Orem's self-care theory in evaluating the effectiveness of patient controlled analgesia versus PRN narcotics in controlling postoperative pain in adults

A nonexperimental, correlational, prospective study was conducted to determine if the acute postoperative pain of patients who have hysterectomies is more effectively controlled by PGA or by p.r.n. narcotic injections. The purpose of the study was to determine within the conceptual framework of Orem's self-care theory whether specific relationships exist between the method of narcotic administration and satisfaction with (a) pain relief obtained, (b) amounts of narcotics, (c) mental alertness and physical mobility, and (d) health locus of control. Of the 40 patients chosen for the study, 30 utilized PGA and 10 received IM p.r.n. narcotic injections.

The researcher used graphic rating scales, Dartmouth Pain Questionnaires, Health Locus of Control Scales, and demographic information forms to collect the data. PGA patients reported significantly greater satisfaction with their pain control than PRN patients. They also reported spending more time in activities which require mental alertness than did the PRN patients. Another finding was that PGA patients began taking pain medications by mouth a whole day earlier than PRN patients.

Differences between PGA and PRN patients' total narcotic usages for the first 72 hours after surgery were not statistically significant. No significant relationship existed between PGA patients' health loci of control and their satisfaction with PGA therapy. The researcher concluded that more research is needed to determine if patients' motivation to engage in and control self-care activities influence their reports of satisfaction with pain control provided by PCA.