A Middle Range Theory:
Chronotherapeutic
Intervention for
Postsurgical Pain
Theory developed by Susan E. Auvil-Novak
By Candice Kiskadden
Overview Objectives
O Discuss the theory of Chronotherapeutic Intervention
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for postsurgical pain (CIPP)
Describe purpose and major concepts of CIPP
List contexts for use of the CIPP theory
Discuss nursing implications of CIPP
Characterize the evidence of empirical testing of CIPP
Outline current research articles using CIPP
Communicate application to author’s practice
Theory of Chronotherapeutic
Intervention for Postsurgical
Pain
O CIPP theory states pain management is time
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dependent
“Chronotherapeutic” approaches to pain
Derived from theory, literature review, and
studies
Used three separate studies
Analgesic utilization is a feedback loop for
pain reception
Who is Susan E. Auvil-Novak?
O Authored four
Susan E. Auvil-Novak, Ph.D, RN
publications related
to nursing
O Publication focus
was on time aspects
Analysis and Evaluation
CIPP Theory
Purpose and Major Concepts
O Prescriptive Mid-range Nursing Theory
O Focused on postoperative pain perception
O Pain is chronologically rhythmic
O Different pain interventions needed at
different levels through cycle
O Maximize pain control and minimize adverse
effects
Context for Use
O Theory has evidenced-based practice references
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to past studies
Clinical evidence supports theory of CIPP
pharmacologic administration
Can be applied to different types of pain stimuli
Uses model of Individual Biologic Time Structure
Use of CIPP pain management enhances
postoperative outcomes
Can be used for populations unable to verbally
communicate: children, neonates
Nursing Implications
O Recent studies support congruency with CIPP
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Theory
Patient controlled analgesics currently utilized
postoperatively
Theory is socially relevant and can be applied
transculturally
Increases the nursing evidence-based practice
for pain control
Heathcare professionals can provide better pain
control with less adverse effects
Evidence of Empirical Testing
O Empirical validation of gynecologic oncology
patients
O Compounding evidence supported the
theory in three separate studies
O Testing has proved the theory to be accurate
and valid
O CIPP has been cited in many other scholarly
publications
Research Utilizing CIPP
O Henly, S. J., Kallas, K. D., Klatt, C. M., &
Swenson, K. K. (2003). The notion of time in
symptom experiences. Nursing Research,
52(6), 410-417.
O Sherwood, G. D., McNeill, J. A., Starck, P. L.,
& Disnard, G. (2003). Changing acute pain
management outcomes in surgical patients.
AORN Journal, 77(2), 374-395.
Henly, Kallas, Klatt,
& Swenson
O Appropriately uses CIPP Theory to build new
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SET theory
Uses theory to build on nursing practice
Uses CIPP theory as empirical study to
illustrate critical points
Does not continue to develop CIPP theory
Relevant to current evidence-based nursing
practices
Sherwood, McNeill, Starck,
& Disnard
O Appropriately uses CIPP theory to increase
research knowledge
O Supports hypothesis of postoperative pain
management
O Contributes to chronotherapeutic approach
of pain assessment
O Contends that CIPP theory enhances
postoperative outcomes and precipitate
recovery
Practice Application
O No direct application to Operating Room
nursing
O Preoperative assessment can include CIPP
for greater pain management
O Effective for immediately postoperative
O OR nurses and CRNAs can influence
prescriber for order of CIPP
References
Auvil-Novak , S. E. (1997). A middle-range theory of chronotherapeutic intervention for postsurgcial
pain. Nursing Research, 46(2), 66-71. Retrieved from
http://www.nursingcenter.com/lnc/JournalArticle?Article_ID=102327
Henly, S. J., Kallas, K. D., Klatt, C. M., & Swenson, K. K. (2003). The notion of time in symptom
experiences. Nursing Research, 52(6), 410-417. Retrieved from
http://www.nursingcenter.com/lnc/journalarticle?Article_ID=443674
McEwan, M., & Wills, E. M. (2011). Theoretical Basis for Nursing (3rd ed.). Philadelphia, PA: Lippincott
Williams & Wilkins.
Sherwood, G. D., McNeill, J. A., Starck, P. L., & Disnard, G. (2003). Changing acute pain management
outcomes in surgical patients. AORN Journal, 77(2), 374-395. Retrieved from
http://www.aornjournal.org/article/S0001-2092(06)61206-4/fulltext