Pain Management Practices in a Pediatric Emergency Room (PAMPER) Study Interventions With Nurses
Pain Management Practices in a Pediatric Emergency Room (PAMPER) Study Interventions With Nurses
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DOI：
10.1097/pec.0b013e3181b0a0af
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发表时间：
2009-08-01
影响因子：
1.4
通讯作者：
Chalut, Dominic
中科院分区：
文献类型：
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作者：
Le May, Sylvie;Johnston, C. Celeste;Chalut, Dominic
背景和目的：儿童疼痛在急诊科（ED）是由护士管理不善，尽管有证据表明，疼痛是最常见的投诉的儿童参加ED之一。我们的目标是2倍：验证针对急诊儿科护士的量身定制的教育干预是否会提高护士的疼痛管理知识和疼痛管理实践（记录疼痛、给予镇痛剂、非药物干预）。本干预研究采用前后设计（基线、干预后即刻[T-2]和干预后6个月[T-3]）使用了护士样本（N = 50）和儿童的回顾性图表审查（N = 450;在基线、T-2和T-3时各审查了150张图表），这些患者在艾德就诊时被诊断为已知会产生中度至重度疼痛（烧伤、急性腹痛、深部撕裂伤、骨折、扭伤）。主要成果：结果：疼痛管理经验评估量表的应答率在基线时为84%（42/50），在T-2时为50%（21/42）。基线时PNKAS的平均评分为28.2（SD，4.9; max，42.0），T-2时为31.0（SD，4.6）。配对t检验结果显示，两次比较差异有统计学意义（t =-3.129，P = 0.005）。参与胶囊治疗的护士从基线（59.3%）到T-2（80.8%; chi（2）= 12.993，P < 0.001）以及从基线（59.3%）到T-3（89.1%; chi（2）= 29.436，P < 0.001）改善了他们的疼痛记录。此外，护士从基线（16.7%）到T-3（31.9%; chi（2）= 8.623，P = 0.003）增加了非药物干预。最后，我们获得了在两个时间段内至少服用1粒胶囊的护士组和没有服用任何胶囊的护士组之间疼痛记录的显著差异（T-2和T-3; chi（2）= 20.424，P < 0.001; chi（2）= 33.333，P < 0.001）。随着时间的推移，这些干预措施有助于提高护士对疼痛管理的认识和一些做法。我们认为，针对护士的需求和时间表的干预措施比被动传播教育内容更有影响。
Background and Aim: Children's pain in emergency departments (EDs) is poorly managed by nurses, despite evidence that pain is one of the most commonly presenting complaints of children attending the ED. Our objectives were 2-fold: to verify if tailored educational interventions with emergency pediatric nurses would improve nurses' knowledge of pain management and nurses' pain management practices (documentation of pain, administration of analgesics, nonpharmacological interventions).Methods: This intervention study with a pre-post design (baseline, immediately after the intervention [T-2], and 6 months after intervention [T-3]) used a sample of nurses (N = 50) and retrospective chart reviews of children (N = 450; 150 charts reviewed each at baseline, T-2, and T-3) who presented themselves in the ED with a diagnosis known to generate moderate to severe pain (burns, acute abdominal pain, deep lacerations, fracture, sprain). Principal outcomes: nurses' knowledge of pain management (Pediatric Nurses Knowledge and Attitudes Survey [PNKAS] on pain) and nurses' clinical practices of pain management (Pain Management Experience Evaluation [PMEE]).Results: Response rate on the PNKAS was 84% (42/50) at baseline and 50% (21/42) at T-2. Mean scores on PNKAS were 28.2 (SD, 4.9; max, 42.0) at baseline and 31.0 (SD, 4.6) at T-2. Results from paired t test showed significant difference between both times (t = -3.129, P = 0.005). Nurses who participated in the capsules improved their documentation of pain from baseline (59.3%) to T-2 (80.8%; chi(2) = 12.993, P < 0.001) as well as from baseline (59.3%) to T-3 (89.1%; chi(2) = 29.436, P < 0.001). In addition, nurses increased their nonpharmacological interventions from baseline (16.7%) to T-3 (31.9%; chi(2) = 8.623, P = 0.003). Finally, we obtained significant differences on pain documentation between the group of nurses who attended at least 1 capsule and the group of nurses who did not attend any capsule at both times (T-2 and T-3; chi(2) = 20.424, P < 0.001; chi(2) = 33.333, P < 0.001, respectively).Conclusions: The interventions contributed to the improvement of the nurses' knowledge of pain management and some of the practices over time. We believe that an intervention tailored to nurses' needs and schedule has more impact than just passive diffusion of educational content.