Tsuboi Kaoru, Tsuboi Norihiko, Yamashita Kana, Nakagawa Satoshi, Yotani Nobuyuki
Department of Critical Care and Anesthesia, National Center for Child Health and Development, Tokyo, Japan.
Department of Nursing, National Center for Child Health and Development, Tokyo, Japan.
Pediatr Int. 2023 Jan;65(1):e15499. doi: 10.1111/ped.15499.
Nurses play an essential role in pain management in the pediatric intensive care unit (PICU). However, their perceptions regarding pediatric pain and current practice of pain assessment in Japanese PICUs remain unknown.
In January 2021, we conducted a multicenter, cross-sectional survey across 35 PICUs in Japan. A structured questionnaire which focused on nurses' perceptions of pediatric pain and pain assessment was developed, pilot-tested, and revised. Twenty copies of the questionnaire were sent to each institution and were distributed to the nursing staff.
A total of 356 nurses from 22 institutions responded. Median age of the respondents was 33 years and 84.6% were female. Median length of nursing experience and PICU experience were 10 and 4 years, respectively. Use of pain scales for assessing pain in children who can self-report pain, preverbal children, and children unable to self-report pain due to cognitive impairment were 90.7%, 55.9%, and 50.0%, respectively. Nurses' satisfaction regarding pain management in their PICU was 31.9% and their confidence in pain assessment and management were 32.6% and 44.9%, respectively. Lack of knowledge (95.8%), difficulty assessing pain in children (95.2%), and delay in physician's action (91.8%) were the most perceived barriers to optimal pain management.
The use of pain scales is insufficient and nurses' satisfaction proved to be extremely low in the Japanese PICUs. Substantial effort is required to enhance the level of current pain management and improve outcomes.
护士在儿科重症监护病房（PICU）的疼痛管理中起着至关重要的作用。然而，日本PICU护士对儿科疼痛的认知以及当前疼痛评估的实践情况仍不为人所知。
2021年1月，我们在日本的35个PICU进行了一项多中心横断面调查。我们编制了一份聚焦于护士对儿科疼痛及疼痛评估认知的结构化问卷，进行了预测试并修订。向每个机构发送了20份问卷，并分发给护理人员。
来自22个机构的356名护士进行了回复。受访者的年龄中位数为33岁，女性占84.6%。护理经验和PICU经验的中位数分别为10年和4年。对于能够自我报告疼痛的儿童、尚不能言语的儿童以及因认知障碍无法自我报告疼痛的儿童，使用疼痛量表进行疼痛评估的比例分别为90.7%、55.9%和50.0%。护士对其所在PICU疼痛管理的满意度为31.9%，对疼痛评估和管理的信心分别为32.6%和44.9%。知识缺乏（95.8%）、难以评估儿童疼痛（95.2%）以及医生行动延迟（91.8%）是最佳疼痛管理中最常被感知到的障碍。
在日本的PICU中，疼痛量表的使用不足，护士的满意度极低。需要付出巨大努力来提高当前疼痛管理水平并改善结果。
