深部开放伤口疼痛管理循证护理审查指标的实施及困难因素分析  

Implementation of evidence-based nursing indicators for deep open wound pain management and its difficulties

作　　者：张萍[1] 方雅璇[2] 项平 陈谊[1] 王瑞亭[3] Zhang Ping;Fang Yaxuan;Xiang Ping;Chen Yi;Wang Ruiting(Division of Orthopaedics and Traumatology,Department of Orthopaedics,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China;School of Nursing,Southern Medical University,Guangzhou 510515,China;Department of Infectious Management,Nangfang Hospital,Southern Medical University,Guangzhou 510515,China)

机构地区：[1]南方医科大学南方医院骨科-创伤骨科,广州510515 [2]南方医科大学护理学院,广州510515 [3]南方医科大学南方医院感染管理科,广州510515

出　　处：《中华创伤骨科杂志》2020年第6期544-548,共5页Chinese Journal of Orthopaedic Trauma

摘　　要：目的分析深部开放伤口疼痛管理循证护理审查指标的实施及困难因素。方法自2018年5月至10月在南方医科大学南方医院骨科采用目的性取样的方法选取2名创伤骨科换药护士,并采用方便取样的方法选取20例有深部开放性伤口的患者。根据疼痛管理最佳循证护理指南13项实践标准,结合伤口护理和疼痛管理的研究证据,制定深部开放伤口无痛换药方案,实施并评估方案实施的执行情况和疼痛缓解的效果,采用临床证据实践应用系统(PACES)和GRiP软件对深部伤口无痛换药最佳循证实践方案的执行过程进行评价分析。采用IBM SPSS 21.0统计学软件对比分析方案实施前、后的疼痛评分。结果PACES结果显示,在项目期间,护士对最佳实践的执行率显著提高,并在项目完成后1个月保持在合理水平。基线评估时和后续评价1时患者在换药前的疼痛评分分别为(3.2±2.3)、(3.5±1.2)分,基线评估时和后续评价1时换药中的疼痛评分分别为(5.4±2.3)、(4.2±2.4)分;对基线评估和后续评价1中,采用护理措施降低伤口换药疼痛的评分的差值进行比较,差异有统计学意义(P<0.05)。结论本项目的实施提高了疼痛管理对最佳实践的执行率,其中面临了尤其是跨学科合作和组织机构中的困难。本研究将护理循证指南转化为临床实践的经验为循证护理提供了借鉴。Objective To analyze the implementation of evidence-based nursing indicators for deep open wound pain management and its difficulties.Methods From May to October 2018 at Department of Traumatology and Orthopaedics,Nanfang Hospital,2 nurses were selected by objective sampling and 20 patients with deep open wound by convenient sampling.According to the 13 best practices in nursing guidelines for pain management,we formulated a no-pain dressing change program for deep open wounds on the basis of the research evidence in wound care and pain management.After the program was implemented,its effect on pain relief was evaluated.Practical Application of Clinical Evidence System(PACES)and software GRiP were used to evaluate the whole implementation process.IBM SPSS 21.0 was used to analyze the pain scores before and after implementation.Results The results of PACES showed that the implementation rate of best practices by the 2 nurses increased significantly during the project period and remained at a reasonable level one month after the project.The patients'pain scores before dressing were 3.2±2.3 and 3.5±1.2 at the baseline evaluation and the follow-up evaluation 1,respectively;the pain scores during dressing at the base evaluation and the subsequent evaluation 1 were 5.4±2.3 and 4.2±2.4.The effect of implementation of evidence-based nursing indicators for deep open wound pain management on pain relief was significant(P<0.05).Conclusions This project improved the implementation rate of the best pain management practices in dressing change for deep open wounds,but the implementation encountered difficulties in interdisciplinary cooperation and organizational structure.This study may provide a reference for other evidence-based nursing projects aiming at transforming evidence-based nursing guidelines into clinical practice.

关 键 词：循证实践 疼痛 创伤和损伤 无痛换药 

分 类 号：R473.6[医药卫生—护理学] R-03[医药卫生—临床医学]