Heckroth Antje, Pludra Vanessa, Johannssen Christian, Guest Charlotte, Wiedermann Frauke, Bantel Carsten
Carl von Ossietzky Universitat Oldenburg, Oldenburg, Germany.
Hanse Institut Oldenburg, Oldenburg, Germany.
Br J Pain. 2021 Feb;15(1):40-53. doi: 10.1177/2049463719880333. Epub 2019 Oct 17.
Nurses are the main administrators of opioids in hospitals and enjoy some autonomy when using them to manage pain. Nevertheless evidence suggests they exercise this freedom restrictively with the reasons for this self-limitation remaining unclear. Nurses are influenced by personal and professional values and by patients' attributes. Intoxicated patients pose a particular challenge. This study therefore investigated whether cautious attitudes towards opioids were aggravated in intoxicated patients and influenced by personal values.
A two-version questionnaire was developed. Each presented a case vignette describing a patient in acute pain who was either intoxicated or not intoxicated. Questionnaires contained identical case statements inquiring about concerns regarding opioids, preferred analgesics and statements about opioids and personal values. They were distributed prospectively in a cross-sectional, multi-centre design. Equal distribution of both questionnaires was achieved through randomization of wards. Regression analysis was employed to determine predictors for responses to the case statements.
In total, n = 374 (26%) nurses returned questionnaires, 85% were female, 39% worked in surgery and 64% had >10 years experience. A total of 78% were concerned using opioids in the intoxicated patient and 70% preferred non-opioids instead. Most nurses agreed familiarity with an opioid gives them more confidence and they were more concerned in patients with a history of drug abuse. They neither associated opioids with helping patients to die nor with drug abuse. The majority endorsed value statements representing 'universalism', 'hedonism' and 'benevolence' while disagreeing with 'power' and 'stimulation'. Nurses concerns were predicted by values indicating 'conformity' and 'achievement'.
Nurses were concerned giving opioids to intoxicated patients and preferred non-opioids instead. These concerns were predicted by personal values representing 'Conservation' ('conformity') and 'Self-Enhancement' ('achievement'). Therefore, stigmatizing mental models likely contribute to nurses' reluctance to use opioids. Interestingly, personal ambition might protect nurses from discriminatory thoughts and practice.
护士是医院中阿片类药物的主要管理者，在使用阿片类药物管理疼痛时享有一定的自主权。然而，有证据表明他们在使用这种自主权时较为受限，而这种自我限制的原因尚不清楚。护士会受到个人和职业价值观以及患者特征的影响。醉酒患者带来了特殊的挑战。因此，本研究调查了对阿片类药物的谨慎态度在醉酒患者中是否会加剧，以及是否受个人价值观的影响。
设计了一个有两个版本的问卷。每个版本都呈现了一个病例 vignette，描述了一名处于急性疼痛中的患者，该患者要么醉酒要么未醉酒。问卷包含相同的病例陈述，询问对阿片类药物的担忧、首选的镇痛药以及关于阿片类药物和个人价值观的陈述。它们以前瞻性的横断面多中心设计进行分发。通过病房随机化实现两个问卷的均等分发。采用回归分析来确定对病例陈述回答的预测因素。
总共 n = 374 名（26%）护士返回了问卷，85%为女性，39%在外科工作，64%有超过 10 年的工作经验。总共 78%的护士对在醉酒患者中使用阿片类药物表示担忧，70%更倾向于使用非阿片类药物。大多数护士同意熟悉一种阿片类药物会让他们更有信心，并且他们对有药物滥用史的患者更担心。他们既不将阿片类药物与帮助患者死亡联系起来，也不将其与药物滥用联系起来。大多数人认可代表“普遍主义”“享乐主义”和“仁爱”的价值观陈述，同时不同意“权力”和“刺激”的价值观陈述。护士的担忧由表示“遵从”和“成就”的价值观预测。
护士对给醉酒患者使用阿片类药物表示担忧，更倾向于使用非阿片类药物。这些担忧由代表“保守”（“遵从”）和“自我提升”（“成就”）的个人价值观预测。因此，带有污名化的思维模式可能导致护士不愿使用阿片类药物。有趣的是，个人抱负可能会保护护士免受歧视性思维和行为的影响。
