3～12岁儿童术后疼痛评估的循证实践

目的：将3～12岁儿童术后疼痛评估的最佳证据应用于临床实践，提高护士对儿童术后疼痛的认知，促进开展正确有效的评估。方法遵循JBI循证护理中心的临床证据实践应用系统（JBI‐PACES）的标准程序，包括证据应用前基线审查、实践变革和证据应用后变革效果的再审查。获取JBI在线临床治疗及护理证据网络（COn‐N EC T＋）数据库中3～12岁儿童术后疼痛评估相关证据，并制订相应审查标准7条。采用现场观察法、访谈、查阅护理病历收集数据。证据应用前后各有30例手术患儿以及22名护士纳入。分析每条证据应用存在的障碍、可获得的资源及解决办法，因地制宜地制订实践方案。以护士每条标准行为依从性率评价证据应用前后的有效性。结果实施3～12岁儿童疼痛评估护理循证实践方案后，在JBI护理质量审查的7条标准中，7条标准的完成率均得到极大提高（0～97％，20％～93％，41％～97％，7％～100％，20％～93％，0～100％，0～97％）。干预后3～12岁儿童术后疼痛从容易被忽视，改进为中重度疼痛能够得到及早评估和管理。结论将JBI儿童术后疼痛评估循证标准应用于3～12岁患儿术后疼痛评估，能提高护士疼痛评估和管理的知识技能，从而提高儿童手术疼痛管理质量，但仍需落实持续质量改进。     

山东省164所医院术后疼痛护理管理现状调查

目的:了解山东省二、三级医院术后疼痛护理管理现状。方法:依据急性疼痛指南和疼痛质量评估体系自行拟定调查问卷,采用分层整群抽样方法对山东省164家医院进行术后疼痛护理管理现状调查分析。结果:32.9%的医院成立术后疼痛管理小组;58.5%的医院将疼痛作为第五项生命体征进行评估,42.7%的医院对患者的静息痛和活动痛进行评估;52.4%的医院对患者进行疼痛知识教育;拥有疼痛资源护士的医院仅占3.7%,对护士进行疼痛在职教育的医院占12.2%。结论:山东省医院术后疼痛护理管理亟待规范,有必要成立规范的术后疼痛管理组织和管理评估体系,提高术后疼痛的管理质量。     

外科护士疼痛认知与实践能力多因素调查分析

摘要：目的 调查某中医医院外科护士疼痛知识与态度,以及术后患者疼痛控制护理质量现状,分析影响因素以制定相应对策。方法：采用《护理人员的疼痛知识和态度问卷》对某中医医院81名外科护士进行疼痛评估、疼痛一般知识、药物镇痛知识、综合应用知识调查,以及静脉自控镇痛知识掌握能力、临床术后患者疼痛控制护理质量现状调查,分析其对术后疼痛知识的掌握及应用情况。结果： 81名外科护士疼痛管理知识与态度总体处于较低水平（47.03±9.74）,不同学历、职称、护龄对护理人员疼痛知识与态度得分无相关性（P>0.05）。外科护士药物镇痛知识、静脉自控镇痛知识缺乏,并影响术后患者疼痛管理护理质量,同时术后患者普遍存在忍痛现象。结论：全面及深入地开展疼痛知识继续教育,改变护士疼痛管理行为,对术后患者进行多形式疼痛健康教育,探讨以护士为主体的术后疼痛管理模式及有中医特色的疼痛护理。     

痛尺在四肢创伤术后早期疼痛评估中的应用

目的探讨痛尺在四肢创伤术后疼痛评估中的作用。方法应用痛尺对手术后的疼痛病人进行疼痛评估,采取货粤的护理措施。结果对80例四肢创伤术后病人的疼痛运用痛尺评估,均能有效减轻术后疼痛。结论改变疼痛观念,选择正确的评估方法,可有效提高护士在疼痛管理中的地位。     

