Bohm Katarina, Lund Roger, Nordlander Jörgen, Vicente Veronica
Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset in Stockholm, Sweden; The Emergency Department, Södersjukhuset in Stockholm, Sweden.
Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset in Stockholm, Sweden.
Int Emerg Nurs. 2019 Sep;46:100779. doi: 10.1016/j.ienj.2019.06.002. Epub 2019 Jul 22.
Pain is a personal and subjective experience. Prehospital emergency nurses (PEN) should work on the basis that all people are equal and entitled to the same care regardless of gender, age, disability or social status. The objective of treatment in health care is that all the pain to be alleviated. People with addiction problems often seek emergency care and pain is a frequent symptom. Research shows that medical staff often under treats pain and treat patients with addiction differently.
To describe PENSs' experiences of relieving pain in patients with addiction problems, otherwise called Substance Abuse Syndrome.
The study is designed with a qualitative approach with semistructured interviews. Eight PENs were interviewed and the material was analyzed according to a manifest content analysis.
The study's main finding is that the PENs wanted to give all patients equal care but often experienced uncertainty in the care of addicts. Many of the perceived emotions created a doubt in what situations would be resolved. Lack of information and knowledge about addiction and their own feelings and values of addicts made it difficult to decide what was right or wrong treatment. The difficulty was further increased when the unclear guidelines and lack of support meant that the treatment still perceived to be different.
Pain management of patients with drug addiction can be characterized as a complex task that requires a high level of skill. PENs often encounter this population in their work. Several factors lead to their experiencing these care situations as difficult to manage. Treatment guidelines are perceived as unclear and giving weak support as to how patients with addiction and pain should be treated. To handle this, PEN sought support in their decision-making from colleagues in ambulance care and the Emergency Department. Their conclusion was that treatment would be different every time, and that patients with addiction and pain were all treated differently. Despite advances in treatment options, patients will continue to be under-treated. Unfortunately, it is not just better knowledge of pain physiology and pharmacology that is the solution. Knowledge about and attitudes to pain and addiction must be corrected before any behaviour can be changed. The results of this study will hopefully make knowledge more nuanced and raise awareness of shortcomings in order to optimize care and treatment in the prehospital environment.
疼痛是一种个人主观体验。院前急救护士应基于所有人无论性别、年龄、残疾状况或社会地位如何，都平等且有权获得相同护理这一理念开展工作。医疗保健中的治疗目标是缓解所有疼痛。有药物成瘾问题的人经常寻求急诊护理，且疼痛是常见症状。研究表明，医护人员常常对疼痛治疗不足，且对有成瘾问题的患者区别对待。
描述院前急救护士在缓解有成瘾问题（即药物滥用综合征）患者疼痛方面的经历。
本研究采用定性研究方法，进行半结构式访谈。对8名院前急救护士进行了访谈，并根据显性内容分析法对资料进行分析。
该研究的主要发现是，院前急救护士希望给予所有患者平等护理，但在护理成瘾患者时常常感到不确定。许多所感知到的心绪让人对何种情况能得到解决产生怀疑。缺乏关于成瘾的信息和知识以及他们自身对成瘾者的感受和价值观，使得难以判定何种治疗是正确或错误的。当指南不明确且缺乏支持意味着治疗仍被视为不同时，困难进一步加剧。
药物成瘾患者的疼痛管理可被视为一项需要高水平技能的复杂任务。院前急救护士在工作中经常接触到这类人群。多种因素导致他们觉得这些护理情况难以处理。治疗指南被认为不明确，且在如何治疗成瘾和疼痛患者方面提供的支持薄弱。为应对这一情况，院前急救护士在决策时向急救护理同事和急诊科同事寻求支持。他们的结论是每次治疗都会不同，有成瘾和疼痛问题的患者都受到不同对待。尽管治疗选择有所进步，但患者仍将继续接受不足的治疗。不幸的是，解决方案不仅仅是更好地了解疼痛生理学和药理学。在任何行为发生改变之前，必须纠正对疼痛和成瘾的认识及态度。本研究结果有望使知识更加细化，并提高对不足之处的认识，以便优化院前环境中的护理和治疗。
