Tarzian Anita J, Hoffmann Diane E
Law and Health Care Program, University of Maryland School of Law, Baltimore, MD 21201-1786, USA.
J Am Med Dir Assoc. 2005 May-Jun;6(3 Suppl):S13-9. doi: 10.1016/j.jamda.2005.03.016.
The objective of this study was to identify pain management demographics, perceived resources, and perceived barriers to adequately manage pain in the nursing home setting.
Mailed survey.
All licensed Connecticut nursing homes.
Directors of Nursing (DONs).
Survey eliciting pain management demographics, perceived resources, and perceived barriers to adequately manage pain in respondents' nursing home.
A total of 113 of 260 DONs (43%) responded to the survey. Respondents believed pain was suboptimally managed, particularly for residents with malignant and nonmalignant chronic pain. Perceived barriers to providing adequate pain management included lack of knowledge about pain management among nurses and physicians, lack of a standardized approach to treating pain, physicians' personal attitudes toward treating pain (eg, fear of addiction or overdose), lack of diagnostic precision in treating pain, and difficulty in choosing the right analgesic. Other barriers are also discussed, including low hospice enrollment of nursing home residents.
Improving pain management in nursing homes requires improving provider knowledge and attitudes, enhancing diagnostic precision, standardizing pain treatment, and achieving an institutional commitment. Although responding DONs seemed aware of the need for improved pain management outcomes at their facilities, the required institutional commitment to accomplish this was not evidenced by these findings.
本研究的目的是确定在疗养院环境中疼痛管理的人口统计学特征、感知到的资源以及充分管理疼痛的感知障碍。
邮寄调查。
康涅狄格州所有持牌疗养院。
护理主任（DONs）。
通过调查获取受访者所在疗养院疼痛管理的人口统计学特征、感知到的资源以及充分管理疼痛的感知障碍。
260名护理主任中有113名（43%）回复了调查。受访者认为疼痛管理未达到最佳效果，尤其是对于患有恶性和非恶性慢性疼痛的居民。提供充分疼痛管理的感知障碍包括护士和医生对疼痛管理的知识缺乏、缺乏标准化的疼痛治疗方法、医生对疼痛治疗的个人态度（如害怕成瘾或用药过量）、疼痛治疗中缺乏诊断准确性以及难以选择合适的镇痛药。还讨论了其他障碍，包括疗养院居民临终关怀登记率低。
改善疗养院的疼痛管理需要提高医护人员的知识和态度、提高诊断准确性、规范疼痛治疗并达成机构承诺。尽管回复的护理主任似乎意识到其所在机构需要改善疼痛管理结果，但这些结果并未表明实现这一目标所需的机构承诺。