采用PDCA循环管理促进妇科护士对术后镇痛认知及行为的转变

[目的]评价以PDCA循环管理方法与护理继续医学教育相结合,促进妇科护士对术后镇痛认识、行为与服务理念的转变,提高病人术后疼痛控制的满意度。[方法]对妇科护士与病人进行问卷调查,针对调查中存在的问题以PDCA循环管理方法与护理继续医学教育相结合,促进妇科护士对术后镇痛态度与行为的改变。[结果]护士镇痛知识成绩由原来的38分上升到84分;疼痛知识健康教育、疼痛评估与记录从30%上升到100%;病人对镇痛药物的担心从76%下降到18%;对术后疼痛控制的满意度从50%上升到95%。[结论]将PDCA循环管理方法与护理继续医学教育相结合,可提高妇科护士对术后镇痛的认知,提高了护理继续医学教育的质量,提高了病人对术后疼痛控制满意度。     

创建手术后无痛护理病房的效果

目的创建手术后无痛护理病房,提升护士疼痛管理理念,使患者术后能得到优质的无痛服务。方法在入住无痛护理病房的128例患者入院时及术后第3天,调查他们关于手术镇痛的认知和无痛需求。同时转变病房护士和患者的关于疼痛及镇痛药的某些不正确观念,提高护士疼痛护理技能,在医师共同参与下,制定无痛护理工作原则和流程,建立疼痛评价体系,对无痛护理进行规范化的管理。结果所有被调查的患者均把无痛放在需求首位。在疼痛评估、疼痛可忍受性以及药物成瘾性等方面的认识上,差异有显著意义(P<0.01)。创建术后无痛护理病房后,护士疼痛评估次数明显增多,按需镇痛措施更及时有效,患者满意度有明显提高。结论创建术后无痛护理病房,护士主动参与疼痛管理,使患者术后能得到优质的无痛护理服务。     

儿童术后疼痛行为评估的研究进展

疼痛是儿童术后最常见的临床症状之一。由于年龄、疾病、手术等因素,患儿往往不能准确描述疼痛的存在和程度,因此,对儿童术后疼痛的评估较为困难。术后疼痛控制不足,会影响患儿疾病的预后,甚至对其生理、心理的发育造成严重影响。疼痛行为评估,即综合分析因疼痛产生的各种身体反应,进而判断疼痛的强度,在儿童术后疼痛评估中的应用越来越广泛。现对儿童术后疼痛行为评估的最新研究进展进行综述。     

采用PDCA循环管理 促进妇科护士对术后镇痛认知及行为的转变

[目的]评价以PDCA循环管理方法与护理继续医学教育相结合，促进妇科护士对术后镇痛认识、行为与服务理念的转变，提高病人术后疼痛控制的满意度。[方法]对妇科护士与病人进行问卷调查，针对调查中存在的问题以PDCA循环管理方法与护理继续医学教育相结合，促进妇科护士对术后镇痛态度与行为的改变。[结果]护士镇痛知识成绩由原来的38分上升到84分；疼痛知识健康教育、疼痛评估与记录从30％上升到100％；病人对镇痛药物的担心从76％下降到18％；对术后疼痛控制的满意度从50％上升到95％。[结论]将PDCA循环管理方法与护理继续医学教育相结合，可提高妇科护士对术后镇痛的认知，提高了护理继续医学教育的质量，提高了病人对术后疼痛控制满意度。     

综合医院护士疼痛知识和态度调查分析

目的:通过对综合医院护士的疼痛管理知识、对待疼痛的态度及影响因素进行调查,为临床疼痛护理管理方向提供依据。方法:采用护士疼痛管理知识和态度调查问卷对500名护士进行调查。收集的数据采用描述性分析和方差分析。结果:本次收回有效问卷485份,有效问卷回收率97%;调查对象对问卷的答对率平均为38%;75%护士没有接受过有关疼痛知识的培训;接受过培训、开展了疼痛评估实践和术后止痛、在外科工作的护士疼痛知识得分显著高于未过培训、未开展疼痛评估实践、其他科室工作的护士(P0.01)。结论:调查群体的疼痛管理知识水平需要进一步提高,医护缺乏疼痛知识、过分担心药物成瘾和副反应、医疗体系不重视是有效疼痛管理的主要障碍因素,使得临床疼痛不能有效控制。     

