福建省烧伤疼痛管理研究现状及模式的构建
发布时间：2019-03-15 08:23
【摘要】：目的:1、编制“烧伤专科医护人员疼痛管理知识、态度和行为问卷”。2、了解福建省烧伤科医护人员对烧伤疼痛管理相关知识的掌握情况及其态度行为,为提高疼痛控制水平提供参考。3、深入探讨烧伤患者对疼痛的真实体验及患者对疼痛管理的期望。4、初步构建烧伤疼痛管理模式,制订各阶段的干预措施。方法:1、以对烧伤患者个别访谈和结合临床专家意见为基础,拟定问卷,进一步根据德尔菲法(Delphi)的修订,编制“烧伤专科医护人员疼痛管理知识、态度和行为问卷”。2、于2014年4~8月对福建省内11家具有独立烧伤专科三甲医院的263名烧伤科医护人员进行调查,其中医生84名、护士179名。3、采用半结构式深度访谈法和观察法,对烧伤患者进行质性访谈,用Nvivo10.0软件进行资料的整理和分析,应用合众法提高资料的可信度。4、在烧伤科医护人员疼痛管理知识、态度和行为的量性研究及烧伤患者疼痛体验及疼痛管理期望的质性研究基础上,同时参考相关文献,通过德尔菲法的修订,初步构建烧伤疼痛管理模式。结果:1、编制“烧伤专科医护人员疼痛管理知识、态度和行为问卷”,问卷共31个条目,内容效度指数为0.97,总问卷的Cronbach’s a系数为0.84,重复测量Pearson相关系数为0.85。2、福建省烧伤科医护人员调查分析:①在疼痛工具了解情况及运用情况方面,医生和护士之间差异均有统计学意义(P0.05)。②医护人员认为烧伤疼痛不能有效管理,属于医护人员自身的原因,排序依次为疼痛评估知识缺乏、疼痛管理知识缺乏、担心患者对止痛药成瘾及担心止痛药的副作用。③医护人员疼痛管理知识问卷的平均正确率为55.55%。单因素分析显示,不同医院、不同职称以及在校有无接受疼痛知识教育,医生问卷正确率不同(P0.05);不同年龄阶段、不同职称、在校有无接受疼痛知识教育以及工作后是否接受疼痛教育知识,护士问卷正确率不同(P0.05)。多元回归分析显示,医生药物作用知识正确率的影响因素是烧伤工作年限、学历;医生非药物镇痛法知识正确率的影响因素是工作后是否接受疼痛知识教育;护士问卷总体正确率的影响因素是职称和在校有无接受疼痛知识教育;护士药物治疗知识正确率的影响因素是在校有无接受疼痛知识教育。④25%的医生和44.7%的护士经常评估患者的疼痛强度;患者轻至中度疼痛时,仅30.2%的护士经常会采取针对性地镇痛措施;患者换药剧烈疼痛仍坚持不用镇痛药,仅30.2%的护士和48.8%的医生经常会对其教育。3、质性访谈结果显示,烧伤患者经历了剧烈的疼痛;烧伤疼痛管理的现状不容乐观;家属的支持和医护人员的鼓励对患者缓解疼痛很重要;患者对疼痛管理充满期望。4、初步建立了烧伤疼痛管理模式,其分为四个阶段和19条干预措施。模式四个阶段分别为准备阶段、评估阶段、干预阶段、康复阶段,涵盖了优化环境、疼痛知识宣教、增强社会支持、促进心理宣泄及情绪指导等内容。结论:1、烧伤专科医护人员疼痛管理知识、态度和行为问卷具有良好的信效度,可作为烧伤专科医护人员疼痛管理知识、态度和行为的测评工具。2、福建省烧伤科医护人员疼痛管理知识欠缺,态度行为不够主动积极。3、镇痛不完善给患者带来痛苦的体验,应建立规范的烧伤疼痛管理模式,为烧伤患者提供方便、安全、有效的烧伤疼痛控制策略,从而缓解其疼痛。4、烧伤疼痛管理模式贯穿烧伤患者从入院至出院这一期间,内容较为全面、具体,可操作性较强。突出了整体护理的理念,更体现了“以病人为中心”的优质护理服务理念。
[Abstract]:Objective:1. To prepare the "The Knowledge, Attitude and Behavior Questionnaire of the Pain Management of the Medical Staff in the Burn College".2. To understand the knowledge and attitude of the medical staff in the burn and pain management in Fujian, and to provide reference for improving the level of pain control. The real experience of the pain and the expectation of the pain management in the patients with burn were discussed.4. The management mode of the burn pain was first constructed and the intervention measures in each stage were set up. Methods:1. Based on the individual interview and clinical expert opinion of the burn patients, the questionnaire was developed, and the "The Knowledge, Attitude and Behavior Questionnaire of the Pain Management of the Medical Staff in the Burn College" was prepared according to the revision of Delphi. In the period from April to August of 2014, there were 263 health care personnel of the three-grade hospital with independent burn in Fujian province, including 84 doctors and 179 nurses, and the semi-structural depth interview method and the observation method were used to conduct the qualitative interview of the burn patients. Based on the qualitative research of the pain management knowledge, attitude and behavior of the medical staff in the burn and injury department and the qualitative research of the pain management expectation of the burn patients, the paper also referred to the relevant literature. The management model of burn pain was first constructed by the revision of Delphi method. Results:1. The "The Knowledge, Attitude and Behavior Questionnaire of the Pain Management of the Medical Staff in the Burn College" and the questionnaire were compiled, the content validity index was 0.97, the Cronbach's a coefficient of the total questionnaire was 0.84, the repeated measurement of Pearson's correlation coefficient was 0.85.2, and the investigation and analysis of the health care personnel of the burn and injury department in Fujian Province: There was a significant difference between the doctor and the nurse (P0.05). According to the medical staff, the pain of the burn can not be effectively managed, which belongs to the cause of the medical staff, and the sequence is the lack of the knowledge of the pain assessment, the lack of the knowledge of the pain management, and the side effect of the patient to the drug addiction and the fear of the pain medication. The average rate of the pain management knowledge questionnaire was 55.55%. The single-factor analysis shows that the correct rate of the doctor's questionnaire is different (P0.05). The correct rate of the doctor's questionnaire is different (P0.05). The correct rate of the nurses was different (P0.05). The multiple regression analysis shows that the influence factor of the accuracy of the doctor's drug action knowledge is the working life of the burn and the degree of education. The influence factor of the accuracy of the knowledge of the non-drug analgesic method of the doctor is whether to accept the knowledge education after work. The influencing factors of the overall correct rate of the nurses' questionnaire are the professional title and the knowledge education of the presence or absence of the pain in the school; the influence factors of the correct rate of the knowledge of the nurse's medication are the presence or absence of the knowledge education for pain in the school. 25% of the doctors and 44.7% of the nurses often assess the pain intensity of the patient; only 30.2% of the nurses in the case of mild to moderate pain often take targeted pain relief measures; the patient's severe pain still persists in the absence of an analgesic, Only 30.2% of the nurses and 48.8% of the doctors often have their education.3. The qualitative interview shows that the burn patients experienced severe pain; the current status of the management of the burn pain is not optimistic; the support of the family and the encouragement of the medical staff are important to the patient's pain relief; The patient was full of expectations for pain management.4. The management mode of the burn pain was initially established, which was divided into four stages and 19 interventions. The four stages of the mode are preparation stage, evaluation stage, intervention stage and rehabilitation phase, which cover the contents of optimizing environment, knowledge of pain, strengthening social support, promoting psychological discharge and emotional guidance. Conclusion:1. The pain management knowledge, attitude and behavior questionnaire of the medical staff of the burn specialist have good faith and validity, and can be used as the assessment tool of the knowledge, attitude and behavior of the pain management of the medical staff of the burn specialist. The attitude behavior is not active and active.3, the pain is not improved to the patient to bring a painful experience, a standardized burn pain management mode is established, a convenient, safe and effective burn pain control strategy is provided for the patients with the burn, and the pain is relieved. The management of the burn pain management mode through the burn patient from the hospital to the discharge, the content is more comprehensive, the concrete, the operability is strong. The concept of holistic nursing is highlighted, and the high-quality nursing service concept of the "Patient-centered" is more reflected.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R473.6
本文编号：2440457
[Abstract]:Objective:1. To prepare the "The Knowledge, Attitude and Behavior Questionnaire of the Pain Management of the Medical Staff in the Burn College".2. To understand the knowledge and attitude of the medical staff in the burn and pain management in Fujian, and to provide reference for improving the level of pain control. The real experience of the pain and the expectation of the pain management in the patients with burn were discussed.4. The management mode of the burn pain was first constructed and the intervention measures in each stage were set up. Methods:1. Based on the individual interview and clinical expert opinion of the burn patients, the questionnaire was developed, and the "The Knowledge, Attitude and Behavior Questionnaire of the Pain Management of the Medical Staff in the Burn College" was prepared according to the revision of Delphi. In the period from April to August of 2014, there were 263 health care personnel of the three-grade hospital with independent burn in Fujian province, including 84 doctors and 179 nurses, and the semi-structural depth interview method and the observation method were used to conduct the qualitative interview of the burn patients. Based on the qualitative research of the pain management knowledge, attitude and behavior of the medical staff in the burn and injury department and the qualitative research