University of Michigan, Ann Arbor, Michigan, USA.
J Pain Symptom Manage. 2012 Sep;44(3):446-57. doi: 10.1016/j.jpainsymman.2011.09.005. Epub 2012 May 31.
Despite decades of research, national mandates, and widespread implementation of guidelines, recent reports suggest that the quality of pain assessment and management in hospitalized children remains suboptimal. The mismatch between what is advocated and what is done in practice has led experts to argue for a conceptual shift in thinking, where the pain assessment process is viewed from a complex social communication or transaction framework. This article examines the empirical evidence from the recent pediatric pain assessment and decision-making literature that supports adaptation of Schiavenato and Craig's "Pain Assessment as a Social Transaction" model in explaining pediatric acute pain management decisions. Multiple factors contributing to children's pain experiences and expressions are explored, and some of the difficulties interpreting their pain scores are exposed. Gaps in knowledge related to nurses' clinical pain management decisions are identified, and the importance of children's and parents' preferences and roles and the influence of risks and adverse events on decision making are identified. This review highlights the complexity of pediatric nurses' pain management decisions toward the clinical goal of improving comfort while minimizing risk. Further study evaluating the propositions related to nurses' decisions to intervene is needed in pediatric clinical settings to better synthesize this model for children.
尽管已经进行了几十年的研究、国家制定了相关规定并广泛实施了指南，但最近的报告表明，住院儿童的疼痛评估和管理质量仍然不尽如人意。理论与实践之间的不匹配促使专家们呼吁在思维上进行概念上的转变，即将疼痛评估过程视为复杂的社会沟通或交易框架。本文从最近的儿科疼痛评估和决策文献中探讨了实证证据，这些证据支持在解释儿科急性疼痛管理决策时采用 Schiavenato 和 Craig 的“疼痛评估作为社会交易”模型。本文探讨了导致儿童疼痛体验和表达的多种因素，并揭示了一些在解释他们的疼痛评分时遇到的困难。还确定了与护士临床疼痛管理决策相关的知识差距，并确定了儿童和家长的偏好和角色以及风险和不良事件对决策的影响的重要性。这篇综述强调了儿科护士为实现改善舒适度同时最小化风险这一临床目标而做出疼痛管理决策的复杂性。需要在儿科临床环境中进一步研究评估与护士干预决策相关的命题，以便更好地为儿童综合该模型。
