McMillan S C, Tittle M
Hosp J. 1995;10(1):89-107. doi: 10.1080/0742-969x.1995.11882784.
The purpose of this study was to describe the pain and pain-related symptoms experienced by persons receiving treatment in a cancer center or a hospice and to describe the nurses' responses to these problems. The sample consisted of 25 hospice and 19 cancer center patients who were being treated for pain. Pain was assessed three times in a 24-hour period using a visual analogue scale (VAS). Constipation was assessed using the Constipation Assessment Scale. Sedation was assessed on a 0 (fully alert) to 4 (comatose) scale. The nurses' documentation was assessed using the Chart Audit for Pain. Results showed that patients in the cancer center and hospice continued to experience pain (VAS M = 38.6 and 29.7 respectively) in spite of their pain management regimens. The cancer center patients were given an average of 38% of the maximum ordered dose of analgesic while the hospice patients self-administered 93% of the ordered dose. The cancer center nurses documented the efficacy of the analgesics in only 26% of cases while hospice nurses recorded this information in 96% of the charts. Sedation was not found to be a problem. Constipation was reported by 100% of cancer center patients and 84% of hospice patients but was rarely documented by nurses in either setting. It appears that nurses need to do more thorough assessment of patient symptoms and more consistent follow-up evaluation and documentation.
本研究的目的是描述在癌症中心或临终关怀机构接受治疗的患者所经历的疼痛及与疼痛相关的症状，并描述护士对这些问题的应对措施。样本包括25名正在接受疼痛治疗的临终关怀患者和19名癌症中心患者。使用视觉模拟量表（VAS）在24小时内对疼痛进行三次评估。使用便秘评估量表评估便秘情况。镇静程度按0（完全清醒）至4（昏迷）的量表进行评估。使用疼痛图表审核来评估护士的记录。结果显示，尽管有疼痛管理方案，但癌症中心和临终关怀机构的患者仍持续经历疼痛（VAS平均值分别为38.6和29.7）。癌症中心患者平均接受的镇痛剂剂量为最大医嘱剂量的38%，而临终关怀患者自行服用了医嘱剂量的93%。癌症中心的护士仅在26%的病例中记录了镇痛剂的疗效，而临终关怀机构的护士在96%的病历中记录了此信息。未发现镇静是一个问题。100%的癌症中心患者和84%的临终关怀患者报告有便秘，但在这两种情况下护士都很少记录。看来护士需要对患者症状进行更全面的评估，并进行更一致的随访评估和记录。
