University of Iowa, College of Nursing, Iowa City, IA United States of America.
University of Iowa, College of Nursing, Iowa City, IA United States of America; Comer Children's Hospital, University of Chicago, Chicago, IL United States of America.
J Pediatr Nurs. 2019 Sep-Oct;48:55-62. doi: 10.1016/j.pedn.2019.07.005. Epub 2019 Jul 17.
Pain assessment is the first step in managing pain; however, this can be challenging, particularly in settings such as the Pediatric Intensive Care Unit (PICU). This paper reports the current pain assessment practices from a study that was conducted describing the prevalence of pain, pain assessment, painful procedures, interventions, and characteristics of critically-ill children. Specifically, this paper addresses the child's communicative ability, pain scales, and characteristics of pain.
The primary study was a cross-sectional, multi-site, descriptive design. Data from a 24-hour time period were collected from medical records and bedside nurses.
Data were collected from the records of 220 children across 15 PICUs. The average number of pain assessments per child was 11.5 (SD 5.8, range 1-28). Seven behavioral scales and five self-report scales were used. There were times when no scale was used, "assume pain present" was recorded, or a sedation scale was documented. Twelve pain scales, including the target population, scoring, psychometric properties, and clinical utility are described.
Results of this study indicate that a wide range of pain assessment tools are used, including behavioral scales for children unable to self-report.
Foremost, the appropriate assessment method needs to be chosen for each child to manage pain. Knowledge of the criteria for the use of each pain assessment scale will help the clinician select the appropriate scale to use for each child. The practice of "assume pain present," as well as standardization of pain scales, and clinical support tools needs further investigation.
疼痛评估是疼痛管理的第一步；然而，这可能具有挑战性，尤其是在儿科重症监护病房（PICU）等环境中。本文报告了一项研究中的当前疼痛评估实践，该研究描述了疼痛的普遍性、疼痛评估、疼痛操作、干预措施以及危重症儿童的特征。具体来说，本文涉及儿童的沟通能力、疼痛量表和疼痛特征。
主要研究是一项横断面、多地点、描述性设计。从病历和床边护士收集了 24 小时的数据。
从 15 个 PICU 的 220 名儿童的记录中收集了数据。每个儿童的平均疼痛评估次数为 11.5（SD 5.8，范围 1-28）。使用了七种行为量表和五种自我报告量表。有时不使用量表，记录“假设存在疼痛”，或记录镇静量表。描述了 12 种疼痛量表，包括目标人群、评分、心理计量特性和临床实用性。
这项研究的结果表明，广泛使用了各种疼痛评估工具，包括无法自我报告的儿童的行为量表。
最重要的是，需要为每个孩子选择适当的评估方法来管理疼痛。了解每种疼痛评估量表的使用标准将有助于临床医生为每个孩子选择适当的量表。“假设存在疼痛”的做法，以及疼痛量表和临床支持工具的标准化，需要进一步研究。
