McMillan S C, Tittle M, Hagan S, Laughlin J
University of South Florida College of Nursing, Tampa 33612, USA.
Cancer Nurs. 2000 Oct;23(5):327-36. doi: 10.1097/00002820-200010000-00001.
Unrelieved pain continues to be a problem among hospitalized patients with cancer. The purpose of this study was to evaluate pain management outcomes in a group of veterans with cancer receiving inpatient care. The sample consisted of 90 veterans with cancer hospitalized in one of two large veterans medical centers in the southeastern United States. Daily pain was assessed by administering the visual analog scale (VAS) for pain three times in a 24-hour period and averaging these three scores. The Brief Pain Inventory (BPI) and Constipation Assessment Scale (CAS) were administered once. The charts were audited using the Chart Audit for Pain (CAP). The sample was predominantly male (93.3%) and white (82.8%). The length of time since diagnosis ranged from newly diagnosed during this hospitalization to 16 years. Average daily pain was 32.9 on the VAS and 4 on the BPI. However, approximately one-fourth of the patients reported average daily pain above the midpoint (VAS > 50), and some patients reported average daily pain to be as high as 98. Fewer than half of charts (42%) showed evidence that a pain rating scale was used. Other assessment data also were very limited. Patients reported that pain interfered with all activities on the BPI, with highest interference scores for walking and sleep (mean, 5.5). Although 80% of the patients reported some problem with constipation, the chart audit indicated that this was recorded in only 11 patient records. No patient records indicated a problem with sedation. The findings indicate that limited attempts were made to manage pain using nonpharmacologic methods. In addition, only one of the nine charts reporting these attempts showed evidence that results from the attempt were evaluated. It may be concluded that pain management continues to be less than ideal in these veterans hospitals. Study results indicate that nurses are not documenting careful assessment of pain, not documenting evaluation of approaches to pain management, and not attending to the constipation that is inevitable when opioids are administered. Continued emphasis on nursing education related to pain management is needed. Future research should be undertaken to evaluate these outcomes.
疼痛未得到缓解仍是癌症住院患者面临的一个问题。本研究的目的是评估一组接受住院治疗的癌症退伍军人的疼痛管理效果。样本包括90名在美国东南部两家大型退伍军人医疗中心之一住院的癌症退伍军人。通过在24小时内三次使用视觉模拟疼痛量表（VAS）评估每日疼痛，并将这三个分数平均。简短疼痛问卷（BPI）和便秘评估量表（CAS）仅使用一次。使用疼痛图表审核（CAP）对病历进行审核。样本主要为男性（93.3%）和白人（82.8%）。自确诊以来的时间长度从本次住院新确诊到16年不等。VAS平均每日疼痛为32.9，BPI为4。然而，约四分之一的患者报告平均每日疼痛高于中点（VAS>50），一些患者报告平均每日疼痛高达98。不到一半的病历（42%）显示有使用疼痛评级量表的证据。其他评估数据也非常有限。患者报告疼痛干扰了BPI上的所有活动，对行走和睡眠的干扰得分最高（平均5.5）。尽管80%的患者报告有便秘问题，但病历审核表明仅在11份患者记录中有记载。没有患者记录显示有镇静问题。研究结果表明，使用非药物方法管理疼痛的尝试有限。此外，在报告这些尝试的九份病历中，只有一份显示有对尝试结果进行评估的证据。可以得出结论，这些退伍军人医院的疼痛管理仍不尽如人意。研究结果表明，护士没有认真记录疼痛评估情况，没有记录疼痛管理方法的评估情况，也没有关注使用阿片类药物时不可避免的便秘问题。需要持续强调与疼痛管理相关的护理教育。未来应开展研究以评估这些结果。
