Zwakhalen Sandra M G, van Dongen Katinka A J, Hamers Jan P H, Abu-Saad Huda Huijer
Clinical Researcher, Department of Health Care Studies, Section of Nursing Science, Universiteit Maastricht, Maastricht, The Netherlands.
J Adv Nurs. 2004 Feb;45(3):236-45. doi: 10.1046/j.1365-2648.2003.02884.x.
Although important progress has been made during the past decade, research on pain in people with intellectual disabilities is still scarce. Pain assessment in people with intellectual disabilities is a frequent and difficult problem, especially for nurses working with people with intellectual disabilities on a daily basis. Gathering more information about pain in people with intellectual disabilities is of major importance and relevance for nursing, and adds to the developing body of knowledge.
To investigate the nature and relative importance of non-verbal indicators used by nurses to assess pain in people with a severe or profound intellectual disability.
A questionnaire consisting of 158 indicators of pain was used. A total of 135 nurses from nine institutions specializing in the care of people with intellectual disability were asked to rate each indicator on a scale of 1-10 to show which non-verbal expressions they considered important in diagnosing pain.
A total of 109 nurses responded. All 158 indicators were mentioned as being important to indicate pain. All except four had a range of 9. Seven (moaning during manipulation, crying during manipulation, painful facial expression during manipulation, swelling, screaming during manipulation, not using (affected) body part, and moving the body in a specific way of behaving) were reported as 'very important' by more than 50% of nurses. The lowest score (median 5.5; minimum 1, maximum 10) was given to the indicator 'waving arm movements'. The pain of people with severe intellectual disability appeared to be assessed differently from that of people with profound intellectual disability. Indicators belonging to the 'physiological' category scored relatively higher in the group of nurses specializing in profound disability. In contrast, indicators belonging to the 'social-emotional' category were scored relatively higher by nurses specializing in severe disability.
Nurses used a wide range of indicators to assess pain in people with intellectual disability. Functional abilities and level of disability seem to influence the indicators used.
尽管在过去十年中取得了重要进展，但对智障人士疼痛的研究仍然匮乏。智障人士的疼痛评估是一个常见且棘手的问题，对于每天与智障人士打交道的护士来说尤其如此。收集更多关于智障人士疼痛的信息对护理工作至关重要且具有现实意义，也丰富了不断发展的知识体系。
调查护士用于评估重度或极重度智障人士疼痛的非语言指标的性质和相对重要性。
使用一份包含158个疼痛指标的问卷。来自九家专门护理智障人士机构的135名护士被要求对每个指标按1至10分进行评分，以表明他们认为哪些非语言表达在诊断疼痛时很重要。
共有109名护士做出回应。所有158个指标都被提及对表明疼痛很重要。除了四个指标外，其他所有指标的评分范围都是9分。超过50%的护士将七个指标（操作过程中呻吟、操作过程中哭泣、操作过程中痛苦的面部表情、肿胀、操作过程中尖叫、不使用（受影响的）身体部位以及以特定行为方式移动身体）报告为“非常重要”。得分最低的指标（中位数为5.5；最低分为1，最高分为10）是“挥动手臂动作”。重度智障人士的疼痛评估方式似乎与极重度智障人士不同。在专门护理极重度智障人士的护士群体中，属于“生理”类别的指标得分相对较高。相比之下，属于“社会情感”类别的指标在专门护理重度智障人士的护士中得分相对较高。
护士使用多种指标来评估智障人士的疼痛。功能能力和残疾程度似乎会影响所使用的指标。
