Departement of Health and Caring Sciences, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway.
Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway.
J Clin Nurs. 2020 May;29(9-10):1488-1498. doi: 10.1111/jocn.15194. Epub 2020 Feb 7.
To describe what is known from the existing literature on nonpharmacological interventions targeting pain in patients admitted to the ICU.
Patients receiving intensive care nursing are exposed to a wide range of pain provoking tissue damage, diseases, surgery and other medical procedures in addition to the pain caused by nursing care procedures. The present shift to light sedation to improve patient outcomes and comfort underscores the need for effective pain management. Opioids are the mainstay for treating pain in the ICUs, whereas nonpharmacological treatments are understudied and possibly under-used.
A scoping review was undertaken using five of the six steps in the Arksey and O´Malley framework: (a) identification of the research question, (b) identification of relevant studies, (c) study selection, (d) charting the data and (e) collating, summarising and reporting the results. CINAHL, MEDLINE, PubMed, BMJ Best Practice, British Nursing Index and AMED databases were searched using relevant keywords to capture extensive evidence. Data were analysed using the six-step criteria for scoping reviews suggested by Arksey and O´Malley for data extraction. To ensure quality and transparency, we enclosed the relevant Equator checklist PRISMA.
Our search yielded 10,985 articles of which 12 studies were included. Tools for pain assessments were VAS, NRS, ESAS and BPS. Interventions explored were hypnosis, simple massage, distraction, relaxation, spiritual care, harp music, music therapy, listening to natural sounds, passive exercise, acupuncture, ice packs and emotional support. Reduction in pain intensity was conferred for hypnosis, acupuncture and natural sounds.
The findings support further investigations of acupuncture, hypnosis and listening to natural sounds.
The main finding suggests the use of comprehensive multimodal interventions to investigate the effects of nonpharmacological treatment protocols on pain intensity, pain proportion and the impact on opioid consumption and sedation requirements.
描述现有文献中针对 ICU 患者疼痛的非药物干预措施。
接受重症监护护理的患者除了接受护理程序引起的疼痛外，还会受到广泛的引起疼痛的组织损伤、疾病、手术和其他医疗程序的影响。目前，为了改善患者的转归和舒适度，转向轻度镇静，这突显了有效疼痛管理的必要性。阿片类药物是治疗 ICU 疼痛的主要药物，而非药物治疗的研究较少，可能使用不足。
采用 Arksey 和 O´Malley 框架的六个步骤中的五个步骤进行了范围综述：（a）确定研究问题，（b）确定相关研究，（c）研究选择，（d）数据图表和（e）整理、总结和报告结果。使用相关关键词在 CINAHL、MEDLINE、PubMed、BMJ Best Practice、英国护理索引和 AMED 数据库中搜索，以捕获广泛的证据。使用 Arksey 和 O´Malley 提出的用于数据提取的范围综述的六个步骤标准对数据进行分析。为了确保质量和透明度，我们附上了相关的 EQUATOR 清单 PRISMA。
我们的搜索结果产生了 10985 篇文章，其中 12 项研究被纳入。疼痛评估工具包括 VAS、NRS、ESAS 和 BPS。探索的干预措施包括催眠、简单按摩、分散注意力、放松、精神关怀、竖琴音乐、音乐疗法、听自然声音、被动运动、针灸、冰袋和情感支持。催眠、针灸和自然声音可以减轻疼痛强度。
这些发现支持进一步调查针灸、催眠和听自然声音。
主要发现表明，使用综合多模式干预措施来调查非药物治疗方案对疼痛强度、疼痛比例以及对阿片类药物消耗和镇静需求的影响。
