Nurses' perceptions of pain management for older-patients in the Emergency Department: A qualitative study
Nurses' perceptions of pain management for older-patients in the Emergency Department: A qualitative study
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DOI：
10.1016/j.pec.2016.08.019
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发表时间：
2017-02-01
影响因子：
3.5
通讯作者：
Hogan, Teresita
中科院分区：
文献类型：
--
作者：
Gorawara-Bhat, Rita;Wong, Alexandra;Hogan, Teresita
目的：1)从护士对老年患者疼痛评估的认知中找出主题；2)利用主题指导制定最佳干预措施，以提高急诊科疼痛评估的质量。方法：对20名护士进行访谈，直至主题饱和。结果：护士“挑战”和“克服挑战的策略”两大主题及其分主题--“与病人相关”和“与系统相关”--在护士的认知中显著。护士报告的应对挑战的策略是基于他们自己的职业生活经验。讨论和结论：建立了一个2×2的框架来概念化挑战、策略、次主题及其分类，得到4种类型，包括与适当的策略类型相匹配的挑战类型。虽然紧急挑战和策略在文献中得到证实，但本研究是第一次开发出一种类型方案，有助于指导制定最佳干预措施，以提高老年患者疼痛评估的质量。实践启示：类型框架可以指导疼痛评估工具的开发，以及评估老年患者多维疼痛所需的组合。根据目前的发现，一种新的临床干预措施被证明显著改善了急诊室老年患者的疼痛管理。(C)2016爱思唯尔爱尔兰有限公司。保留所有权利。
Objectives: 1) Identify themes arising from nurses' perceptions of assessing older-patients' pain; 2) use themes to guide development of optimal interventions to improve quality of pain assessment in the emergency department (ED).Methods: Nurse interviews (n = 20) were conducted until theme saturation. They were transcribed, coded, and analyzed using qualitative methodology.Results: Two major themes-nurse 'challenges' and 'strategies' to overcome challenges, and their subthemes - classified as 'patient-related' or 'system-related,' were salient in nurses' perceptions. Strategies nurses reported for managing challenges were based in their own professional lived experiences.Discussion and conclusion: A 2 x 2 framework was developed to conceptualize challenges, strategies, subthemes and their classifications, yielding 4 typologies comprising challenge types matched with appropriate strategy types. While emergent challenges and strategies are corroborated in the literature, the present study is the first to develop a scheme of typologies beneficial for guiding the development of optimal interventions to improve the quality of assessing pain in older-patients.Practice implications: The typology framework can guide the development of pain assessment tools and the needed combinations for assessing multidimensional pain in older-patients. Using the present findings, a new clinical intervention was shown to significantly improve pain management for olderpatients in the ED. (C) 2016 Elsevier Ireland Ltd. All rights reserved.