School of Nursing and Midwifery, the University of Newcastle, Callaghan NSW 2308, Australia.
Priority Research Centre of Brain and Mental Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan Australia.
Int Nurs Rev. 2018 Dec;65(4):524-533. doi: 10.1111/inr.12465. Epub 2018 Jun 29.
To identify and synthesize evidence regarding the knowledge and attitudes of nurses, and barriers and facilitators to effective pain assessment and management in infants and children.
Pain among children is a common experience. Relief from pain is a fundamental human right, yet hospitalized children continue to experience unrelieved pain. Provision of effective pain management is an integral part of the nurse's role.
Guided by Whittemore & Knafl's five-stage framework, primary peer-reviewed studies published in English between 2000 and 2018 were searched using CINAHL, PubMed, ProQuest, PsycINFO and Scopus. The initial search yielded 292 papers. Twenty-seven papers were included in this review: quantitative (n = 18), qualitative (n = 5) and mixed-methods (n = 4).
Findings showed that nurses internationally have poor knowledge and attitudes of basic pain assessment and management principles. Barriers to effective pain management include the absence of pain education and assessment tools, parents' reluctance to report pain and insufficient prescription of analgesia by physicians. Facilitators for the effective management of pain include parental participation in care, trusting and respectful relationships between nurses and children, and adequate nurse-patient ratios.
The review findings suggest a need to improve education for nurses, doctors and the patients' family in relation to paediatric pain management, communication and interprofessional collaborations. There is a need to maximize facilitators and overcome barriers, such as those identified in this review, to ensure the quality of paediatric pain management.
Nursing and health policy should mandate the prioritization of paediatric pain management and the clinical roles and responsibilities of the interdisciplinary team members. Undergraduate, postgraduate and in-service education for nurses and other health professionals should also address paediatric pain management. In-service education on paediatric pain management should be compulsory for all health professionals caring for children.
确定并综合有关护士的知识和态度，以及影响婴儿和儿童有效疼痛评估和管理的障碍和促进因素的证据。
儿童疼痛是一种常见的经历。缓解疼痛是一项基本人权，但住院的儿童仍在经历未缓解的疼痛。提供有效的疼痛管理是护士角色的一个组成部分。
在 Whittemore 和 Knafl 的五阶段框架的指导下，检索了 2000 年至 2018 年期间以英文发表的主要同行评议研究，使用 CINAHL、PubMed、ProQuest、PsycINFO 和 Scopus 进行检索。最初的搜索产生了 292 篇论文。本综述共纳入 27 篇论文：定量研究（n=18）、定性研究（n=5）和混合方法研究（n=4）。
研究结果表明，国际护士对基本疼痛评估和管理原则的知识和态度较差。有效疼痛管理的障碍包括缺乏疼痛教育和评估工具、家长不愿报告疼痛以及医生开止痛药不足。有效疼痛管理的促进因素包括家长参与护理、护士与儿童之间的信任和尊重关系以及充足的护士与患者比例。
综述结果表明，需要提高护士、医生和患者家属在儿科疼痛管理、沟通和跨专业合作方面的教育。需要最大限度地发挥促进因素并克服障碍，例如本综述中确定的障碍，以确保儿科疼痛管理的质量。
护理和卫生政策应优先考虑儿科疼痛管理以及跨学科团队成员的临床角色和责任。还应为护士和其他卫生专业人员提供本科、研究生和在职教育，以解决儿科疼痛管理问题。所有照顾儿童的卫生专业人员都应接受强制性的儿科疼痛管理在职教育。
