Date of Award


Degree Name

PhD Nursing

Dissertation Committee

Cynthia D. Connelly, PhD, RN, FAAN, Chair; Jane M. Georges, PhD, RN, Chairperson; Ruth A. Bush, PhD, MPH, Chairperson


pain, opioid-sparing, nurse-controlled, aromatherapy, Electronic Health Record, total hip or knee arthroplasty


Objectives: The purpose of this study was to examine relationships among nursing interventions and pain status during hospitalization in orthopedic surgical patients receiving total hip or knee arthroplasty in one of four community hospitals in San Diego, California.

Background: The epidemic of opioid-related adverse events creates a need for opioid sparing approaches to pain management. Pain management practices have been studied in relation to medicine; however, the relationship between pain and opioid sparing, nurse-specific interventions is not clear.

Methods: The retrospective descriptive study examined Electronic Health Record (EHR) data of patients (N = 1657) discharged after a total hip or knee arthroplasty from one of four community hospitals between March 1, 2016 and April 30, 2017. Data extracted included patients’ sociodemographic characteristics, daily morphine equivalent, average time between nursing pain assessments, actual and acceptable levels of pain, and use of adjunct therapy. Descriptive and inferential statistics were used to describe the sample and examine relationships between variables. Binomial logistic regression was utilized to identify factors that increased the likelihood of controlled pain during hospitalization for the study sample.

Results: Approximately two-thirds (65.3%) of patients had their pain controlled during hospitalization; the average daily morphine equivalent day 2 post op was 1.25 mg (SD = 1.03) for the overall sample, and 1.28 mg (SD = 1.08) for those with controlled pain; slightly over one-fourth (26.8%) used aromatherapy during hospitalization. Significant group differences between patients reporting controlled vs. uncontrolled pain during hospitalization were found in patients’ age, BMI, surgeon, time between nurse pain assessments, sedation status, nerve block, aromatherapy and comfort massage use. Logistic regression indicated patients with lower BMI, longer time between nurse pain assessments on day 2 post op, received aromatherapy during hospitalization, and a nerve block were more likely to have controlled pain during hospitalization, c2(14) = 122.47, p < .001. Patients whose surgeons conducted less than 60 or more than 89 surgeries during the study and patients who were not lightly drowsy or easy to arouse were more likely to experience uncontrolled pain during hospitalization.

Conclusions: The daily morphine equivalent administered to patients on day two post op and during hospitalization was not significantly different for patients with controlled vs. uncontrolled pain. The results of this study show patients with controlled pain are using adjunct therapies more than those with uncontrolled pain during hospitalization; more information is needed regarding the reasons patients with uncontrolled pain are not using adjunct therapy. Pain level and lack of readily available adjunct therapies may present overwhelming barriers to patients with uncontrolled pain.

Implications: Nurse-controlled variables empower nurses to improve patient care while decreasing patients’ risk for post-surgical opioid-related complications and addictions. Future research is needed to clarify patients’ and nurses’ perspectives in pain treatments and variability.


I am deeply grateful to the Jonas family for the Jonas Nursing Scholarships. It is a prestigious honor to be named Jonas Scholar and I intend to give back in appreciation of this family’s support. I would like to think Sharp Healthcare for their generous support as recipient of the Marion Hubbard and Center of Nursing Excellence scholarships. They have truly achieved their vision of being the “Best place to work.”

I am deeply grateful to my dissertation chair and committee members. To Dr. Connelly whose selfless guidance has been my forte to finish strong. To Dr. Bush who has been a brilliant teacher and friend throughout my time in USD. To Dr. Georges who has been a positive force in my development both as a nurse and personally.

I would like to think the University of San Diego (USD) faculty, colleagues, friends, and family who have contributed to this research study and my evolution in the doctoral program.

Document Type

Dissertation: Open Access



Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

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