住院癌症患者的疼痛管理结局与医护人员疼痛管理行为的研究

Pain management outcomes of Chinese inpatients and pain management behaviors of physicians and nurses

摘要:

目的 调查住院癌症患者疼痛管理结局与医护人员疼痛管理行为的现状及相关关系。方法 采用方便抽样法,取2018年1~8月北京某三甲肿瘤专科医院153例住院癌症疼痛患者,应用美国疼痛协会患者结局问卷修订版调查患者的疼痛管理结局；通过查阅医嘱和护理记录判断医护人员的疼痛管理行为。结果 疼痛管理结局： 59.48%患者疼痛有效缓解；25%患者有中重度便秘；疼痛对患者活动、睡眠及情绪有轻中度影响；疼痛管理感知维度得分为(6.98±2.17)。医护人员的疼痛管理行为：医生为95.42%患者开具长期镇痛药物医嘱,规范处理33.33%患者的爆发痛,为35.29%患者开具预防便秘的医嘱；护士为85%患者进行及时、连续的疼痛评估,但评估内容均不全面；为61.44%患者提供疼痛护理指导,为24.84%患者提供疼痛随访支持。患者的疼痛管理结局与医生开具预防便秘的医嘱、护士疼痛评估是否及时连续、有无提供疼痛护理指导有关(P<0.05)。结论 当前住院癌症患者的疼痛管理结局尚不满意,医护人员疼痛管理行为与诊疗规范仍有差距,且与疼痛管理结局密切相关。

Abstract:

Objective To explore Chinese cancer inpatients’ pain management outcomes (PMOs), and physicians’ and nurses’ pain management behaviours and their relationship. Methods A convenience sample of 153 patients with cancer pain was recruited from a tertiary cancer hospital in Beijing from January to August 2018. The Chinese version of the Revised American Pain Society Patient Outcome Questionnaire was used to measure PMOs. Physicians’ and nurses’ pain management behaviours were surveyed through a medical document review. Results PMOs: 59.48% of participants had effective pain relief. 25% had moderate to severe constipation. Activity, sleep and affect were mildly affected by pain; Perceptions of care were moderate (6.98±2.17). Physicians’ and nurses’ behaviours: In total, 95.42% of participants were prescribed long-term analgesics by a doctor, 33.33% of participants who had breakthrough pain were treated correctly, and 35.29% were prescribed laxatives to prevent opioid-induced constipation. 85% of participants had immediate and continuous pain assessments, but the assessments were uncomprehensive. A total of 61.44% received pain education in the hospital, and 24.84% received nurse support after discharge. The immediacy and continuity of pain assessment, nurses’ pain education and physicians’ orders to prevent opioid-induced constipation were correlated with PMOs (P<0.05). Conclusions PMOs were unsatisfactory. A gap exists between clinical practices and guidelines, and physicians’ and nurses’ pain management behaviours were closely correlated with PMOs.