Pierik Jorien G J, IJzerman Maarten J, Gaakeer Menno I, Vollenbroek-Hutten Miriam M R, Doggen Carine J M
Enschede and Goes, The Netherlands.
Enschede and Goes, The Netherlands.
J Emerg Nurs. 2017 May;43(3):228-238. doi: 10.1016/j.jen.2016.10.007. Epub 2017 Mar 28.
Unrelieved acute musculoskeletal pain continues to be a reality of major clinical importance, despite advancements in pain management. Accurate pain assessment by nurses is crucial for effective pain management. Yet inaccurate pain assessment is a consistent finding worldwide in various clinical settings, including the emergency department. In this study, pain assessments between nurses and patients with acute musculoskeletal pain after extremity injury will be compared to assess discrepancies. A second aim is to identify patients at high risk for underassessment by emergency nurses.
The prospective PROTACT study included 539 adult patients who were admitted to the emergency department with musculoskeletal pain. Data on pain assessment and characteristics of patients including demographics, pain, and injury, psychosocial, and clinical factors were collected using questionnaires and hospital registry.
Nurses significantly underestimated patients' pain with a mean difference of 2.4 and a 95% confidence interval of 2.2-2.6 on an 11-points numerical rating scale. Agreement between nurses' documented and patients' self-reported pain was only 27%, and 63% of the pain was underassessed. Pain was particularly underassessed in women, in persons with a lower educational level, in patients who used prehospital analgesics, in smokers, in patients with injury to the lower extremities, in anxious patients, and in patients with a lower urgency level.
Underassessment of pain by emergency nurses is still a major problem and might result in undertreatment of pain if the emergency nurses rely on their assessment to provide further pain treatment. Strategies that focus on awareness among nurses of which patients are at high risk of underassessment of pain are needed.
尽管疼痛管理取得了进展，但未得到缓解的急性肌肉骨骼疼痛仍是一个具有重大临床意义的现实问题。护士进行准确的疼痛评估对于有效的疼痛管理至关重要。然而，在包括急诊科在内的各种临床环境中，全球范围内一直存在疼痛评估不准确的情况。在本研究中，将比较护士与急性肌肉骨骼疼痛患者（肢体受伤后）之间的疼痛评估，以评估差异。第二个目的是识别急诊护士评估不足风险较高的患者。
前瞻性的PROTACT研究纳入了539名因肌肉骨骼疼痛而入住急诊科的成年患者。使用问卷和医院登记系统收集了关于疼痛评估以及患者特征的数据，包括人口统计学、疼痛和损伤情况、心理社会因素以及临床因素。
在11分数字评分量表上，护士显著低估了患者的疼痛，平均差异为2.4，95%置信区间为2.2 - 2.6。护士记录的疼痛与患者自我报告的疼痛之间的一致性仅为27%，63%的疼痛未得到充分评估。在女性、教育程度较低者、使用院前镇痛药的患者、吸烟者、下肢受伤的患者、焦虑患者以及紧急程度较低的患者中，疼痛尤其容易被低估。
急诊护士对疼痛评估不足仍然是一个主要问题，如果急诊护士依靠他们的评估来提供进一步的疼痛治疗，可能会导致疼痛治疗不足。需要制定策略，提高护士对哪些患者疼痛评估不足风险较高的认识。
