Biobehavioral Cancer Prevention and Control Training Program, University of Washington, School of Public Health, Seattle, Washington, USA.
University of Iowa, College of Nursing, Iowa City, Iowa, USA.
J Pain Symptom Manage. 2018 May;55(5):1296-1303. doi: 10.1016/j.jpainsymman.2018.01.004. Epub 2018 Jan 31.
Family caregivers (FCGs) of hospice cancer patients face significant challenges related to pain management. Addressing many of these challenges requires effective communication between FCGs and hospice nurses, yet little empirical evidence exists on the nature of communication about pain management between hospice nurses and FCGs.
We identified ways in which FCGs of hospice cancer patients communicated their pain management challenges to nurses during home visits and explored nurses' responses when pain management concerns were raised.
Using secondary data from audio recordings of hospice nurses' home visits, a deductive content analysis was conducted. We coded caregivers' pain management challenges and immediate nurses' responses to these challenges.
From 63 hospice nurse visits, 101 statements describing caregivers' pain management challenges were identified. Thirty percent of these statements pertained to communication and teamwork issues. Twenty-seven percent concerned caregivers' medication skills and knowledge. In 52% of the cases, nurses responded to caregivers' pain management challenges with a validating statement. They provided information in 42% of the cases. Nurses did not address 14% of the statements made by caregivers reflecting pain management challenges.
To optimize hospice patients' comfort and reduce caregivers' anxiety and burden related to pain management, hospice nurses need to assess and address caregivers' pain management challenges during home visits. Communication and educational tools designed to reduce caregivers' barriers to pain management would likely improve clinical practice and both patient- and caregiver-related outcomes.
临终关怀癌症患者的家属（FCG）在疼痛管理方面面临着重大挑战。要解决这些挑战中的许多问题，需要 FCG 和临终关怀护士之间进行有效的沟通，但关于护士和 FCG 之间关于疼痛管理沟通的性质，实证证据很少。
我们确定了临终关怀癌症患者的家属在家庭访视期间向护士表达疼痛管理挑战的方式，并探讨了护士在提出疼痛管理问题时的反应。
使用临终关怀护士家庭访视的音频记录的二级数据，进行了演绎内容分析。我们对护理人员的疼痛管理挑战以及对这些挑战的即时护士反应进行了编码。
在 63 次临终关怀护士访视中，确定了 101 个描述护理人员疼痛管理挑战的陈述。这些陈述中有 30%涉及沟通和团队合作问题。27%涉及照顾者的药物技能和知识。在 52%的情况下，护士对照顾者的疼痛管理挑战做出了肯定的回应。在 42%的情况下，他们提供了信息。护士没有解决照顾者提出的 14%的陈述，这些陈述反映了疼痛管理方面的挑战。
为了优化临终关怀患者的舒适度，并减轻照顾者在疼痛管理方面的焦虑和负担，临终关怀护士需要在家庭访视期间评估和解决照顾者的疼痛管理挑战。旨在减少照顾者疼痛管理障碍的沟通和教育工具可能会改善临床实践以及患者和照顾者相关的结果。
