Denness Kayla J, Carr Eloise C J, Seneviratne Cydnee, Rae Janice M
Acute Pain Service, Alberta Health Services, South Health Campus, Calgary, Alberta, Canada.
Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada.
Can J Pain. 2017 Dec 19;1(1):226-236. doi: 10.1080/24740527.2017.1403285. eCollection 2017.
: The aim of this study was to explore the factors influencing orthopedic surgery nurses' decisions to administer pro re nata (PRN) opioid analgesia for postoperative pain. : Fast-track surgery programs reduce length of stay by identifying and addressing factors causing patients to remain in hospital, including pain (H. Kehlet, Lancet. 2013;381:9878(9878)). The management of acute pain is an important component of quality care for patients after total knee arthroplasty. : The study used a qualitative design of focused ethnography. Ten nurses working on an orthopedic surgery unit at a large urban hospital in western Canada participated in semistructured interviews that used a patient vignette to examine factors that influenced participants' pain management in the context of fast-track surgery. Interviews were transcribed and analyzed using thematic analysis and constant comparison. : Nurses described a complex clinical environment where the interplay of several factors informed decisions to administer PRN opioid analgesia. The unit's culture and physical space influenced nurses' assessments of pain and their decisions whether to treat pain with PRN opioids. Each nurse's self-concept affected pain management decisions because of perceived importance of pain control and perceived duty to provide analgesics. The subjectivity of pain added another layer of complexity as nurses responded to the patient's expression of pain from within the milieu of the unit culture and their unique self-concept. : Understanding the complexity of factors that influence nurses' postoperative pain management provides clinical nurses and nursing leaders with directions for future education and research, guided by the goal of continued improvement in pain management in the challenging setting of fast-track surgeries.
本研究的目的是探讨影响骨科手术护士决定按需给予阿片类镇痛药以缓解术后疼痛的因素。快速康复外科计划通过识别和解决导致患者住院时间延长的因素，包括疼痛（H. Kehlet，《柳叶刀》。2013；381：9878(9878)），来缩短住院时间。急性疼痛的管理是全膝关节置换术后患者优质护理的重要组成部分。
该研究采用了聚焦人种志的定性设计。加拿大西部一家大型城市医院骨科手术科室的10名护士参与了半结构化访谈，访谈使用患者案例来研究在快速康复外科背景下影响参与者疼痛管理的因素。访谈内容被转录，并采用主题分析和持续比较的方法进行分析。
护士们描述了一个复杂的临床环境，其中多种因素的相互作用为按需给予阿片类镇痛药的决定提供了依据。科室的文化和物理空间影响了护士对疼痛的评估以及他们是否用按需阿片类药物治疗疼痛的决定。由于对疼痛控制的重要性的认知以及提供镇痛药的责任感，每位护士的自我概念都影响了疼痛管理的决定。疼痛的主观性又增加了一层复杂性，因为护士们在科室文化环境和他们独特的自我概念中对患者的疼痛表达做出反应。
了解影响护士术后疼痛管理的因素的复杂性，为临床护士和护理领导者提供了未来教育和研究的方向，其目标是在快速康复外科这一具有挑战性的环境中持续改善疼痛管理。
