Changing the relationship among nurses' knowledge, self-reported behavior, and documented behavior in pain management: Does education make a difference?
Changing the relationship among nurses' knowledge, self-reported behavior, and documented behavior in pain management: Does education make a difference?
复制标题
DOI：
10.1016/s0885-3924(96)00183-2
复制
发表时间：
1996-11-01
影响因子：
4.7
通讯作者：
Germino, B
中科院分区：
文献类型：
--
作者：
Dalton, JA;Blau, W;Germino, B
一个旨在改变知识以改变疼痛管理实践和患者结果的教育计划被提供给在一个以农村为主的州的社区为癌症患者提供日常护理的护士。采用准实验时间序列设计来衡量该计划在改变护士知识、态度和行为方面的有效性，并评估结果之间的关系。数据来自护士(N=29)和病人图表(N=209)在程序实施前和之后(N=163)。护士的知识增加了，但变化并不具有统计学意义；三个分测试的平均正确答案百分比不同，差异在整个研究过程中持续存在。护士们认为病人应该是“无痛的”。对行为的记录，例如练习活动，很少发生，直到项目结束后6个月才显示出很小的变化。记录的疼痛强度等级、疼痛位置、疼痛部位数量、精神错乱、焦虑或抑郁情绪、睡眠、恶心和呕吐、便秘和一般活动均有所增加。含有丙氧酚的止痛剂的使用记录减少；氢化吗啡、美沙酮和芬太尼透皮贴剂的使用增加。对护士知识问题的正确回答和行为记录之间的关系的分析提供了越来越多的、在统计学上微不足道的结果，需要在未来的研究中重新检查。未来的计划应该强调止痛剂的剂量和等止痛剂剂量的计算。图表文档中的当前实践可能提供有关实践行为变化的不完整信息；需要对疼痛管理实践进行更详细的记录。据报道，参与该项目的护士感觉可信度和有效性都有所提高。尽管行为的改变发生得很慢，但教育确实起到了作用。(C)美国癌症疼痛缓解委员会，1996年。
An educational program designed to change knowledge in order to change pain management practices and patient outcomes was offered to nurses who provide day-to-day care to patients with cancer in communities in a predominately rural state. A quasi-experimental time-series design was used to measure the effectiveness of the program in changing nurse knowledge, attitude and behavior, and to evaluate the relationships between the outcomes. Data were collected from nurses (N=29) and patient charts before (N=209) and after (N=163) the program. Nurses' knowledge increased, but the change was not statistically significant; the mean percent of correct answers on the three subtests were different and differences persisted throughout the study. Nurses believed that patients should be ''pain free.'' Documentation of behaviors, for example, practice activities, occurred infrequently and showed little change until 6 months after the program. Increase in documentation of pain-intensity ratings, pain location, number of sites of pain, presence of confusion, anxious or depressed mood, sleep, nausea and vomiting, constipation, and general activity were noted. Documentation of the use of a propoxyphene-containing analgesic decreased; increase in the use of hydromorphone methadone and transdermal fentanyl was noted. Analysis of the relationships between correct responses to nurse knowledge questions and documentation of behavior provided increasing, statistically insignificant results that need to be reexamined in future research. Future programs should emphasize analgesic dosing and calculation of equianalgesic doses. Current practices in chart documentation may provide incomplete information regarding change in practice behaviors; more detailed documentation of pain management practices is needed. Nurses who participated in the program anecdotally reported feelings of increased credibility and effectiveness. Although change in behavior is slow to occur, education does make a difference. (C) U.S. Cancer Pain Relief Committee, 1996.