Design and evaluation of a nurse-led telehealth pain management protocol for post-surgical patients

Thesis Abstract

Postoperative pain management remains a critical determinant of recovery trajectory, patient satisfaction, and healthcare costs, with conventional in-person follow-up often impeded by logistical barriers and variable access to timely analgesia; telehealth presents a scalable solution but lacks robust, nurse-led protocols tailored to post-surgical contexts. This study aims to design, implement, and evaluate a nurse-led telehealth pain management protocol for post-surgical patients to enhance analgesia effectiveness, reduce opioid reliance, and improve functional recovery. The specific objectives are (1) to develop a theory-informed telehealth protocol for post-surgical pain assessment, analgesia titration, and patient education anchored in the pain management and self-efficacy theories; (2) to implement the protocol in a controlled clinical setting with adult surgical patients; (3) to evaluate feasibility, acceptability, and adherence among patients and nurses; (4) to determine the protocol’s impact on pain intensity trajectories, analgesic consumption, functional outcomes, and readmission rates; and (5) to assess cost implications and patient-reported quality of life. The study adopts a mixed-methods design guided by the Consolidated Framework for Implementation Research (CFIR) to examine both process and outcomes. The quantitative component employs a quasi-experimental, non-randomized design with propensity score matching, enrolling 240 adult post-operative patients across two tertiary hospitals over 12 months. The intervention group receives the nurse-led telehealth protocol post-discharge for four weeks, including scheduled video consultations, remote pain scores (0–10 numeric rating scale), algorithm-driven analgesia adjustments, and standardized education modules; the control group receives standard post-discharge care. Data collection instruments include the Brief Pain Inventory (BPI), the Oswestry Disability Index (ODI) or equivalent functional measures appropriate to surgery type, the SF-12 for health-related quality of life, the Healthcare Utilization Questionnaire, and caregiver burden scales. Instrument validity and reliability are established through prior validation studies and pilot testing, with internal consistency assessed via Cronbach’s alpha (target ?0.70). Data analysis comprises intention-to-treat principles. Descriptive statistics will characterize baseline characteristics. Pain trajectory analysis will utilize growth curve modeling and mixed-effects regression to compare primary outcomes (average pain intensity over four weeks) between groups, adjusting for confounders. Secondary analyses will include multivariate regression for analgesic consumption, repeated measures ANOVA for functional and quality-of-life outcomes, time-to-event analyses for readmissions, and cost-effectiveness modeling from the payer and societal perspectives. The qualitative component entails semi-structured interviews with a purposive sample of 30 patients and 15 nurses to explore acceptability, perceived barriers, and facilitators, analyzed via thematic analysis following Braun and Clarke’s approach; triangulation will integrate qualitative insights with quantitative findings. Ethical considerations include informed consent, data confidentiality, and adherence to clinical safety standards for remote monitoring; data governance complies with national data protection regulations. The study’s anticipated findings suggest that the nurse-led telehealth protocol will produce steeper declines in mean pain scores, reduced opioid consumption, and improved short-term functional outcomes compared with standard care, alongside higher patient and nurse satisfaction and lower unscheduled healthcare utilization. The expected economic evaluation indicates favorable incremental cost-effectiveness ratios driven by reduced readmissions, shorter hospital stays, and decreased emergency department visits. The anticipated contribution to knowledge encompasses (a) a reproducible, theory-grounded telehealth protocol for post-surgical pain management led by nursing professionals; (b) empirical evidence on effectiveness, feasibility, and cost implications within real-world hospital settings; and (c) a nuanced understanding of implementation determinants to guide scale-up across diverse surgical populations. The conclusion is that nurse-led telehealth pain management can be a transformative component of postoperative care, contingent on robust training, interoperable digital infrastructure, and ongoing clinical governance. Recommendations emphasize policy pathways for integrating telehealth into standard postoperative pathways, workforce development to support tele-nursing competencies, and future research to evaluate long-term outcomes, applicability to high-risk surgeries, and adaptability in resource-limited environments.