| Summary: | 碩士 === 國立陽明大學 === 醫務管理研究所 === 104 === Background
Pain has been listed as the fifth vital signs by Joint Commission on Accreditation of Healthcare Organizations(JCAHO), and the effects of pain treatment is also an important indicator for healthcare quality. Postoperative pain is the most common and thorny health problem of domestic adult nursing care requirement. If patients’ pain isn’t under good control at all, it may influence patients’ physical rehabilitation and mood, and even make much more waste of medical costs by extending hospital days. Because of the above-mentioned, providing appropriate pain nursing after surgery is not only duty of nursing staff but rights and interests of patients. According to the research, there will be positive effect for clinical nursing after nursing staff taking lessons on pain management, but if it could relieve pain of patients does not be proved yet. That’s the motivation of the research.
Purpose
Take discussion of nurses’ cognition, standard procedure execution and patients’ pain relief difference before and after the pain training program.
Methodology
A medical center with the pain-free hospital policy carrying out just handled 16 sessions of "Pain Assessment and Management Training Program" from April to July (four months) 2014. This study was an observational study before and after the intervention in two ways. First , study objects are the hospital nurses exclude special units such as operating room, dialysis room, supply centers. Research tool is " pain management knowledge and attitude of nurses " questionnaire, a questionnaire before and after the tests are the same person ID, fill out and recover to pair before and after class. The second approach, study objects are general surgery and orthopedic surgery hospitalized patients. Retrieving a Medical Center patients’ pain assessment data of nursing information system, the survey was conducted before and after of educational intervention for four months. Research data was conducted to SAS 9.4 statistics, use Paired-samples T test and logistic regression statistical methods to analysis before and after the educational intervention if the caregivers awareness, compliance and implementation of standard procedures and patients pain relief results have apparently change.
Results
Overall paramedics, the questionnaire pretest average score is 22.15 (standard deviation 4.25), and post-test average score is 24.48 (SD 4.34).Before and after test results have significant differences (P <0.001).Pretest answers correct rate is 59.9% and posttest answers correct rate is up to 66.2%. Nurses performance standard procedures compliance has three indicators, First one is "pain assessment at least once a day", as showing before and after the intervention, the rate of implementation are all up to 100%; Second one is "pain score> 3, assessment once every eight hours", "good compliance" is promoted after intervention,X2 = 40.16, P <0.001, there are significant differences. In addition, in the pain score> 3 surgical patients, during and after the intervention compared to the previous intervention have a higher odds ratio (OR = 1.713, P <0.001).In type of surgery, the ratio shows that the general surgery gets much more compliance than joint reconstruction, sports medicine, spine surgery, TMT and others. And the third one indicator is "pain score> 3 points, giving drugs or nursing treatments", "good compliance" promotes after the intervention, X2 = 67.09, P <0.001, there are significant differences, during and after the intervention compared to the previous intervention have a higher odds ratio (OR = 2.480, P <0.001).In type of surgery, the ratio shows that the general surgery gets much more compliance than joint reconstruction, spine surgery, TMT.
Surgery patients pain relief performance has three indicators, "pain scores of surgical patients had been > 3 in 3 days after the surgery, and after 3 days <= 3", "postoperative pain scores is <= 3" and "postoperative pain scores is <= 3 points or pain scores after 3 days > 3,after 3 days <= 3 ",there is no significant difference before and after the intervention. In the type of surgery, " pain scores of surgical patients had been > 3 in 3 days after the surgery, and after 3 days <= 3"has more pain control in hand surgery, joint reconstruction, pediatric orthopedics, sports medicine, TMT than general surgery; "postoperative pain scores is <=3 "has much more pain control in general surgery than hand surgery, joint reconstruction, pediatric orthopedics, sports medicine, spine surgery, TMT and other surgical department;" postoperative pain scores are all <= 3 or pain scores in 3 days after surgery > 3, after 3 days <= 3 "has much more pain control in hand surgery and TMT than general surgery, but general surgery is better than spinal surgery.
Conclusion
Nursing staff are the key men deciding pain-treating satisfaction of patients. If they have insufficient knowledge to treat with pain, it will let the effects of pain relief go down so far. According to the research, it could probably improve pain awareness level and standard procedure execution deference of nurses after they taking the pain training program. Because of that, it should be more appropriate and necessary to turn common knowledge into pain-nursing guidance. But the part isn’t probed into the research, if nurses taking pain training program and patients’ pain relief has nothing to do with is related to the part could be further studied in the future, also being the reference to other hospitals and the basis for nurses’ training program.
Keywords
nurses、pain training program、pain assessment、postoperative pain、pain management
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