標準護理措施介入對癌症疼痛照護成效的影響

The Effects of The Standardized Pain Nursing Intervention on Management of Cancer Pain

李秀枝(Shiow-Zhi Li)

指導教授 ： 盧美秀

臺北醫學大學/護理學院/護理學研究所/碩士(2003年)

摘要

疼痛為癌症病人及家屬最害怕的症狀之一，亦是他們最關心的問題，但卻未能接受適當的評估、記錄及處置。本研究主要探討「癌症疼痛護理標準」介入於癌症病人疼痛照護上之成效。研究目的有：1.建構癌症疼痛護理標準，並確立其可行性；2.比較標準護理措施介入與否對癌症疼痛照護成效的差異。3.分析癌症病人之疼痛程度與生活影響程度之相關；疼痛程度、等待藥物處置時間與疼痛處置滿意程度間之相關性。 本研究為一介入性研究，研究設計採前後測之類實驗研究設計（quasi-experimental design），於某區域教學醫院所有癌症住院病人為母群體，以簡單隨機（simple random sampling）方式抽出一個實驗組病房及一個對照組病房，所有取樣之研究對象皆為同一腫瘤科主治醫師的病人，實驗組取樣27人，對照組取樣30人，實驗組個案介入癌症疼痛標準護理措施，對照組個案則接受一般疼痛護理措施，於住院第一天及第五天由研究者依「癌症疼痛照護成效評量表」面談收集資料。 研究結果發現，標準護理措施介入後：1.實驗組個案之疼痛程度小於對照組，但無統計上顯著差異。2.實驗組個案之生活影響程度小於對照組，且日常生活及情緒影響達統計上顯著差異。3.實驗組個案對疼痛處置滿意程度大於對照組，且達統計上顯著差異。4.實驗組個案護理人員協助應用非藥物處置方法頻率大於對照組，且達統計上顯著差異。5.實驗組病房護理人員告知疼痛控制重要性比率大於對照組，且達統計上顯著差異。6.實驗驗組個案之等待藥物處置時間小於對照組，且達統計上顯著差異。7.實驗組病房護理人員疼痛程度評估記錄一致性及完整性大於對照組，且達統計上顯著差異。8.整體個案疼痛程度與生活影響程度呈現顯著正相關，疼痛程度與對醫師疼痛處置滿意程度呈現顯著負相關，等待藥物處置時間與對護理人員疼痛處置滿意程度呈現顯著負相關。 由以上介入措施照護成效之差異可知，以護理過程為架構之系統性「癌症疼痛護理標準」，確實能夠指引臨床護理人員，提昇癌症疼痛照護品質，值得持續推廣於臨床。 關鍵字：癌症疼痛、標準護理措施、照護成效

關鍵字

癌症疼痛 ； 標準護理措施 ； 照護成效

並列摘要

Pain is one of the scariest symptoms to patients with cancer and their families and is the most important issue they concern about. Unfortunately, it is poorly assessed, documented, and treated. We aimed to approach the effects of the standardized nursing intervention on management of cancer pain. The purpose of this paper was three-fold. The first was to construct the standardized pain nursing intervention of cancer pain. The second was to assess the effects of implementation of the standardized nursing intervention. The third was to analyze the correlation between pain score and the interference with life and the correlation among pain score, the time waiting for analgesic and patient satisfaction as well. The study was an interventional research, using a quasi-experimental design. Cancer patients with pain were drawn from an experimental ward (experimental group, n=27) and a control ward (control group, n=30) which was chosen with simple random sampling from five wards. The experimental group received the standardized pain nursing intervention while the control group received usual care routine. The two groups were interviewed according to the “The Evaluation Sheet of Effects of The Cancer Pain Intervention” at the first and the fifth day from admission. The outcome of the study after the standardized pain nursing intervention showed that（1）the average pain score of experimental group was lower than control group, and there was no statistically significant difference；（2）the average level of pain interfere with life of experimental group was lower than control group, and there were statistically significant differences in general activity and mood；（3）the average level of patient satisfaction to pain management, the average frequency of non-pharmacology approaches about pain management, the average rate in telling patients about the importance of pain control, the consistence and the whole in document of pain score of experimental group was higher than control group, the time that patients wating for analgesics treatment of experimental group was shorter than control group, and there were statistically significant differences；（4）the correlation between pain score and the level of pain interference with life revealed positively strong relationship；the correlation between pain score and the level of patient satisfaction with pain management of doctor revealed negatively strong relationship as well as the time that patients wating for analgesics treatment and the level of patient satisfaction with pain management of nurse. In conclusion, the standardized pain nursing intervention actually can be applied to guide the pain management to nurse and to promote the quality of cancer care. The intervention should be farther applied to pain management of cancer pain. Key words：cancer pain, standardized pain nursing intervention

並列關鍵字

cancer pain ； standardized pain nursing intervention

參考文獻

林靜琪、邱豔芬(1997)·癌症末期住院病人自述需要之探討 ·慈濟醫學，9(4)，295-305。

林佳靜(1998)·癌症疼痛因應量表之發展與癌症疼痛因應行為之探討 · 護理研究，6(5)，405-415。

徐南麗(1995) · 腫瘤護理標準之建立與護理品質之評值 ·國家衛生研究院研究計劃成果報告。 黃淑鶴、林佳靜、陳明麗、賴允亮(2001)·探討音樂治療於癌末病患疼痛對生活影響程度改善之成效 ·榮總護理，18(4)，358-368。

梁淑媛、林佳靜、陳品玲、劉淑娟(2000)·癌症病人及其家屬對癌痛及其影響感受之比較 · 新臺北護理期刊，2(2)，17-29。

許玲女、張遠萍、陳淑卿、賴裕和(2001)·護理人員對癌症疼痛及麻醉性止痛藥之信念及其相關因素探討 ·長庚護理，12(3)，200-207。