Ersek Mary, Jablonski Anita
J Gerontol Nurs. 2014 Jul;40(7):52-60. doi: 10.3928/00989134-20140311-01. Epub 2014 Mar 18.
This mixed methods study examined perceived facilitators and obstacles to adopting evidence-based pain management protocols vis-a-vis documented practice changes that were measured using a chart audit tool. This analysis used data from a subgroup of four nursing homes that participated in a clinical trial. Focus group interviews with staff yielded qualitative data about perceived factors that affected their willingness and ability to use the protocols. Chart audits determined whether pain assessment and management practices changed over time in light of these reported facilitators and barriers. Reported facilitators included administrative support, staff consistency, and policy and procedure changes. Barriers were staff attitudes, regulatory issues, and provider mistrust of nurses' judgment. Overall, staff reported improvements in pain practices. These reports were corroborated by modest but significant increases in adherence to recommended practices. Change in clinical practice is complex and requires attention to both structural and process aspects of care.
这项混合方法研究考察了在采用循证疼痛管理方案方面所察觉到的促进因素和障碍，同时对照使用图表审核工具衡量的已记录实践变化情况。该分析使用了参与一项临床试验的四家养老院亚组的数据。对工作人员进行的焦点小组访谈产生了关于影响他们使用这些方案的意愿和能力的感知因素的定性数据。图表审核确定了鉴于这些报告的促进因素和障碍，疼痛评估和管理实践是否随时间而改变。报告的促进因素包括行政支持、工作人员的一致性以及政策和程序的变化。障碍包括工作人员的态度、监管问题以及提供者对护士判断的不信任。总体而言，工作人员报告了疼痛管理实践方面的改善。这些报告得到了对推荐实践的依从性适度但显著增加的证实。临床实践的改变是复杂的，需要关注护理的结构和过程方面。
