Campbell Cathy L, Kelly Meghan, Rovnyak Virginia
University of Virginia School of Nursing, Charlottesville, Virginia.
Nurs Health Sci. 2017 Sep;19(3):381-387. doi: 10.1111/nhs.12359. Epub 2017 Jun 13.
The development and evaluation of evidence-based, safe, and effective home-based pain management models for caregivers implementation is receiving greater attention in the literature because of international initiatives intended to increase the number of people who receive end-of-life care in home-based settings. The purpose of this "retrospective descriptive design" study was to describe pharmacological pain management and outcomes for 40 cancer and non-cancer patients receiving hospice care at home. While the median pain score was higher at admission in the cancer group than in the hospice care at home group, the difference was not significant at or within 48 hour of admission. Overall, there was a significant decrease in pain from the first measurement to the second. Within the last seven days of life, the majority of participants were not able to provide a pain severity score when asked to evaluate the effectiveness of pain management, thus their caregiver provided a proxy evaluation. Pain management was effective in the home setting. More research is needed on the best methods to teach lay caregivers to assess pain and evaluate the effectiveness of pharmacological modalities to manage pain.
由于国际社会旨在增加在家中接受临终关怀的人数的倡议,基于证据的、安全有效的居家疼痛管理模式的开发和评估,以供护理人员实施,在文献中受到了越来越多的关注。这项“回顾性描述性设计”研究的目的是描述40名在家中接受临终关怀的癌症和非癌症患者的药物疼痛管理及结果。虽然癌症组入院时的疼痛评分中位数高于在家中接受临终关怀组,但在入院时或入院后48小时内,差异并不显著。总体而言,从第一次测量到第二次测量,疼痛有显著减轻。在生命的最后七天内,大多数参与者在被要求评估疼痛管理效果时无法提供疼痛严重程度评分,因此由他们的护理人员进行代理评估。居家疼痛管理是有效的。需要更多研究来确定教导非专业护理人员评估疼痛以及评估药物治疗方式管理疼痛效果的最佳方法。