Crowe Marie, Gillon Deborah, Jordan Jennifer, McCall Cate
Department of Psychological Medicine, University of Otago, Christchurch, New Zealand(1).
Centre for Postgraduate Nursing Studies, University of Otago, Christchurch, New Zealand.
Int J Nurs Stud. 2017 Mar;68:40-50. doi: 10.1016/j.ijnurstu.2016.12.009. Epub 2016 Dec 23.
There is evidence that chronic pain is not recognised or managed effectively in older people. It is important to examine how older people cope with this because of the impact it can have on their quality of life and mortality. It will also enable nurses to work with older people to support effective coping skills and provide information on other useful coping strategies.
To examine how older people cope with non-malignant chronic pain.
This is a qualitative meta-synthesis using Confidence in the Evidence from Reviews of Qualitative Research developed by Grading of Recommendations Assessment Development and Evaluation working group to evaluate the strength of the evidence.
PubMed and Ovid Medline from 1995 to 2015.
Following a systematic search strategy all papers were assessed in relation to inclusion criteria and quality. Only qualitative studies were included. Themes were extracted from each study and a meta-synthesis conducted before completing an evaluation of confidence in the findings.
Seventeen primary studies were included in the meta-synthesis. Three meta-themes were identified: 'adjusting to the inevitable', 'doing it my way without medication' and 'the importance of support in managing the struggle'. There was high confidence in the evidence for 'doing it my way without medication' and moderate confidence in the evidence for the other two meta-themes.
Given that the participants in the primary studies were generally wary of health professionals and stoic in their response to pain, it is important for nurses to communicate in ways that engage older people and ensure their independence and sense of control remains intact. Identification of current coping strategies will enable the nurse and the older person to work together to assess their effectiveness and to adapt these if more effective coping is required.
有证据表明，老年人的慢性疼痛未得到有效识别和处理。鉴于其对老年人生活质量和死亡率可能产生的影响，研究老年人如何应对这一问题非常重要。这也将使护士能够与老年人合作，支持他们掌握有效的应对技巧，并提供其他有用应对策略的信息。
研究老年人如何应对非恶性慢性疼痛。
这是一项定性元分析，采用推荐分级评估、制定与评价工作组开发的定性研究综述证据可信度方法来评估证据强度。
1995年至2015年的PubMed和Ovid Medline。
按照系统检索策略，所有论文均根据纳入标准和质量进行评估。仅纳入定性研究。从每项研究中提取主题，并在完成对研究结果可信度评估之前进行元分析。
元分析纳入了17项原始研究。确定了三个元主题：“顺应不可避免之事”、“不服药按自己的方式应对”以及“支持在应对挣扎中的重要性”。对“不服药按自己的方式应对”这一证据的可信度较高，对其他两个元主题的证据可信度中等。
鉴于原始研究中的参与者通常对医护人员持谨慎态度，且在应对疼痛时坚忍克己，护士以能与老年人建立沟通的方式进行交流，并确保他们的独立性和掌控感不受影响非常重要。识别当前的应对策略将使护士和老年人能够共同努力，评估这些策略的有效性，并在需要更有效的应对方式时进行调整。
