Drake Gareth, de C Williams Amanda C
Research Department of Clinical, Educational, and Health Psychology, University College London, London, United Kingdom.
Research Department of Clinical, Educational, and Health Psychology, University College London, London, United Kingdom.
Pain Manag Nurs. 2017 Feb;18(1):3-15. doi: 10.1016/j.pmn.2016.11.001. Epub 2016 Dec 28.
The objective of this review was to examine the effects of nursing education interventions on clinical outcomes for acute pain management in hospital settings, relating interventions to health care behavior change theory. Three databases were searched for nursing education interventions from 2002 to 2015 in acute hospital settings with clinical outcomes reported. Methodological quality was rated as strong, moderate, or weak using the Effective Public Health Practice Project Quality Assessment Tool for quantitative studies. The 12 eligible studies used varied didactic and interactive teaching methods. Several studies had weaknesses attributable to selection biases, uncontrolled confounders, and lack of blinding of outcome assessors. No studies made reference to behavior change theory in their design. Eight of the 12 studies investigated nursing documentation of pain assessment as the main outcome, with the majority reporting positive effects of education interventions on nursing pain assessment. Of the remaining studies, two reported mixed findings on patient self-report of pain scores as the key measure, one reported improvements in patient satisfaction with pain management after a nursing intervention, and one study found an increase in nurses' delivery of a relaxation treatment following an intervention. Improvements in design and evaluation of nursing education interventions are suggested, drawing on behavior change theory and emphasizing the relational, contextual, and emotionally demanding nature of nursing pain management in hospital settings.
本综述的目的是研究护理教育干预措施对医院环境中急性疼痛管理临床结果的影响，并将这些干预措施与医疗保健行为改变理论联系起来。检索了三个数据库，以查找2002年至2015年急性医院环境中有关护理教育干预措施且报告了临床结果的研究。使用有效公共卫生实践项目定量研究质量评估工具将方法学质量评为强、中或弱。12项符合条件的研究采用了不同的讲授式和互动式教学方法。几项研究存在因选择偏倚、未控制的混杂因素以及结果评估者缺乏盲法而导致的缺陷。没有研究在其设计中提及行为改变理论。12项研究中有8项将疼痛评估的护理记录作为主要结果进行调查，大多数研究报告教育干预措施对护理疼痛评估有积极影响。在其余的研究中，两项研究报告了以患者疼痛评分自我报告为关键指标的混合结果，一项研究报告护理干预后患者对疼痛管理的满意度有所提高，还有一项研究发现干预后护士提供放松治疗的次数有所增加。建议借鉴行为改变理论，改进护理教育干预措施的设计和评估，并强调医院环境中护理疼痛管理的关系性、情境性和情感需求性。
