Bouri Fadi, El Ansari Walid, Mahmoud Shady, Elhessy Ahmed, Al-Ansari Abdulla, Al-Dosari Mohamed Al Ateeq
Department of Orthopedic Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha 3050, Qatar.
Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha 3050, Qatar.
Healthcare (Basel). 2018 Aug 13;6(3):98. doi: 10.3390/healthcare6030098.
Pain is a challenge for orthopedic healthcare professionals (OHCP). However, pain studies examined the competencies of a single OHCP category, did not consider various pain management domains or barriers to optimal pain service, and are deficient across the Arabic Eastern Mediterranean region. We surveyed OHCP's recognition and knowledge of pain and perceived barriers to optimal pain service (361 OHCP, five hospitals). Chi square compared doctors' ( = 63) vs. nurses/physiotherapists' ( = 187) views. In terms of pain recognition, more nurses had pain management training, confidently assessed pediatric/elderly pain, were aware of their departments' pain protocols, and felt that their patients receive proper pain management. More doctors comfortably prescribed opiate medications and agreed that some nationalities were more sensitive to pain. For pain knowledge, more nurses felt patients are accurate in assessing their pain, vital signs are accurate in assessing children's pain, children feel less pain because of nervous system immaturity, narcotics are not preferred due respiratory depression, and knew pre-emptive analgesia. As for barriers to optimal pain service, less nurses agreed about the lack of local policies/guidelines, knowledge, and skills; time to pre-medicate patients; knowledge about medications; complexity of the clinical environment; and physicians being not comfortable prescribing pain medication. We conclude that doctors required confidence in pain, especially pediatric and geriatric pain, using vital signs in assessing pain and narcotics use. Their most perceived barriers were lack of local policies/guidelines and skills. Nurses required more confidence in medications, caring for patients on narcotics, expressed fewer barriers than doctors, and the complexity of the clinical environment was their highest barrier. Educational programs with clinical application could improve OHCPs' pain competencies/clinical practices in pain assessment and administration of analgesics.
疼痛是骨科医疗保健专业人员（OHCP）面临的一项挑战。然而，以往的疼痛研究仅考察了单一OHCP类别的能力，未考虑各种疼痛管理领域或实现最佳疼痛服务的障碍，而且阿拉伯东地中海地区在这方面的研究也很匮乏。我们调查了OHCP对疼痛的认知和知识以及他们所认为的实现最佳疼痛服务的障碍（涉及五家医院的361名OHCP）。采用卡方检验比较医生（n = 63）和护士/物理治疗师（n = 187）的观点。在疼痛认知方面，更多护士接受过疼痛管理培训，能够自信地评估儿科/老年患者的疼痛，了解所在科室的疼痛治疗方案，并且认为他们的患者得到了适当的疼痛管理。更多医生能够自如地开具阿片类药物，并认同某些国籍的人对疼痛更敏感。在疼痛知识方面，更多护士认为患者能够准确评估自身疼痛，生命体征可准确评估儿童疼痛，儿童因神经系统不成熟而疼痛较轻，因呼吸抑制而不首选麻醉药品，并且了解超前镇痛。至于实现最佳疼痛服务的障碍，较少护士认同存在缺乏地方政策/指南、知识和技能、给患者进行术前用药的时间、药物知识、临床环境复杂以及医生开具疼痛药物时不自在等问题。我们得出结论，医生在疼痛评估方面，尤其是儿科和老年患者的疼痛评估、利用生命体征评估疼痛以及使用麻醉药品方面需要增强信心。他们最常提到的障碍是缺乏地方政策/指南和技能。护士在药物使用、护理使用麻醉药品的患者方面需要更多信心，他们所提到的障碍比医生少，临床环境复杂是他们面临的最大障碍。开展具有临床应用的教育项目可以提高OHCP在疼痛评估和镇痛药管理方面的疼痛相关能力及临床实践水平。
