Department of Nursing Research and Evidence-Based Practice, University of Chicago Medicine, Chicago, Illinois; Section of Vascular Surgery and Endovascular Therapy, University of Chicago Biological Sciences Division, Chicago, Illinois.
Department of Nursing Research and Evidence-Based Practice, University of Chicago Medicine, Chicago, Illinois.
Pain Manag Nurs. 2022 Jun;23(3):267-272. doi: 10.1016/j.pmn.2022.01.005. Epub 2022 Feb 16.
The majority of patients in the pediatric intensive care unit (PICU) experience pain daily, while nonpharmacologic interventions are indicated for pain management in children, there is limited information on which nonpharmacologic interventions are provided in the PICU and which patients receive those interventions. The aim of this descriptive correlational secondary data analysis was to determine what nonpharmacologic interventions were recorded in the electronic health record of PICU patients and patterns in use by patient demographics.
SETTING/SUBJECTS: All patients hospitalized in 15 participating PICUs are located within 12 unique children's hospitals across the United States were eligible for participation.
Nonpharmacologic interventions used in the PICU were identified and differences between patients who did and did not receive those interventions were examined using Fisher's exact test. A generalized linear mixed effects model was constructed to determine patient characteristics that predict nonpharmacologic pain intervention application.
Of 220 enrolled patients, 97 (44%) had nonpharmacologic pain interventions recorded in their electronic health record. The most frequently recorded interventions included repositioning (65%), decreasing environmental stimuli (55%), caregiver presence (37%), distraction (23%), and music therapy (20%). Children who had moderate to severe pain were most likely to receive nonpharmacologic pain interventions.
Nonpharmacologic pain management is applied inconsistently across PICUs and may be underdocumented or underutilized. Additional research is needed to determine when nurses use nonpharmacologic pain interventions, their rationale for applying these interventions across differing groups, and the effectiveness of these interventions in managing pain in critically ill children.
儿科重症监护病房（PICU）的大多数患者每天都经历疼痛，虽然非药物干预措施适用于儿童疼痛管理，但关于 PICU 中提供了哪些非药物干预措施以及哪些患者接受了这些干预措施的信息有限。本描述性相关性二次数据分析的目的是确定在 PICU 患者的电子健康记录中记录了哪些非药物干预措施，以及这些干预措施的使用模式与患者人口统计学特征之间的关系。
设置/研究对象：符合条件的研究对象为美国 12 家独特儿童医院的 15 家参与 PICUs 中住院的所有患者。
使用 Fisher 精确检验确定 PICU 中使用的非药物干预措施，并检查接受和未接受这些干预措施的患者之间的差异。构建了广义线性混合效应模型，以确定预测非药物性疼痛干预应用的患者特征。
在 220 名入组患者中，97 名（44%）的电子健康记录中记录了非药物性疼痛干预措施。记录最频繁的干预措施包括重新定位（65%）、减少环境刺激（55%）、照顾者存在（37%）、分散注意力（23%）和音乐治疗（20%）。有中度至重度疼痛的儿童最有可能接受非药物性疼痛干预措施。
PICU 之间非药物性疼痛管理的应用不一致，可能记录不足或利用不足。需要进一步研究以确定护士何时使用非药物性疼痛干预措施、他们在不同群体中应用这些干预措施的理由以及这些干预措施在管理危重症儿童疼痛方面的有效性。
