病人主訴術後疼痛強度與護理人員評估結果差異之比較

Postoperative Pain: Comparative Differences between That Reported by Patients and Nurses

李秀枝(Shiow-Zhi Li) ； 吳聖良(Shang-Liang Wu)

《護理雜誌》 57卷3期 (2010/06) Pp. 60-68

https://doi.org/10.6224/JN.57.3.60

摘要

Background: Pain management after surgery has long been ignored or managed inadequately. Pain assessment is the first and most important step toward adequate pain relief. While many studies have shown significant differences between pain reported by patients and that reported by care providers, little has been reported on this issue in Taiwan.
Purposes: The purpose of this study was to investigate differences in pain intensity following surgery as self-reported by patients and assessed by nurses.
Methods: This prospective and descriptive study was based on a purposive sampling conducted between April 1 and July 31, 2008 in the surgical wards of a regional teaching hospital in central Taiwan. Subjects recruited were in their first postoperative day. Their assessed pain intensity was rated on a numeric rating scale of 0 to 10. This study included 216 pairs of pain records (patient self-reports and nurse assessments).
Results: Two major findings included: (1) Pain intensity scores self-assessed by patients ranged from 0 to 10. Scores assigned by nurses ranged between 0 and 6. Thus, patient scores were significantly higher than those assigned by nurses (p＜.01). There was a discord in scoring between the two groups, with the gap ranging from 1 to 8. About 53.7% of nurses underestimated patient pain, while 31.5% overestimated it; and (2) The factor of nurse communication about pain with the patients had a negligible impact upon results.
Conclusions/Implications for practice: Nurses significantly underestimated patient pain, as compared to patient self-reporting. This demonstrates that most nurses do not query their patients about subjective pain perception. Study results recommend that pain assessment and communication should be added to the in-service training curriculum for staff in order to facilitate nurse communication of pain intensity using a numeric rating scale and patient self-report records. The objective should be to improve consistency between patient self-reporting on and nursing assessments of pain.

關鍵字

術後疼痛 ； 評估 ； 病人主訴

並列摘要

Background: Pain management after surgery has long been ignored or managed inadequately. Pain assessment is the first and most important step toward adequate pain relief. While many studies have shown significant differences between pain reported by patients and that reported by care providers, little has been reported on this issue in Taiwan.
Purposes: The purpose of this study was to investigate differences in pain intensity following surgery as self-reported by patients and assessed by nurses.
Methods: This prospective and descriptive study was based on a purposive sampling conducted between April 1 and July 31, 2008 in the surgical wards of a regional teaching hospital in central Taiwan. Subjects recruited were in their first postoperative day. Their assessed pain intensity was rated on a numeric rating scale of 0 to 10. This study included 216 pairs of pain records (patient self-reports and nurse assessments).
Results: Two major findings included: (1) Pain intensity scores self-assessed by patients ranged from 0 to 10. Scores assigned by nurses ranged between 0 and 6. Thus, patient scores were significantly higher than those assigned by nurses (p＜.01). There was a discord in scoring between the two groups, with the gap ranging from 1 to 8. About 53.7% of nurses underestimated patient pain, while 31.5% overestimated it; and (2) The factor of nurse communication about pain with the patients had a negligible impact upon results.
Conclusions/Implications for practice: Nurses significantly underestimated patient pain, as compared to patient self-reporting. This demonstrates that most nurses do not query their patients about subjective pain perception. Study results recommend that pain assessment and communication should be added to the in-service training curriculum for staff in order to facilitate nurse communication of pain intensity using a numeric rating scale and patient self-report records. The objective should be to improve consistency between patient self-reporting on and nursing assessments of pain.

並列關鍵字

postoperative pain ； assessment ； self-report