School of Medicine, West Virginia University, Morgantown, West Virginia, USA.
Prehosp Emerg Care. 2012 Oct-Dec;16(4):519-26. doi: 10.3109/10903127.2012.695436. Epub 2012 Jul 23.
To identify and investigate the barriers and enablers perceived by paramedics regarding the administration of analgesia to pediatric emergency medical services (EMS) patients.
This was a qualitative study in which in-depth semistructured interviews of a purposively-sampled group of 16 paramedics were performed before achieving redundancy. The interviews were structured and the data were thematically analyzed. Emerging themes were categorized into four domains, and novel themes were identified and further explored.
Thirteen of 16 paramedics reported success with analgesia in children at least once in their careers. Provider anxiety, unfamiliarity and discomfort with pediatrics, unfamiliarity with the protocol, insufficient didactic and clinical education, and concern for adverse effects from analgesic agents were perceived as barriers to pediatric pain management. The paramedics had differing beliefs about the importance of pain control, the role of parents in medical care for children, and the paramedic's ability to assess pediatric patients. Having a positive relationship with online medical control and using commercially available assistive guides were viewed as enablers for pediatric pain management. The response from paramedic supervisors and emergency department staff, unwanted attention from authority figures, perceived superiority of hospital care, difficulty obtaining intravenous access, and overall culture of stinginess in medication administration played important roles in an overall preference to defer pediatric analgesia. Some paramedics mentioned a specific experience or mentoring relationship with a more seasoned provider who taught them the importance of pain management. Paramedics reported various effects of transport distance on their decision to administer analgesia.
We have identified a number of previously unrecognized barriers to and enablers for prehospital pediatric analgesia. The majority of these factors lead to an overall preference of paramedics to defer administration of analgesic agents. A number of educational and EMS system changes could be made to address these barriers and increase the frequency of appropriate pediatric prehospital analgesia.
确定并调查护理人员对儿科急诊医疗服务（EMS）患者给予镇痛的认知障碍和促进因素。
这是一项定性研究，采用目的抽样法对 16 名护理人员进行了深入的半结构化访谈，直到达到冗余。访谈是结构化的，数据进行了主题分析。出现的主题被分为四个领域，新出现的主题被识别并进一步探讨。
16 名护理人员中有 13 名报告在职业生涯中至少有一次成功为儿童使用了镇痛剂。提供者焦虑、对儿科的不熟悉和不适、对方案不熟悉、缺乏足够的理论和临床教育、对镇痛剂不良反应的担忧被认为是儿科疼痛管理的障碍。护理人员对疼痛控制的重要性、父母在儿童医疗保健中的作用以及护理人员评估儿科患者的能力有不同的看法。与在线医疗控制建立良好的关系并使用商业上可用的辅助指南被视为促进儿科疼痛管理的因素。护理人员主管和急诊部工作人员的反应、权威人士的不必要关注、医院护理的优越性、静脉通路获取困难以及药物管理总体上吝啬的文化，在整体上对推迟儿科镇痛剂的使用产生了重要影响。一些护理人员提到了与经验更丰富的提供者的特定经历或指导关系，这些提供者教导他们疼痛管理的重要性。护理人员报告了转运距离对他们决定给予镇痛剂的各种影响。
我们已经确定了一些以前未被认识到的院前儿科镇痛的障碍和促进因素。这些因素大多导致护理人员总体上倾向于推迟使用镇痛剂。可以进行一些教育和 EMS 系统的改变，以解决这些障碍并增加适当的院前儿科镇痛剂的使用频率。