对非药物方法减轻儿童术后疼痛的调查研究

采用芬兰Tarja Polkki博士设计的问卷对福建省5所省级医院178名护士进行调查,了解护士使用非药物方法减轻学龄儿童术后疼痛情况,探讨减轻儿童术后疼痛的最佳护理方法.结果提示护士常用的方法有提供术前准备知识、安慰、创造舒适环境、转移注意力和改变体位.护士的年龄、受教育程度、职称、护理经验、有无子女、有无陪伴子女住院经历以及所在医院和科室注重减轻儿童术后疼痛护理的程度,均与某些非药物方法的使用存在显著相关.因此,应加强护士对使用非药物方法减轻儿童术后疼痛重要性和必要性的认识,使用多种非药物方法减轻学龄儿童术后疼痛.     

在肛肠外科建立无痛病房的效果研究

目的：探讨在肛肠外科建立无痛病房的效果。方法：构建肛肠外科无痛病房,包括建立疼痛管理团队并确定职责,对科室人员进行培训与考核,制订镇痛方案等。建立无痛病房前后采用调查问卷对患者及护理人员进行调查。结果：无痛病房建立后,患者术后疼痛评分（2.8±0.8）、48h内疼痛频次（0.9±0.6）、需止疼药物频次（0.5±0.4）、首次排便时疼痛评分（1.8±0.7）、平均住院日（7.9±0.6）,均小于建立前（P〈0.01）,满意度评分（4.2±0.5）高于建立前（P〈0.01）。护理人员对疼痛评估（1.8±0.4）、疼痛一般知识（8.4±0.9）、药物镇痛知识（17.4±0.8）、疼痛知识的综合应用（3.8±0.5）4个指标得分均高于建立前（P〈0.05）。结论：通过建立无痛病房,实施规范化的疼痛管理护理工作程序,提升了护理人员疼痛知识掌握程度及疼痛管理水平,减轻了患者术后疼痛,提高了患者对镇痛效果的满意度。     

福建省三级甲等医院临床护士疼痛知识与态度调查分析

目的：调查福建省三级甲等医院临床护士疼痛知识与态度情况,分析其影响因素。方法：通过发放护理人员疼痛管理知识与态度问卷（KASRP）,调查福建省11所三级甲等医院440名临床护士的疼痛认知情况,分析其影响因素。结果：福建省临床护士疼痛认知水平偏低,问卷平均正确率为48.35%;接受疼痛知识继续教育不同情况的护士,其疼痛知识与态度不同（P〈0.05）。结论：临床护理人员疼痛知识缺乏,部分护士没有接受疼痛知识继续教育,应进一步加强疼痛管理规范化培训,以提高临床护士疼痛知识水平和临床护理质量。     

Knowledge, assessment and management of pain related to nursing procedures used with premature babies: Questionnaire study for caregivers

The aim of the study was to discover how much Finnish nursing staff know about the pain experienced by premature babies and about pain assessment. The types of helping methods used by caregivers in the nursing of premature babies were also studied. A semistructured questionnaire was sent in autumn 1995 to all registered nurses, practical children's nurses and medical laboratory technologists who take heel blood samples (n = 280) working in paediatric intensive care units in all Finnish university hospitals. The response rate was 70.4%. The structured questions were processed quantitatively at Kuopio University with the SPSS/PC+ data processing program (SPSS, Chicago, IL, USA), and the open questions were processed using quantitative content analysis. The results indicate that the respondents have rather extensive knowledge about the pain experienced by premature babies, pain assessment, pain management and about nursing and helping methods. Pain was assessed mostly on the basis of behaviour and physiological changes, and only infrequently on the basis of biochemical changes. The respondents described the helping methods they use in considerable detail. The most common was to increase the baby's feeling of security. The answers to the open questions revealed that the actions used by the respondents in pain assessment and pain management were not completely consistent with their knowledge. The results demonstrate that caregivers do not use their knowledge adequately in their pain management practices. Future studies should observe the three groups of caregivers in order to discover how they treat premature babies' pain.     

