Ortiz Mia Maris, Carr Eloise, Dikareva Anastasia
BSN student in the Faculty of Nursing, University of Calgary, Alberta, Canada.
Faculty of Nursing, and Associate Dean, Faculty of Graduate Studies, University of Calgary.
Can J Nurs Res. 2014 Sep;46(3):65-93. doi: 10.1177/084456211404600305.
Despite decades of pain research, substandard pain management continues to be distressingly prevalent across health-care settings. This integrative literature review analyzes and synthesizes barriers to effective pain management and identifies areas for future investigation in a Canadian context. Three sets of key barriers were identified through thematic analysis of 24 original research studies published in the period 2003-13: patient, professional, and organizational. These barriers rarely occurred in isolation, with many studies reporting examples in all three categories. This suggests that interventions need to reflect the multifactorial nature of pain management. Reframing pain education as a public health initiative could lead to sustainable improvement, as could the strengthening of partnerships between patients and health-care providers. There are tremendous opportunities for the advanced practice nurse to take a lead in pain management. The delivery of high-quality care that encompasses effective pain management strategies must be a priority for nursing. Research approaches, such as pragmatic mixed methods, that offer contextual understanding of how pain is managed are suggested.
尽管经过了数十年的疼痛研究，但在各个医疗环境中，不合格的疼痛管理仍然普遍存在，令人担忧。这篇综合文献综述分析并综合了有效疼痛管理的障碍，并确定了加拿大背景下未来的研究领域。通过对2003年至2013年期间发表的24项原创研究进行主题分析，确定了三组关键障碍：患者、专业人员和组织。这些障碍很少单独出现，许多研究都报告了所有三个类别中的例子。这表明干预措施需要反映疼痛管理的多因素性质。将疼痛教育重新定位为一项公共卫生举措可能会带来可持续的改善，加强患者与医疗服务提供者之间的伙伴关系也会如此。高级实践护士在疼痛管理方面发挥带头作用有巨大的机会。提供包含有效疼痛管理策略的高质量护理必须是护理工作的优先事项。建议采用诸如务实混合方法等研究方法，以提供对疼痛管理方式的背景理解。
