated through pre-tests and post-tests. Debriefing and feedback will be given immediately after the activityD3,D4;L3. The Evaluation phase will involve gathering feedback and assessing performance to determine the program's effectivenessL4. Junior nursing staff will complete a pre-test of 20 multiple-choice questions before a one-hour lecture covering pain anatomy, relief methods, medication side effects, emergency management guidelines, and an introduction to ERAS. A post-test will follow the lecture. Next, staff will engage in simulation training with two independent case scenarios, focusing on pain assessment, management of EA-related complications, and PCA handling. Their performances will be evaluated using a performance checklist, followed by a group reflection sessionL3. Participants will then conduct pain assessments in real cases under supervisionD1,D2, with evaluations using the same performance checklist. A second post-test will occur three weeks later to assess knowledge retention. After this, a debriefing session will be held, and an evaluation questionnaire will be distributed.
Result & Outcome :
From June to September 2025, a total of 6 nurses completed the enhancement program and involved 6 patients in real case practice. Their demographic characteristics are shown in Table 1. The outcome results are presented in Table 2. The knowledge test showed an improvement in the average score from 12.3 to 15 out of 20 in the first post-test. The second post-test indicates that the enhancement has a lasting effect, with an average score of 15.8 out of 20. The performance checklist showed an improvement in completed items, increasing from 12.33 to 15.2 out of 16 for EA, and from 13.33 to 16 out of 18 for PCA. Notably, all participants completed the critical items in the real case practice. The real case practice demonstrated effective pain management by the participants, with patient pain scores decreasing from 4.67 to 2 out of 10. In the evaluation, all participants deemed the lecture to be informative and engaging, and they found the duration of the lecture to be appropriate. Additionally, all participants agreed that the simulation training enhanced their pain assessment skills and their competence in managing postoperative pain and related emergency scenarios. It is noteworthy that all participants reported a lack of prior experience in checking PCA settings and refilling medication. In conclusion, the enhancement program successfully improves postoperative pain management in the Enhanced Recovery After Surgery (ERAS) Program for patients undergoing elective colorectal operations and facilitates their recovery.
