摘要
Objective:To investigate the effect of a pain management core competency education program on surgical nurses’pain knowledge and pain management nursing practice behaviors.Methods:An 8-h education program focused on pain management core competency was provided twice in two weeks including the multidimensional nature of pain,pain assessment,pharmacological and nonpharmacological management,and knowledge application was developed and implemented for surgical nurses by a multidisciplinary team.Multimodal teaching approaches such as didactic teaching and vignettes of cases for nurses to discuss were used.The Clinical Pain Knowledge Test(CPKT)was completed by 135 and 107 nurses from 17 surgical wards pre and post-program,respectively.Two hundred and three patients’medical records were randomly sampled according to the number of operations in each ward one week before and in the fifth week after the intervention,respectively.Documentation of patients’postoperative pain management nursing practice behaviors and pain intensity scores were collected.Results:After the intervention,the CPKT scores of nurses significantly increased from 45.6%±12.3%to 54.2%±10.2%(t=5.786,P<0.001).Nurses’postoperative pain management nursing practice improved,with proportion of pain assessment documentation increased from 59.6%(121/203)to 74.9%(152/203)(χ^(2)=10.746,P=0.001),those using pain intensity assessment tools increased from 81.8%(99/121)to 95.4%(145/152)(χ^(2)=13.079,P<0.001),and intramuscular injection of nonopioids decreased from 12.6%(13/103)to 2.7%(3/111)(χ^(2)=7.598,P=0.006).Patients’average worst pain score on the operation day significantly decreased(Z=-2.486,P=0.013),and scores from the first to the third postoperative day also decreased(Z=-2.172,P=0.030).Conclusions:Implementation of a pain management core competency education program for surgical nurses can increase their knowledge of core competencies of pain management,improve selected pain management practices,and decrease patients’postoperative pain intensity.
目的探讨疼痛管理核心能力教育项目对外科护士疼痛知识和疼痛护理实践的影响。方法由多学科团队设计并实施外科护士疼痛护理核心能力教育项目,每周8 h,共2周,内容包括疼痛的多维性质、疼痛评估、药物与非药物治疗以及知识应用等,采用讲授、个案讨论等多种形式的教学方法。采用临床疼痛知识测验(the Clinical Pain Knowledge Test,CPKT)在课程前后对来自17个外科病区的护士进行评估,课程前后分别评估了135、107名护士。在课程前1周及课程后第5周按各病区手术量随机抽取203份患者病历,收集患者的术后疼痛护理实践及疼痛强度评分记录。结果课程实施后护士的临床疼痛知识测验评分由(45.6%±12.3%)提高到(54.2%±10.2%)(t=5.786,P<0.001)。术后疼痛护理实践记录中,疼痛评估记录的比例由59.6%增加到74.9%(χ^(2)=10.746,P=0.001),使用疼痛强度评估工具的比例由81.8%增加到95.4%(χ^(2)=13.079,P<0.001),肌内注射非阿片类药物的比例由12.6%降至2.7%(χ2=7.598,P=0.006)。患者手术当天及术后3 d疼痛程度(最痛平均分)均降低(P<0.05)。结论对外科护士实施疼痛管理核心能力教育项目可提高其疼痛管理核心能力知识水平,改善部分疼痛护理实践,减轻患者的术后疼痛程度。
基金
supported by the IASP Developing Countries Project:Initiative for Improving Pain Education.
