Margonary Heather, Hannan Margaret S, Schlenk Elizabeth A
Pediatr Nurs. 2017 Mar-Apr;43(2):65-70.
Pain treatment begins with a nurse’s assessment, which relies on effective assessment skills. Hospital settings have implemented pain assessment education, but there is limited evidence in pediatric transitional care settings. The purpose of this quality improvement (QI) initiative was to develop, implement, and evaluate an evidence-based pain education session with 20 nurses in a pediatric specialty hospital that provides transitional care. Specific aims were to assess nurses’ knowledge and attitudes of pain, and evaluate assessment skills based on nurses’ documentation. A prospective pre-post design with three assessments (baseline, post-intervention, and one-month follow-up) was used. The Shriner’s Pediatric Nurses’ Knowledge and Attitudes Regarding Pain questionnaire and an electronic health record review were completed at each assessment. There was significant improvement in nurses’ knowledge and attitudes of pain after the education session (F[2,6] = 50.281, p < 0.0001) from baseline to post-intervention (p < 0.0001), which was maintained at follow-up (p = 0.009). Pain assessment frequency by nurses significantly increased from 43.1% at baseline to 64.8% at post-intervention, and 67.7% at follow-up (χ²[2] = 20.55, p < 0.0001). Developmentally appropriate pain scale usage increased significantly, from 13.1% at baseline to 77.4% at post-intervention, and 81.8% at follow-up (χ²[2] = 169.19, p < 0.0001). Nursing interventions for pain increased significantly, from 33.3% at baseline to 84.0% at post-intervention, and stabilized at 80.0% at follow-up (χ²[2] = 8.91, p = 0.012). Frequency of pain reassessments did not show a statistically significant change, decreasing from 77.8% at baseline to 44.0% at post-intervention and 40.0% at follow-up (χ²[2]= 3.538, p = 0.171). Nurses’ pain knowledge and documentation of assessment skills were improved in this QI initiative.
疼痛治疗始于护士的评估，这依赖于有效的评估技能。医院环境中已开展疼痛评估教育，但在儿科过渡护理环境中的相关证据有限。这项质量改进（QI）举措的目的是为一家提供过渡护理的儿科专科医院的20名护士制定、实施并评估一次循证疼痛教育课程。具体目标是评估护士对疼痛的知识和态度，并根据护士的记录评估其评估技能。采用了具有三次评估（基线、干预后和为期一个月的随访）的前瞻性前后对照设计。每次评估时都要完成施赖纳儿科护士关于疼痛的知识和态度问卷以及电子健康记录审查。从基线到干预后，教育课程结束后护士对疼痛的知识和态度有显著改善（F[2,6]=50.281，p<0.0001）（p<0.0001），在随访时保持这一改善（p=0.009）。护士进行疼痛评估的频率从基线时的43.1%显著增加到干预后的64.8%，随访时为67.7%（χ²[2]=20.55，p<0.0001）。适合不同发育阶段的疼痛量表使用显著增加，从基线时的13.1%增加到干预后的77.4%，随访时为81.8%（χ²[2]=169.19，p<0.0001）。针对疼痛的护理干预显著增加，从基线时的33.3%增加到干预后的84.0%，随访时稳定在80.0%（χ²[2]=8.91，p=0.012）。疼痛重新评估的频率没有显示出统计学上的显著变化，从基线时的77.8%降至干预后的44.0%，随访时为40.0%（χ²[2]=3.538，p=0.171）。在这项质量改进举措中，护士的疼痛知识和评估技能记录得到了改善。
