Sandvik Reidun K N M, Mujakic Maida, Haarklau Ingvild, Emilie Gosselin, Moi Asgjerd L
Department of Health and Caring Sciences, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway; Centre for Care Research, West, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway.
Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway.
Pain Manag Nurs. 2024 Dec;25(6):606-614. doi: 10.1016/j.pmn.2024.06.013. Epub 2024 Sep 7.
Patients in the intensive care unit suffer from pain caused by life-threatening illness or injury but also treatments such as surgery and nursing procedures such as venipuncture. Unconsciousness following head trauma or sedation stage complicates self-report, and both under- and over-management of pain can occur. Inadequate assessment and treatment might follow from unsuitable pain assessment practices. The aim of this study was to evaluate the effect of the implementation of a pain assessment tool on nurses` documentation of pain and the administration of analgesia and sedation.
Quantitative pre-post design.
The study was conducted at one intensive care unit at a university hospital and involved 60 patient records and 30 pre-implementations and 30 post-implementations of the Critical-Care Pain Observation Tool (CPOT).
After implementation, a 38% adherence rate was found. The frequency of nurses' pain evaluations increased significantly from 1.3 to 2.3 per nursing shift. The implementation of CPOT also improved how often nurses identified pain by use of facial expressions, muscle tension, and cooperation with the mechanical ventilator, whereas focus on vital signs dropped (p = .014). A larger proportion of patients (17%) received paracetamol after the CPOT implementation compared with before (8%). Findings were statistically significant at p < .01.
Implementation of CPOT increased the frequency of pain evaluations, and the observable patient behavior was more often interpreted as pain-related. Nurses' adherence rate to sustained patient behavior focus being modest highlights the essential need for ongoing improvements in practice. Implementation of a new tool must be followed by non-pharmacological and pharmacological pain management steps.
Implementing the CPOT as a pain assessment tool has the potential to enhance assessment practices. However, it is important to note that simply increasing assessment frequency does not guarantee nursing interventions to alleviate pain. This indicates the need for additional steps to be taken in order for nurses to complete the pain assessment cycle and effectively address interventions and reassessments.
重症监护病房的患者会遭受由危及生命的疾病或损伤所引起的疼痛，同时也会因手术等治疗以及诸如静脉穿刺等护理操作而疼痛。头部创伤后的意识丧失或镇静阶段会使自我报告变得复杂，并且可能出现疼痛管理不足或过度的情况。不合适的疼痛评估方法可能导致评估和治疗不充分。本研究的目的是评估实施一种疼痛评估工具对护士记录疼痛以及给予镇痛和镇静药物的影响。
定量前后对照设计。
该研究在一家大学医院的一个重症监护病房进行，涉及60份患者记录，其中30份是重症监护疼痛观察工具（CPOT）实施前的记录，30份是实施后的记录。
实施后，发现依从率为38%。护士进行疼痛评估的频率从每个护理班次1.3次显著增加到2.3次。CPOT的实施还提高了护士通过面部表情、肌肉紧张程度以及与机械通气的配合来识别疼痛的频率，而对生命体征的关注减少了（p = 0.014）。与实施CPOT之前（8%）相比，实施后有更大比例的患者（17%）接受了对乙酰氨基酚治疗。结果在p < 0.01时具有统计学意义。
CPOT的实施增加了疼痛评估的频率，并且患者的可观察行为更常被解读为与疼痛相关。护士对持续关注患者行为的依从率适中，这突出了在实践中持续改进的迫切需求。实施新工具后必须采取非药物和药物疼痛管理措施。
将CPOT作为疼痛评估工具实施有可能改善评估方法。然而，需要注意的是，仅仅增加评估频率并不能保证护士采取减轻疼痛的干预措施。这表明需要采取额外的步骤，以便护士完成疼痛评估周期并有效进行干预和重新评估。