Identification of perceived barriers of pain management in Iranian children: a qualitative study

Hospitalized children are often inadequately treated for their pain. Paediatric nurses experience these inadequacies more than other health-care team members. This research was an attempt in the form of a phenomenological study to reveal some major barriers in children pain management as the nurses had perceived. Sixteen nurses were interviewed in the medical, surgical and infectious paediatric wards of a hospital in Iran. Data analysis were based on Colaizzi method that surfaced three main themes in different areas namely: organizational barriers, limitations relating to child's characteristics and barriers relating to the nature of disease and its treatments. The study results have shown organizational limitations added to the lack of authority for administering some medical intervention, inadequate equipment and utilities and unavailability of opioids as the main pain controlling and restricting factors. Additional factors that relate to the child specifications like age, temperament, behaviour, expression and gender affect the assessment and treatment of pain. The results revealed identified barriers in real context. It seems that some guidelines are needed to achieve optimal pain management.     

Pain and anxiety management in the postoperative gastro-surgical setting

BACKGROUND: Despite increasing knowledge and technological advances, patients continue to experience pain and anxiety in the postoperative setting. AIM OF THE STUDY: The aim of this study was to examine how nurses managed patients' pain and anxiety within the gastro-surgical hospital setting. METHODS: An observational design was selected to examine nurses' management of postoperative patients' pain and anxiety. Six nurses who were involved in direct patient care in one of two gastro-surgical wards in a public teaching hospital in Melbourne, Australia, were randomly selected to participate. The observation period comprised a fixed 2-hour segment, and each nurse was observed on three different occasions. FINDINGS: Patient assessment was a major concern for participants, which was influenced by the modes of assessment used, patients' medical condition and operation procedure, and their self-reports of pain or anxiety. Communication with health care professionals and policy and protocol concerns also affected nurses' pain and anxiety management decisions. Formal communication through the multidisciplinary ward round tended to be somewhat fragmented, as the medical consultant did not seek out the bedside nurse. Nurses had good knowledge of unit policies and protocols and, while attempting to enforce them, spent considerable time encouraging medical colleagues to abide by these guidelines. Finally, nurses made complex clinical judgements which extended beyond the administration of analgesics or antianxiety drugs. STUDY LIMITATIONS: It is possible that nurses demonstrated a raised awareness of how they managed patients' pain and anxiety during observation periods. CONCLUSIONS: The study confirmed the importance of examining the complexities of the clinical context in determining how nurses manage pain and anxiety in the postoperative setting.     

儿科护士对《医疗事故处理条例》认知现状调查

目的：了解北京市儿科护士对《医疗事故处理条例》的认知程度、医疗相关法律法规的学习状况及护士长的法律意识。方法：采用自设问卷调查,对北京市4家＂三甲＂综合医院儿科护士进行调查。结果：对《医疗事故处理条例》认知程度的调查满分16分,平均分10.48±2.38分。〈9.6分为较差,占35.1%;9.6～12.8分之间为一般,占38.7%;≥12.8分为良好,占26.2%。结论：学校和医院应加强儿科护士的法律教育,护士长应充分发挥指导作用,儿科护士则需增加法律知识的学习,学会利用法律维护患者的利益和自身的权益。     

