福建省燒傷疼痛管理研究現(xiàn)狀及模式的構(gòu)建
發(fā)布時(shí)間：2019-03-15 08:23
【摘要】：目的:1、編制“燒傷�？漆t(yī)護(hù)人員疼痛管理知識(shí)、態(tài)度和行為問卷”。2、了解福建省燒傷科醫(yī)護(hù)人員對燒傷疼痛管理相關(guān)知識(shí)的掌握情況及其態(tài)度行為,為提高疼痛控制水平提供參考。3、深入探討燒傷患者對疼痛的真實(shí)體驗(yàn)及患者對疼痛管理的期望。4、初步構(gòu)建燒傷疼痛管理模式,制訂各階段的干預(yù)措施。方法:1、以對燒傷患者個(gè)別訪談和結(jié)合臨床專家意見為基礎(chǔ),擬定問卷,進(jìn)一步根據(jù)德爾菲法(Delphi)的修訂,編制“燒傷專科醫(yī)護(hù)人員疼痛管理知識(shí)、態(tài)度和行為問卷”。2、于2014年4~8月對福建省內(nèi)11家具有獨(dú)立燒傷專科三甲醫(yī)院的263名燒傷科醫(yī)護(hù)人員進(jìn)行調(diào)查,其中醫(yī)生84名、護(hù)士179名。3、采用半結(jié)構(gòu)式深度訪談法和觀察法,對燒傷患者進(jìn)行質(zhì)性訪談,用Nvivo10.0軟件進(jìn)行資料的整理和分析,應(yīng)用合眾法提高資料的可信度。4、在燒傷科醫(yī)護(hù)人員疼痛管理知識(shí)、態(tài)度和行為的量性研究及燒傷患者疼痛體驗(yàn)及疼痛管理期望的質(zhì)性研究基礎(chǔ)上,同時(shí)參考相關(guān)文獻(xiàn),通過德爾菲法的修訂,初步構(gòu)建燒傷疼痛管理模式。結(jié)果:1、編制“燒傷�？漆t(yī)護(hù)人員疼痛管理知識(shí)、態(tài)度和行為問卷”,問卷共31個(gè)條目,內(nèi)容效度指數(shù)為0.97,總問卷的Cronbach’s a系數(shù)為0.84,重復(fù)測量Pearson相關(guān)系數(shù)為0.85。2、福建省燒傷科醫(yī)護(hù)人員調(diào)查分析:①在疼痛工具了解情況及運(yùn)用情況方面,醫(yī)生和護(hù)士之間差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。②醫(yī)護(hù)人員認(rèn)為燒傷疼痛不能有效管理,屬于醫(yī)護(hù)人員自身的原因,排序依次為疼痛評估知識(shí)缺乏、疼痛管理知識(shí)缺乏、擔(dān)心患者對止痛藥成癮及擔(dān)心止痛藥的副作用。③醫(yī)護(hù)人員疼痛管理知識(shí)問卷的平均正確率為55.55%。單因素分析顯示,不同醫(yī)院、不同職稱以及在校有無接受疼痛知識(shí)教育,醫(yī)生問卷正確率不同(P0.05);不同年齡階段、不同職稱、在校有無接受疼痛知識(shí)教育以及工作后是否接受疼痛教育知識(shí),護(hù)士問卷正確率不同(P0.05)。多元回歸分析顯示,醫(yī)生藥物作用知識(shí)正確率的影響因素是燒傷工作年限、學(xué)歷;醫(yī)生非藥物鎮(zhèn)痛法知識(shí)正確率的影響因素是工作后是否接受疼痛知識(shí)教育;護(hù)士問卷總體正確率的影響因素是職稱和在校有無接受疼痛知識(shí)教育;護(hù)士藥物治療知識(shí)正確率的影響因素是在校有無接受疼痛知識(shí)教育。④25%的醫(yī)生和44.7%的護(hù)士經(jīng)常評估患者的疼痛強(qiáng)度;患者輕至中度疼痛時(shí),僅30.2%的護(hù)士經(jīng)常會(huì)采取針對性地鎮(zhèn)痛措施;患者換藥劇烈疼痛仍堅(jiān)持不用鎮(zhèn)痛藥,僅30.2%的護(hù)士和48.8%的醫(yī)生經(jīng)常會(huì)對其教育。3、質(zhì)性訪談結(jié)果顯示,燒傷患者經(jīng)歷了劇烈的疼痛;燒傷疼痛管理的現(xiàn)狀不容樂觀;家屬的支持和醫(yī)護(hù)人員的鼓勵(lì)對患者緩解疼痛很重要;患者對疼痛管理充滿期望。4、初步建立了燒傷疼痛管理模式,其分為四個(gè)階段和19條干預(yù)措施。模式四個(gè)階段分別為準(zhǔn)備階段、評估階段、干預(yù)階段、康復(fù)階段,涵蓋了優(yōu)化環(huán)境、疼痛知識(shí)宣教、增強(qiáng)社會(huì)支持、促進(jìn)心理宣泄及情緒指導(dǎo)等內(nèi)容。結(jié)論:1、燒傷�？漆t(yī)護(hù)人員疼痛管理知識(shí)、態(tài)度和行為問卷具有良好的信效度,可作為燒傷專科醫(yī)護(hù)人員疼痛管理知識(shí)、態(tài)度和行為的測評工具。2、福建省燒傷科醫(yī)護(hù)人員疼痛管理知識(shí)欠缺,態(tài)度行為不夠主動(dòng)積極。3、鎮(zhèn)痛不完善給患者帶來痛苦的體驗(yàn),應(yīng)建立規(guī)范的燒傷疼痛管理模式,為燒傷患者提供方便、安全、有效的燒傷疼痛控制策略,從而緩解其疼痛。4、燒傷疼痛管理模式貫穿燒傷患者從入院至出院這一期間,內(nèi)容較為全面、具體,可操作性較強(qiáng)。突出了整體護(hù)理的理念,更體現(xiàn)了“以病人為中心”的優(yōu)質(zhì)護(hù)理服務(wù)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.
【學(xué)位授予單位】：福建醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R473.6
本文編號：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.
【學(xué)位授予單位】：福建醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R473.6
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