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This study was designed to gain information on the quality of nursing care based on the comments in nursing records. The specific aims of the study were to find out if the patients' (i) individual needs are assessed, the goals for nursing care are set, and the nursing interventions are determined; (ii) if the patients' needs are met and (iii) if goal achievement is regularly evaluated by including comments in nursing documents. In addition, the study aimed to describe the up-to-dateness of nursing care plans as well as the frequency of making daily notes. The data were collected on 36 wards of four residential homes. A 30% sample of the nursing documents on each ward was collected (n=332) using the Senior Monitor instrument. The documents studied were mainly nursing care plans and daily note sheets. Seventy-three per cent of the nursing home residents had an up-to-date nursing care plan at the time of data collection. The main results demonstrated that a written statement on the patient's mental ability was lacking in every fourth document although 75% of the patients suffer from at least moderate dementia in Finnish long-term care institutions. Development activities should also be targeted to the documentation of clear and concrete means by which patients' independent functioning is supported. In addition, evaluation was the area that warranted attention and development activities since only every fourth record included information on changes in the patients' functional capability. Although a lot of in-service training has been focused on improving the documentation practices, there is still a need for development. The means by which knowledge is transferred to guide the practice should be carefully considered. Also forms should be developed to meet the special requirements for recording nursing care in long-term care settings. 相似文献
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Manias E 《Nursing & health sciences》2003,5(1):85-94
The purpose of the present study was to examine prescribing and administering activities for sedative and analgesic medication in postoperative patients, and to describe nurses' documentation practices for pain management in nursing notes. A prospective audit was undertaken of medication order charts and nursing notes of 100 patients on the operation day and over the first four days following surgery. Almost all patients received some form of infusion, while the use of 'as required' analgesics varied from one-third to over two-thirds of patients during the postoperative period. Few patients were prescribed fixed-order analgesics or sedative medications. An audit of nursing entries found that nurses had documented inadequately in four major areas: pain assessment, use of non-pharmacological interventions, use of pharmacological interventions, and outcome of interventions. The findings contribute to improving our understanding of nurses' pain management and identify the need to use clinical judgement that is individualized to patients' needs. 相似文献
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目的探讨疼痛规范化护理管理对肝癌患者术后疼痛及睡眠状况的改善效果。方法回顾性分析2016年7月至2020年3月我院收治的行手术治疗的46例肝癌患者的临床资料,根据护理方法的不同将其分为对照组(23例,常规护理管理)和观察组(23例,疼痛规范化护理管理)。比较两组的护理效果。结果护理后,观察组NRS评分低于对照组,CD-RISC评分高于对照组(P<0.05)。护理后,观察组PSQI各维度评分低于对照组(P<0.05)。护理后,观察组患者的EORTC QLQ-C30各维度评分优于对照组(P<0.05)。结论疼痛规范化护理管理用于肝癌术后患者效果显著,可有效缓解术后疼痛,改善患者心理状态及睡眠状况,进而提高生活质量。 相似文献
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Nworah U 《Nursing forum》2012,47(2):91-99
PROBLEM. Adequate pain control continues to be an enigma in the face of the Joint Commission (TJC) well‐intended pain management standards. Notable in the pain standards is the mandate to make pain the fifth vital sign to increase pain visibility and awareness. METHOD. The following databases were searched: EBSCOHost, CINHAL, PubMed Central, Medline, and government/societies sites for guidelines on pain control. Various search terms used included pain, post operative pain, pain control, pain as the 5th vital sign, pain documentation, pain assessment, Joint Commission Pain Standard, PRN effectiveness, and pay‐for‐performance. FINDINGS. Accredited facilities are mandated to have plans to assess for pain and evaluate pain management effectiveness. These mandates have necessitated a flurry of initiatives and programs by hospitals and healthcare facilities focusing on documentation processes to meet TJC compliance. Notable programs include Pain as the 5th Vital Sign and PRN (as needed) effectiveness documentation. Many facilities have programs to assess and document pain but lack programs that effectively control patient's pain. CONCLUSION. This article is a call for facilities to refocus on pain control. A need to evaluate current programs by facilities is evident. Studies show that Pain as the 5th Vital Sign and PRN effectiveness documentation are not effective and invariably have not met the goals of TJC pain standard—adequate and effective pain control. 相似文献
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The present prospective survey was conducted in a 1200-bed hospital to examine postoperative patients' current pain intensity, most intense pain experienced, satisfaction with postoperative pain management, and differences regarding pain and satisfaction levels. All adult patients admitted to a hospital in Hong Kong for surgery, except those receiving local anesthesia, were eligible to enter this study. The patient outcome questionnaire developed by the American Pain Society was used to solicit data about patients' pain and satisfaction with pain relief. The subjects were 294 postoperative patients. Approximately 85% complained about varying degrees of pain during the 24 h prior to the assessment of their pain. When interviewed, most patients complained of mild to moderate pain (median = 2 on a 10-point scale), while the median for 'worst pain intensity' was 5. Approximately 80% of the subjects indicated that both the nurses and physicians reminded them to report pain when it occurred. Only 143 (48.6%) agreed that the nurses and physicians sufficiently emphasized the importance of pain relief. Those who received acute pain services, provided by anesthetists, reported lower levels of current pain intensity. Over 65% of the subjects were satisfied with all levels of health care providers, regarding their postoperative pain management. 相似文献
