Emergency Department and Regional Emergency Healthcare Network, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Injury. 2012 Sep;43(9):1397-402. doi: 10.1016/j.injury.2011.01.029. Epub 2011 Mar 2.
The aim of the study is to give insight into facilitators and barriers in pain management in trauma patients in the chain of emergency care in the Netherlands.
A qualitative approach was adopted with the use of the implementation Model of Change of Clinical Practice. The chain of emergency care concerned prehospital Emergency Medical Services (EMS) and Emergency Departments (EDs). We included two EMS ambulance services and three EDs and conducted five focus groups and 10 individual interviews. Stakeholders and managers of organisations were interviewed individually. Focus group participants were selected based on availability and general characteristics. Transcripts of the audio recordings and field notes were analysed in consecutive steps, based on thematic content analysis. Each step was independently performed by the researchers, and was discussed afterwards. We analysed differences and similarities supported by software for qualitative analysis MaxQDA.
This study identified five concepts as facilitators and barriers in pain management for trauma patients in the chain of emergency care. We described the concepts of knowledge, attitude, professional communication, organisational aspects and patient input, illustrated with quotes from the interviews and focus group sessions. Furthermore, we identified whether the themes occurred in the chain of care. Knowledge deficits, attitude problems and patient input were similar for the EMS and ED settings, despite the different positions, backgrounds and educational levels of respondents. In the chain of care a lack of professional communication and organisational feedback occurred as new themes, and were specifically related to the organisational structure of the prehospital EMS and EDs.
Identified organisational aspects stressed the importance of organisational embedding of improvement of pain management. However, change of clinical practice requires a comprehensive approach focused at all five concepts. We think a shift in attitudes is needed, together with constant surveillance and feedback to emergency care providers. Implementation efforts need to be aimed at the identified barriers and facilitators, tailored to the chain of emergency care and the multi-professional group of emergency care providers.
本研究旨在深入了解荷兰创伤患者在急救护理链中疼痛管理的促进因素和障碍。
采用定性方法，使用临床实践变革实施模型。急救护理链涉及院前急救医疗服务（EMS）和急诊部（ED）。我们纳入了两个 EMS 救护车服务和三个 ED，并进行了五个焦点小组和 10 个个人访谈。对组织的利益相关者和管理人员进行了单独访谈。焦点小组参与者是根据可用性和一般特征选择的。根据主题内容分析，对音频记录和现场笔记的转录进行了连续步骤的分析。研究人员独立执行每个步骤，并在之后进行讨论。我们使用定性分析软件 MaxQDA 分析了差异和相似之处。
本研究确定了五个概念，作为创伤患者在急救护理链中疼痛管理的促进因素和障碍。我们用访谈和焦点小组会议的引述描述了知识、态度、专业沟通、组织方面和患者投入的概念。此外，我们还确定了这些主题是否在护理链中出现。尽管受访者的职位、背景和教育水平不同，但 EMS 和 ED 设置中的知识不足、态度问题和患者投入相似。在护理链中，专业沟通和组织反馈的缺乏作为新的主题出现，这些主题与院前 EMS 和 ED 的组织结构特别相关。
确定的组织方面强调了改进疼痛管理的组织嵌入的重要性。然而，临床实践的变革需要一种全面的方法，重点关注所有五个概念。我们认为需要改变态度，同时对急救护理人员进行持续监测和反馈。实施工作需要针对确定的障碍和促进因素，针对急救护理链和急救护理人员的多专业团队进行定制。
