Erlenwein J, Ufer G, Hecke A, Pfingsten M, Bauer M, Petzke F
Klinik für Anästhesiologie, Zentrum Anästhesiologie, Rettungs- und Intensivmedizin, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland,
Schmerz. 2013 Dec;27(6):553-65. doi: 10.1007/s00482-013-1375-1.
In recent decades, the focus of pain management in hospitals was the organization and quality of control of postoperative pain, although there is a similar demand in nonsurgical departments. The aim of this study was to assess the employees' perspective on problems and corresponding solutions in pain management in a university hospital and to further clarify whether the implementation of concepts and tools of pain management across disciplines is feasible.
Physicians and nursing staff of all inpatient departments of the University Hospital Göttingen were asked about problems in pain management and the importance of various established instruments using a standardized questionnaire. Ratings were recorded on a numeric rating scale (0-10). The analysis was primarily descriptive, the Kruskal-Wallis and Mann-Whitney U test were used when appropriate.
In all, 149 medical and 501 nursing employees were included. The quality of pain management was perceived as better in surgical departments than in the conservative and pediatric departments. In all areas, the lack of an adequate order for baseline- and rescue-analgesic, and accordingly the nursing staff's limited ability to act was rated as problematic. In contrast to the conservative and pediatric departments, the predominant problem of surgical departments was the lack of availability of physicians on the ward. As a solution, the advice provided by pain consultation services was rated highly by the staff in all areas. The importance of implementation of standardized analgesic concepts was also supported equally in all areas. The evaluation of the quality of pain management was related to the employee's estimation of their ability to actively treat pain. Physicians rated problems in quality and organization lower compared to nursing stuff.
The results demonstrate that from the employee's perspective problems in pain management in surgical and nonsurgical departments are very similar. Transferring concepts and structures of surgical pain management, such as standardized concepts and advice and or care through pain services, would meet high levels of acceptance. The results also indicate that the nursing staff's ability to treat should be increased by the provision of adequate rescue-analgesics. To close deficits in the management of care, established concepts of pain management could be extended to all departments of a hospital. Similarities outweigh differences in the employee's assessment.
近几十年来，医院疼痛管理的重点是术后疼痛控制的组织和质量，尽管非手术科室也有类似需求。本研究的目的是评估大学医院员工对疼痛管理问题及相应解决方案的看法，并进一步阐明跨学科实施疼痛管理概念和工具是否可行。
使用标准化问卷，询问哥廷根大学医院所有住院科室的医生和护理人员疼痛管理中的问题以及各种现有工具的重要性。评分采用数字评分量表（0-10）记录。分析主要是描述性的，适当情况下使用Kruskal-Wallis和Mann-Whitney U检验。
共纳入149名医疗人员和501名护理人员。手术科室的疼痛管理质量被认为优于保守科室和儿科科室。在所有领域，缺乏足够的基础镇痛和急救镇痛医嘱，相应地护理人员行动能力有限被认为是有问题的。与保守科室和儿科科室相比，手术科室的主要问题是病房医生人手不足。作为解决方案，疼痛咨询服务提供的建议在所有领域都得到工作人员的高度评价。所有领域对实施标准化镇痛概念的重要性也同样表示支持。疼痛管理质量的评估与员工对其积极治疗疼痛能力的估计有关。与护理人员相比，医生对质量和组织方面问题的评分较低。
结果表明，从员工角度来看，手术科室和非手术科室的疼痛管理问题非常相似。移植手术疼痛管理的概念和架构，如标准化概念、建议或通过疼痛服务进行护理，会获得高度认可。结果还表明，应通过提供足够的急救镇痛药来提高护理人员的治疗能力。为弥补护理管理方面的不足，可将既定的疼痛管理概念扩展到医院的所有科室。员工评估中的相似之处大于差异。