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介绍了英国布里斯托皇家医院成人术后疼痛管理中病人自控镇痛(PCA)的临床应用、护理,结合我国临床PCA使用现状进行分析讨论。认为我国可以借鉴西方PCA管理中的经验,以促进病人术后无痛,达到优质护理的目标。 相似文献
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The quality of postoperative pain management from the perspectives of patients, nurses and patient records 总被引:1,自引:0,他引:1
AIM: To study the quality of postoperative pain management in a university hospital. METHOD: Paired patient and nurse assessments of the patient's pain management were conducted in two departments, complemented with audit of patient records. The Strategic and Clinical Quality Indicators in Postoperative Pain Management questionnaire was answered by 121 patients and 47 Registered Nurses. RESULTS: Of 14 items in the Strategic and Clinical Quality Indicators in Postoperative Pain Management questionnaire, four items in general surgery and five items in thoracic surgery reached the threshold for high quality of care. No significant differences were found between the assessments in the two departments, but the patients in general surgery experienced more pain than the patients in thoracic surgery. In general surgery, the patients assessed their worst pain significantly higher than the nurse did. The patients who experienced more pain than expected were less satisfied with the quality of their care and experienced higher pain intensity levels. For 25 (41.0%) patients in general surgery and four (6.7%) patients in thoracic surgery, pain intensity was documented according to hospital quality goals. CONCLUSION: In both departments, areas for improvements could be found in all subscales of the Strategic and Clinical Quality Indicators in Postoperative Pain Management questionnaire, i.e. communication, action, trust and environment. It is important to discuss what information the patient needs, as well as how and when it should be given. Furthermore, considering earlier pain experience and the goal of pain relief for the individual patient may facilitate an adequate assessment of the patient's pain. In future, electronic health records have the potential to support the use of clinical guidelines. 相似文献
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BACKGROUND: Unrelieved pain after surgery can lead to complications, prolonged hospital stay, and delayed recovery. Because of side effects from opioids and differences in response, it is important to use non-pharmacological methods in addition to analgesics to decrease patient discomfort and anxiety. AIMS: We examined the effects of a systematic method of relaxing the body on the sensory and affective components of postoperative pain, anxiety, and opioid intake after initial ambulation. DESIGN: A randomized controlled trial with relaxation and control groups was used. METHOD: The convenience sample of 102 adults underwent abdominal surgery at a large hospital in Thailand. Systematic relaxation was used for 15 minutes during recovery from the first ambulation after surgery. Pain was measured with 100 mm Visual Analogue Sensation and Distress of Pain Scales before and after the intervention. State anxiety was measured before surgery and after the intervention; opioid intake was recorded 6 hours later. RESULTS: The relaxation group had less post-test sensation and distress of pain (26 and 25 mm less, respectively) than the control group (P = 0.001). Relaxation did not result in significantly less anxiety or 6-hour opioid intake. However, group differences in state anxiety were in the expected direction and fewer participants in the relaxation group requested opioids. Nearly all reported that systematic relaxation reduced their pain and increased their sense of control. CONCLUSION: Substantial reductions in the sensation and distress of pain were found when postoperative patients used systematic relaxation. Although tested in Thailand, we recommend that nurses in other countries try systematic relaxation with postoperative patients, in addition to analgesic medication, measuring pain scores and asking about cultural acceptance. 相似文献
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RATIONALE: Differences between patient and professional assessments on pain and pain management have been reported, but no further analysis has described the statistical problems of pseudocorrelation concerning the nature of these differences. AIM: The aim of the present study was: (1) to investigate the differences between nurse and patient assessments of postoperative pain management in two hospitals, and (2) to discuss the nature and scope of these differences. METHOD: The subjects were 209 inpatients and 63 nurses from a central county hospital and 77 inpatients and 34 nurses from a university hospital. The 'Strategic and Clinical Quality Indicators in Postoperative Pain Management' questionnaire was used, comprising 14 items in four sub-scales (communication, action, trust and environment) and two questions concerning the worst pain experienced during the past 24 hours and general satisfaction. RESULT: Except for the trust sub-scale in one hospital, the correlations between patient and nurse ratings concerning all assessments were significant in both hospitals (r = 0.22-0.59). Both groups of patients had significantly higher (better) scores than judged by the nurses on the environment sub-scale and general satisfaction. In contrast, nurses from both hospitals tended to significantly underestimate patients' worst pain during the past 24 hours. Other differences between patient and nurse assessments were either non-significant or inconsistent between hospitals. Using so-called Oldham plots nurses tended to underestimate severe pain more often than mild pain, as judged by the patients, but this association was weak and statistically significant in one hospital only. CONCLUSION: Although the effects of pseudocorrelation are minimized by using Oldham plots, they are not cancelled. This issue is discussed, and we conclude that this study does not support the notion that the nurses tend to underestimate severe pain more often than mild pain. 相似文献
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目的探讨规范化疼痛管理在肝胆外科术后患后疼痛控制中的应用效果。方法选取2017年11月—2018年4月住院行肝胆外科手术治疗的患者547例,分为对照组369例和观察组178例。对照组采用常规疼痛管理,观察组采取规范化疼痛管理。比较2组患者中重度静息疼痛的发生率、活动性疼痛评分等指标。结果观察组患者术后3天内中重度静息痛的发生率为20.22%,低于对照组的23.31%,差异有统计学意义(P<0.05)。术后6、12、24、48 h时观察组活动性疼痛评分低于对照组,差异有统计学意义(P<0.01)。结论规范化疼痛管理能有效控制肝胆外手术患者术后疼痛程度,有利于患者的快速康复。 相似文献
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