Gnass I, Krutter S, Nestler N
Institut für Pflegewissenschaft und -praxis, Paracelsus Medizinische Privatuniversität, Strubergasse 21, 5020, Salzburg, Österreich.
Schmerz. 2018 Oct;32(5):339-347. doi: 10.1007/s00482-018-0284-8.
People with cancer are increasingly supported by home care services. Pain is a relevant symptom of these diseases and nurses of home care services are involved in the treatment. The German National Expert Standard "Pain management in nursing" includes evidence-based recommendations for the implementation of adequate pain management. Considering the given structural conditions of home care services, nurses describe both barriers and challenges with the implementation.
By means of five guideline-based discussion groups, nurses of 14 home care services were questioned about the challenges they had experienced in pain management. The questioning focuses on the level of implementation of the recommendation for each aspect: pain assessment, pharmacological pain therapy, non-pharmacological pain therapy, pain-related side effects, information, training, and counseling in the care of people with cancer. A qualitative content analysis was conducted.
On the one hand, the results illustrate a need for further knowledge and possibilities, e.g., for the assessment of pain as a multidimensional phenomenon and, on the other hand, that the conditions for continuous pain monitoring of cancer patients in home care services are limited. The need for short-term reconciliation with the treatment team and the practitioners proved to be more difficult than the cooperation with the palliative care network. Involvement of family members is important to ensure uninterrupted treatment.
Beside knowledge and competencies regarding nursing care, structures and processes for interprofessional pain management need further development and research.
癌症患者越来越多地得到家庭护理服务的支持。疼痛是这些疾病的一个相关症状，家庭护理服务的护士参与治疗。德国国家专家标准“护理中的疼痛管理”包括实施适当疼痛管理的循证建议。考虑到家庭护理服务的既定结构条件，护士描述了实施过程中的障碍和挑战。
通过五个基于指南的讨论小组，对14个家庭护理服务机构的护士进行了关于他们在疼痛管理中所经历挑战的询问。询问重点在于每个方面建议的实施水平：疼痛评估、药物性疼痛治疗、非药物性疼痛治疗、疼痛相关副作用、信息、培训以及癌症患者护理中的咨询。进行了定性内容分析。
一方面，结果表明需要进一步的知识和可能性，例如，将疼痛评估为一种多维现象，另一方面，家庭护理服务中对癌症患者进行持续疼痛监测的条件有限。事实证明，与治疗团队和从业者进行短期协调比与姑息治疗网络合作更困难。家庭成员的参与对于确保治疗不间断很重要。
除了护理知识和能力外，跨专业疼痛管理的结构和流程需要进一步发展和研究。
