Gunningberg Lena, Idvall Ewa
Surgery Division, University Hospital, and Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
J Nurs Manag. 2007 Oct;15(7):756-66. doi: 10.1111/j.1365-2934.2006.00753.x.
To study the quality of postoperative pain management in a university hospital.
Paired patient and nurse assessments of the patient's pain management were conducted in two departments, complemented with audit of patient records. The Strategic and Clinical Quality Indicators in Postoperative Pain Management questionnaire was answered by 121 patients and 47 Registered Nurses.
Of 14 items in the Strategic and Clinical Quality Indicators in Postoperative Pain Management questionnaire, four items in general surgery and five items in thoracic surgery reached the threshold for high quality of care. No significant differences were found between the assessments in the two departments, but the patients in general surgery experienced more pain than the patients in thoracic surgery. In general surgery, the patients assessed their worst pain significantly higher than the nurse did. The patients who experienced more pain than expected were less satisfied with the quality of their care and experienced higher pain intensity levels. For 25 (41.0%) patients in general surgery and four (6.7%) patients in thoracic surgery, pain intensity was documented according to hospital quality goals.
In both departments, areas for improvements could be found in all subscales of the Strategic and Clinical Quality Indicators in Postoperative Pain Management questionnaire, i.e. communication, action, trust and environment. It is important to discuss what information the patient needs, as well as how and when it should be given. Furthermore, considering earlier pain experience and the goal of pain relief for the individual patient may facilitate an adequate assessment of the patient's pain. In future, electronic health records have the potential to support the use of clinical guidelines.
研究某大学医院术后疼痛管理的质量。
在两个科室对患者和护士进行配对，由护士对患者的疼痛管理进行评估，并辅以患者记录审核。121名患者和47名注册护士回答了《术后疼痛管理的战略和临床质量指标》问卷。
在《术后疼痛管理的战略和临床质量指标》问卷的14项内容中，普通外科的4项和胸外科的5项达到了高质量护理的阈值。两个科室的评估之间未发现显著差异，但普通外科的患者比胸外科的患者疼痛更严重。在普通外科，患者对其最严重疼痛的评估明显高于护士。疼痛比预期更严重患者对护理质量的满意度较低，且疼痛强度水平较高。普通外科有25名（41.0%）患者和胸外科有4名（6.7%）患者的疼痛强度根据医院质量目标进行了记录。
在两个科室中，《术后疼痛管理的战略和临床质量指标》问卷的所有子量表，即沟通、行动、信任和环境方面，都存在改进的空间。讨论患者需要哪些信息以及应如何、何时提供这些信息非常重要。此外，考虑患者早期的疼痛经历以及个体患者的疼痛缓解目标可能有助于对患者的疼痛进行充分评估。未来，电子健康记录有可能支持临床指南的应用。