广东省护士老年疼痛知识现状调查

目的：了解护士对老年疼痛知识的掌握现状及影响因素,为采取有效措施提高护士老年疼痛护理能力提供依据。方法：采用McCaffery设计的护士疼痛知识与态度调查表及Sloman等设计的护士老年疼痛知识问卷对广东省35家医院的护士进行调查。结果：1502名护士完成了问卷。护士基础疼痛知识及老年疼痛知识均缺乏,平均答对率分别为45.2%、52.9%。不同年龄、学历、职称、工作年限及护理不同比例老年患者的护士的基础疼痛知识、老年疼痛知识得分差异均无统计学意义,但肿瘤科护士及参加疼痛学习班者得分较高。结论：护士疼痛知识不能满足老年疼痛患者的需求,应强化对护士进行老年疼痛专题教育,提高老年疼痛循证护理实践能力,持续改进老年疼痛护理质量。     

The sedation practices of paediatric intensive care unit nurses and the influencing factors in China

Nurses play a key role in administering sedation to mechanically ventilated children, which impacts children's psychological, physiological and cognitive changes in the paediatric intensive care unit. This study aimed to survey the sedation practices of paediatric intensive care unit nurses on mechanically ventilated children in China and explored the influencing factors. A cross‐sectional survey was conducted based on electronic questionnaires comprised of the Nurse Sedation Practices Scale (Chinese version) in 14 different types of paediatric intensive care units of 11 academic hospitals in China from 15 February to 15 April 2017. A convenience sample of 495 nurses [73·4% response rate, (674)] completed the survey. Seven units applied Ramsay Sedation Scale as a sedative assessment tool. The majority of the nurses used observed behaviours and physiological changes of the ventilated children as indicators to assess the sedation level, and they had a positive attitude and intention, which may influence practice positively, whereas high clinical workload and the lack of communication between the nurses and families might hinder practice. The practice of sedation varied greatly in different regions, and the respondents of the northwest region scored lower. Paediatric nurses in China rarely used a validated paediatric instrument to assess sedation, and most nurses relied on physiological and behavioural cues. The quality of sedation training, nursing workload and regional economic disparity affected the sedation practice. The restricted visiting policy and lack of clearly defined nursing responsibilities around sedation may hinder effective sedation assessment and management. This study found that there was no paediatric‐validated tool popularized in paediatric intensive care units in China and explored influencing factors. We suggest that a validated tool, high‐quality training and hospital's policy, such as visiting regulation, should be promoted to improve the sedation practice.     

强化知识培训 提高护士对结直肠癌患者疼痛管理能力

目的:探讨强化知识培训对普外科护士管理结直肠癌患者疼痛能力的影响。方法:选择2011年9～12月在我院普外科工作的25名护理人员进行强化癌性疼痛知识培训,采用疼痛管理知识和态度问卷(KASRP)和随机病历抽查的方式调查普外科护士对结直肠癌患者疼痛管理能力的效果。结果:普外科护理人员进行培训后KASRP平均分和KASRP合格率高于培训前,差异有统计学意义(P<0.05)。结论:癌性疼痛知识强化培训能够规范护理人员的护理行为,提高护理人员疼痛管理能力。     

疼痛护理管理模式在创伤骨科病房中的应用

目的：探讨疼痛护理管理模式在创伤骨科病房中的应用效果。方法：将2012年9~11月我科住院111例患者设为观察组,开展疼痛护理管理模式,即成立疼痛护理管理小组,组织护士全员系统化疼痛护理知识培训,制定落实创伤骨科疼痛护理评估流程及疼痛护理管理流程,规范化药物镇痛,积极的患者疼痛教育,并与2012年5~7月住院的设为对照组的90例未开展疼痛护理管理模式的患者进行比较,比较创伤后术后疼痛评分、平均住院日和护理工作满意度。结果：开展疼痛护理管理模式后,患者术后疼痛评分降低,平均住院日缩短,对护理工作的整体满意度提高。结论：在创伤骨科病房中开展疼痛护理,实施规范化疼痛护理管理流程,能够减轻患者创伤术后疼痛,促进功能康复,缩短平均住院日,提高了患者对护理工作的整体满意度。