of the pain management expectation of the burn patients, the paper also referred to the relevant literature. The management model of burn pain was first constructed by the revision of Delphi method. Results:1. The "The Knowledge, Attitude and Behavior Questionnaire of the Pain Management of the Medical Staff in the Burn College" and the questionnaire were compiled, the content validity index was 0.97, the Cronbach's a coefficient of the total questionnaire was 0.84, the repeated measurement of Pearson's correlation coefficient was 0.85.2, and the investigation and analysis of the health care personnel of the burn and injury department in Fujian Province: There was a significant difference between the doctor and the nurse (P0.05). According to the medical staff, the pain of the burn can not be effectively managed, which belongs to the cause of the medical staff, and the sequence is the lack of the knowledge of the pain assessment, the lack of the knowledge of the pain management, and the side effect of the patient to the drug addiction and the fear of the pain medication. The average rate of the pain management knowledge questionnaire was 55.55%. The single-factor analysis shows that the correct rate of the doctor's questionnaire is different (P0.05). The correct rate of the doctor's questionnaire is different (P0.05). The correct rate of the nurses was different (P0.05). The multiple regression analysis shows that the influence factor of the accuracy of the doctor's drug action knowledge is the working life of the burn and the degree of education. The influence factor of the accuracy of the knowledge of the non-drug analgesic method of the doctor is whether to accept the knowledge education after work. The influencing factors of the overall correct rate of the nurses' questionnaire are the professional title and the knowledge education of the presence or absence of the pain in the school; the influence factors of the correct rate of the knowledge of the nurse's medication are the presence or absence of the knowledge education for pain in the school. 25% of the doctors and 44.7% of the nurses often assess the pain intensity of the patient; only 30.2% of the nurses in the case of mild to moderate pain often take targeted pain relief measures; the patient's severe pain still persists in the absence of an analgesic, Only 30.2% of the nurses and 48.8% of the doctors often have their education.3. The qualitative interview shows that the burn patients experienced severe pain; the current status of the management of the burn pain is not optimistic; the support of the family and the encouragement of the medical staff are important to the patient's pain relief; The patient was full of expectations for pain management.4. The management mode of the burn pain was initially established, which was divided into four stages and 19 interventions. The four stages of the mode are preparation stage, evaluation stage, intervention stage and rehabilitation phase, which cover the contents of optimizing environment, knowledge of pain, strengthening social support, promoting psychological discharge and emotional guidance. Conclusion:1. The pain management knowledge, attitude and behavior questionnaire of the medical staff of the burn specialist have good faith and validity, and can be used as the assessment tool of the knowledge, attitude and behavior of the pain management of the medical staff of the burn specialist. The attitude behavior is not active and active.3, the pain is not improved to the patient to bring a painful experience, a standardized burn pain management mode is established, a convenient, safe and effective burn pain control strategy is provided for the patients with the burn, and the pain is relieved. The management of the burn pain management mode through the burn patient from the hospital to the discharge, the content is more comprehensive, the concrete, the operability is strong. The concept of holistic nursing is highlighted, and the high-quality nursing service concept of the "Patient-centered" is more reflected.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R473.6
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