Kwekkeboom K L, Herr K
College of Nursing, University of Iowa, Iowa City 52242-1121, USA.
Crit Care Nurs Clin North Am. 2001 Jun;13(2):181-94.
Accurate assessment of pain in the critically ill is undoubtedly a challenge. In this setting, however, the nurse can rise to the challenge and have a significant impact on pain management. Some careful thought and planning may allow the nurse to adapt usual assessment tools for use by patients who have difficulty in communicating. When patients cannot communicate, having accurate knowledge about pain and about the patient's condition can help nurses to make appropriate use of behavioral and physiologic signs. More research is necessary to test specific pain assessment tools in ICU settings. In addition, more studies are needed to document the reliability and validity of scales based on behavioral and physiologic indicators of pain in critical care settings. In the meantime, nurses can take several steps to ensure adequate pain assessment: (1) use all means possible to document the patient's self-report of the pain experience, (2) supplement these ratings with behavioral and physiologic indicators of pain status, and (3) document findings to comunicate the patient's pain to others caring for the patient. A careful thorough attempt to assess pain can ensure better pain, outcomes as well as a quicker and more positive return to health.
准确评估重症患者的疼痛无疑是一项挑战。然而，在这种情况下，护士能够应对这一挑战，并对疼痛管理产生重大影响。一些细致的思考和规划或许能让护士调整常用的评估工具，以供沟通有困难的患者使用。当患者无法沟通时，准确了解疼痛及患者的病情有助于护士合理利用行为和生理体征。有必要开展更多研究，以在重症监护病房环境中测试特定的疼痛评估工具。此外，还需要更多研究来证明基于重症护理环境中疼痛行为和生理指标的量表的可靠性和有效性。与此同时，护士可以采取几个步骤来确保进行充分的疼痛评估：（1）尽一切可能记录患者对疼痛体验的自我报告，（2）用疼痛状态的行为和生理指标补充这些评分，（3）记录结果，以便将患者的疼痛情况告知其他护理患者的人员。认真彻底地尝试评估疼痛能够确保更好地缓解疼痛、改善结果，以及更快、更积极地恢复健康。
