基于指南的成人腹部手术患者术后疼痛评估与管理的循证实践  

Evidence-based practice for pain assessment and management in adult patients undergoing abdominal surgery based on guidelines

作　　者：潘巧 李漓[1] 王灵晓[1] 耿艳云 崔璀[2] Pan Qiao;Li Li;Wang Lingxiao;Geng Yanyun;Cui Cui(Department of Nursing,Zhujiang Hospital,Southern Medical University,Guangzhou 510282,China;Department of Oncology,Zhujiang Hospital,Southern Medical University,Guangzhou 510282,China)

机构地区：[1]南方医科大学珠江医院护理部,广东广州510282 [2]南方医科大学珠江医院肿瘤科,广东广州510282

出　　处：《现代临床护理》2021年第12期13-20,共8页Modern Clinical Nursing

基　　金：优化中国术后疼痛管理项目(PAIN OUT project:An Initiative Assisting Healthcare Providers Optimize Management of Postoperative Pain in China by Continuous Quality Improvement and Peer Review),项目编号为223590;南方医科大学珠江医院护理科研与循证护理实践项目,项目编号为hl2019xz02;广东省卫生健康适宜技术推广项目。

摘　　要：目的将手术后疼痛评估与管理的最佳证据应用于成人腹部手术患者,并评价其效果。方法应用修订版爱荷华循证实践模式,在指南的基础上,构建并实施成人腹部手术患者术后疼痛评估与管理的循证实践方案,依据16条手术后疼痛评估与管理最佳证据,制定10条质量审查指标,建立并实施标准操作流程,开展护士培训和患者教育。比较循证实践前后护士的疼痛知识和态度水平及护士对患者疼痛评估与管理各指标的执行情况的差异。比较循证实践前后手术患者的疼痛相关疗效的差异。结果循证实践后,护士的疼痛管理知识答对率从48.5%提高到53.2%(P<0.05);护士对患者的疼痛筛查、评估频率、干预效果评价、术后疼痛教育的执行率均较循证实践前提高(P<0.05);患者对医疗护理的感知改善,非药物镇痛方法的使用增加(P<0.001),疼痛对日常功能活动的影响较循证实践前下降(P<0.001)。结论应用成人腹部手术后疼痛评估与管理最佳证据,可提高护士的疼痛管理知识,改善疼痛护理实践和提高患者疼痛疗效。Objective To apply the best evidence for postoperative pain assessment and management in adult patients undergoing abdominal surgery and evaluate its effects.Methods The Iowa Model-Revised was used to guide the development and implementation of evidence-based postoperative pain assessment and management which is based on guidelines,in adult patients with abdominal surgery.According to the 16 best evidence for postoperative pain assessment and management,ten quality audit indicators were developed.Standardized procedure of pain assessment and management,nurse training and patient education were implemented.Before and after evidence-based practice,nurses’level of knowledge and attitude regarding pain,and nurses’implementation of pain assessment and management measures,as well as pain-related patient reported outcomes were compared.Results The correct rate of nurses’score of Knowledge and Attitudes Survey Regarding Pain(KASRP)significantly increased from 48.5%to 53.2%(P<0.05).Rate of pain screening,assessment frequency,evaluation of intervention effect,and postoperative pain education by nurses significantly increased(P<0.05).Patients’perceptions of care significantly improved and their use of nondrug intervention increased(P<0.001),and interference of pain with function significantly decreased(P<0.001).Conclusions Implementation of the best evidence of postoperative pain assessment and management in adult patients undergoing abdominal surgery can increase nurses’knowledge of pain management,improve pain management practice and pain-related patient reported outcomes.

关 键 词：成人 术后疼痛 疼痛评估 管理 循证实践 

分 类 号：R473.6[医药卫生—护理学]