住院成人的疼痛强度：疼痛管理障碍与促进因素的多层次分析

Pain Intensity in Hospitalized Adults: A Multilevel Analysis of Barriers and Facilitators of Pain Management.

作者信息

Van Hecke Ann, Van Lancker Aurélie, De Clercq Bart, De Meyere Céline, Dequeker Sara, Devulder Jacques

机构信息

Ann Van Hecke, PhD, RN, is Professor, University Centre for Nursing and Midwifery, Department of Public Health, Faculty of Medicine and Health Science, Ghent University, Belgium; and Staff Member, Nursing Science, Ghent University Hospital, Belgium. Aurélie Van Lancker, MSc, RN, is PhD Student, University Centre for Nursing and Midwifery, Department of Public Health, Faculty of Medicine and Health Science, Ghent University, Belgium. Bart De Clercq, MSc, is PhD Student, Department of Public Health, Faculty of Medicine and Health Science, Ghent University, Belgium. Céline De Meyere, MSc, RN, is Student in Master of Science in Nursing and Midwifery; and Sara Dequeker, MSc, RN, is Student in Master of Science in Nursing and Midwifery, Ghent University, Belgium. Jacques Devulder, PhD, MD, is Professor, Multidisciplinary Pain Centre, Ghent University Hospital, Belgium.

出版信息

Nurs Res. 2016 Jul-Aug;65(4):290-300. doi: 10.1097/NNR.0000000000000160.

DOI:10.1097/NNR.0000000000000160

PMID:27362515

Abstract

BACKGROUND

Despite an enhanced interest and evolution in pain management, prevalence remains high. Interventions to optimize pain-related care can only be effective if barriers are identified and accounted for.

AIM

To assess pain intensity and examine its association with patient- (including health literacy defined in this study as "requiring help to read health information"), nurse-, and system-related (including social capital defined as "the importance of network and norms at work") barriers/facilitators to pain management.

METHODS

A two-center, cross-sectional study was performed between October 2012 and April 2013. The study included patients and nurses of 39 noncritical wards of two hospitals in Belgium. Patients who were 18 years of age or older and without impaired cognition or consciousness were eligible to take part. All nurses working in the included ward were invited to participate. Pain intensity and patient-related barriers were collected by a structured and standardized questionnaire, completed in dialogue with the patient. Nurses completed the questionnaire on the nurse- and system-related barriers and the social capital scale. Multilevel analysis was used to analyze the data because of the hierarchical structure of the data.

RESULTS

The average pain of all patients across all wards on a 0-10 scale was 2.2 (SD = 3.6). The multilevel analysis indicates that pain intensity can be explained by variables at patient and ward levels. A significant independent association was found between higher pain intensity and younger age, receiving pain medication, the conviction of patients that pain medication does not improve pain, inadequate health literacy in patients, nurses without advanced education, and nurse's concerns about side effects. Social capital did not emerge as predictor of pain intensity.

DISCUSSION

Patient and nurse level factors should be taken into account in hospitals when setting up strategies to improve pain management.

摘要

背景

尽管在疼痛管理方面人们的关注度有所提高且取得了进展，但疼痛的患病率仍然很高。只有识别并考虑到障碍因素，优化疼痛相关护理的干预措施才会有效。

目的

评估疼痛强度，并研究其与患者相关（本研究将健康素养定义为“阅读健康信息需要帮助”）、护士相关以及系统相关（将社会资本定义为“工作中网络和规范的重要性”）的疼痛管理障碍/促进因素之间的关联。

方法

2012年10月至2013年4月间进行了一项双中心横断面研究。该研究纳入了比利时两家医院39个非重症病房的患者和护士。年龄在18岁及以上、认知或意识未受损的患者有资格参与。邀请了在所纳入病房工作的所有护士参与。通过与患者对话完成的结构化标准化问卷收集疼痛强度和患者相关障碍。护士完成关于护士和系统相关障碍以及社会资本量表的问卷。由于数据的层次结构，使用多水平分析来分析数据。

结果

所有病房所有患者的平均疼痛程度在0 - 10分制上为2.2（标准差 = 3.6）。多水平分析表明，疼痛强度可以由患者和病房层面的变量来解释。研究发现，较高的疼痛强度与年龄较小、接受止痛药物治疗、患者认为止痛药物不能缓解疼痛、患者健康素养不足、未接受高等教育的护士以及护士对副作用的担忧之间存在显著的独立关联。社会资本并未成为疼痛强度的预测因素。