Schafheutle E I, Cantrill J A, Noyce P R
School of Pharmacy and Pharmaceutical Sciences, University of Manchester, Manchester, UK.
J Adv Nurs. 2001 Mar;33(6):728-37. doi: 10.1046/j.1365-2648.2001.01714.x.
During a patient's stay on a surgical ward, nurses hold a great deal of responsibility for pain management, especially when analgesics are prescribed on a PRN ('as needed') basis. Despite the availability of effective analgesics and new technologies for drug administration, studies continue to demonstrate suboptimal pain management.
To identify perceived barriers to effective pain management in nursing practice.
The data are drawn from six nurse interviews and a survey of 180 nurses in 14 United Kingdom (UK) hospitals, which built upon detailed observations of nurses on surgical wards.
In a question about possible reasons for suboptimal pain management, nurses identified a number of barriers that concerned organizational aspects such as workload and lack of staff, and also legal or institutional constraints. Nurses further stated that analgesic prescribing was sometimes inadequate, or that doctors or the pain team were unavailable to review medication. Further barriers that nurses may be less aware of were identified in a question concerning nurses' reasons for not asking patients a pain-related question during drug rounds. Previous observations had shown this to be the predominant time for pain questioning. The most commonly mentioned reasons were that patients were asleep, on epidural or patient controlled analgesia (PCA), or had recently had an analgesic. Nurses' replies also revealed that they relied considerably on patients' nonverbal behaviour and used this to assess analgesia requirements. Nurses' views and judgements regarding pain management were further supported in replies to a number of attitude statements and a question about the aim of administering analgesia.
The strength of this work is that it identified two types of potential barriers to effective pain management, recognized and more subconscious ones, and both need to be addressed before introducing systems aimed at improving pain management.
在患者住院手术期间，护士在疼痛管理方面承担着重大责任，尤其是在按“必要时”（PRN）开具镇痛药的情况下。尽管有有效的镇痛药和新的给药技术，但研究仍表明疼痛管理效果欠佳。
确定护理实践中有效疼痛管理的感知障碍。
数据来自对6名护士的访谈以及对英国14家医院180名护士的调查，该调查基于对外科病房护士的详细观察。
在关于疼痛管理效果欠佳可能原因的问题中，护士们指出了一些与组织方面相关的障碍，如工作量和人员短缺，以及法律或制度限制。护士们还表示，镇痛药的处方有时不充分，或者医生或疼痛管理团队无法对药物进行复查。在一个关于护士在查房时未询问患者疼痛相关问题原因的问题中，发现了一些护士可能不太意识到的其他障碍。此前的观察表明，查房是询问疼痛情况的主要时间。最常提到的原因是患者睡着了、正在接受硬膜外镇痛或患者自控镇痛（PCA），或者最近使用过镇痛药。护士们的回答还显示，他们相当依赖患者的非语言行为，并以此来评估镇痛需求。护士们对疼痛管理的看法和判断在对一些态度陈述以及关于给予镇痛药目的的问题的回答中得到了进一步支持。
这项研究的优势在于它识别出了有效疼痛管理的两种潜在障碍，一种是已意识到的，另一种是更潜意识的，在引入旨在改善疼痛管理的系统之前，这两种障碍都需要加以解决。
