Nurs Res. 2021;70(4):273-280. doi: 10.1097/NNR.0000000000000509.
Clinicians may place more weight on vocal complaints of pain than the other pain behaviors when making decisions about pain management.
We examined the association between documented pain behaviors and pharmacological pain management among nursing home residents.
We included 447,684 residents unable to self-report pain, with staff-documented pain behaviors (vocal, nonverbal, facial expressions, protective behaviors) and pharmacological pain management documented on the 2010-2016 Minimum Data Set 3.0. The outcome was no pharmacological pain medications, as needed only (pro re nata [PRN]), as scheduled only, or as scheduled with PRN medications. We estimated adjusted odds ratios and 95% confidence intervals from multinomial logistic models.
Relative to residents with vocal complaints only, those with one pain behavior documented (i.e., nonverbal, facial, or protective behavior) were more likely to lack pain medication versus scheduled and PRN medications. Residents with multiple pain behaviors documented were least likely to have no treatment relative to scheduled with PRN medications, PRN only, or scheduled only pain medication regimens.
The type and number of pain behaviors observed are associated with pharmacological pain management regimen. Improving staff recognition of pain among residents unable to self-report is warranted in nursing homes.
临床医生在决定疼痛管理时，可能会更重视疼痛的声音抱怨，而不是其他疼痛行为。
我们研究了记录的疼痛行为与养老院居民药物治疗疼痛管理之间的关系。
我们纳入了 447684 名无法自我报告疼痛的居民，这些居民的工作人员记录了疼痛行为（声音、非语言、面部表情、保护行为）和药物治疗疼痛管理情况，记录在 2010-2016 年最低数据集中 3.0。结果是没有药物治疗疼痛，仅按需（pro re nata [PRN]）、仅按时或按时加 PRN 药物治疗。我们使用多项逻辑回归模型估计了调整后的优势比和 95%置信区间。
与仅报告声音抱怨的居民相比，有一个疼痛行为记录（即非语言、面部或保护行为）的居民与没有药物治疗相比，更有可能没有疼痛药物治疗，无论是按时治疗还是 PRN 药物治疗。记录了多种疼痛行为的居民与仅按时治疗 PRN 药物、仅 PRN 药物或仅按时药物治疗方案相比，最不可能没有治疗。
观察到的疼痛行为的类型和数量与药物治疗疼痛管理方案有关。在养老院中，需要提高工作人员对无法自我报告的居民疼痛的识别能力。
