骨科快速康复外科建立护士主导的疼痛管理多学科团队的实践
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摘要
目的:分析在骨科快速康复外科中建立护士主导的疼痛多学科团队的效果。方法:采用非同期对照研究,方便抽取我院骨伤科2017年1月至2018年6月行关节置换手术的98例患者作为研究对象。其中2017年1-9月的48例患者为对照组,采用急性疼痛服务管理模式;2017年10月至2018年6月的50例患者为观察组,采用多学科协作疼痛管理模式。通过比较两组患者术后疼痛情况、排气排便时间、平均住院日及患者满意度来分析多学科协作疼痛管理模式的实践效果。结果:在多学科协作疼痛管理模式下,观察组患者术后24 h、48 h疼痛程度均低于对照组,排气排便时间及住院时间较对照组缩短,患者满意度高于对照组,两组比较差异均具有统计学意义(P<0.05)。结论:以护士为主导的多学科协作疼痛管理模式控制疼痛效果显著、患者术后康复时间缩短且患者满意度提高。
Objective: To explore the effect of nurse-led multidisciplinary team for pain management in fast track surgery of orthopedics. Methods: A non-synchronous controlled study was conducted by conveniently selecting 98 patients who underwent joint replacement in the Department of Orthopedics and Traumatology of our hospital from January 2017 to June 2018. Among them, 48 patients admitted from January 2017 to September 2017 were in the control group and 50 patients from October 2017 to June 2018 were in the observation group. Indicators including postoperative pain, exhaust and defecation time, average hospitalization days and patient satisfaction were observed and analyzed in order to determine the practical effect of multidisciplinary pain management mode. Results: In the multidisciplinary cooperative pain management mode, the pain intensity of patients in the observation group at 24 hours and 48 hours was lower than that of the control group,and the time of exhaust and defecation and hospitalization was shorter than that of the control group with patient satisfaction being higher than that of the control group. The difference between the two groups was statistically significant(P<0.05).Conclusion: The multidisciplinary cooperative pain management mode with nurses as leaders entails significant and useful effects on pain control, including shorter postoperative rehabilitation time and improved patient satisfaction.
Objective: To explore the effect of nurse-led multidisciplinary team for pain management in fast track surgery of orthopedics. Methods: A non-synchronous controlled study was conducted by conveniently selecting 98 patients who underwent joint replacement in the Department of Orthopedics and Traumatology of our hospital from January 2017 to June 2018. Among them, 48 patients admitted from January 2017 to September 2017 were in the control group and 50 patients from October 2017 to June 2018 were in the observation group. Indicators including postoperative pain, exhaust and defecation time, average hospitalization days and patient satisfaction were observed and analyzed in order to determine the practical effect of multidisciplinary pain management mode. Results: In the multidisciplinary cooperative pain management mode, the pain intensity of patients in the observation group at 24 hours and 48 hours was lower than that of the control group,and the time of exhaust and defecation and hospitalization was shorter than that of the control group with patient satisfaction being higher than that of the control group. The difference between the two groups was statistically significant(P<0.05).Conclusion: The multidisciplinary cooperative pain management mode with nurses as leaders entails significant and useful effects on pain control, including shorter postoperative rehabilitation time and improved patient satisfaction.
引文
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[15]童莺歌,刘敏君,叶爱芬,等.以疼痛资源护士为媒介的在职疼痛护理培训.中国实用护理杂志,2013,29(20):28-30.Tong YG,Liu MJ,Ye AF,et al.Pain nursing training based on pain resource nurses.Chin JPrac Nurs,2013,29(20):28-30.
[16]张春玲,孙胜男,张春燕,等.创伤骨科以护士为主导的疼痛管理模式研究.护理学杂志,2014,29(2):25-27.Zhang CL,Sun SN,Zhang CY.Nurse-led pain management program in department of orthopaedic and trauma surgery.Journal of Nursing Science,2014,29(2):25-27.
[17]毕东军,施欢欢,陈冯琳,等.多学科疼痛管理在外科康复中的实践.医院管理论坛,2016,33(8):43-45.Bi DJ,Shi HH,Chen FL,et al.The practice of multidisciplinary pain management in surgical rapid recovery.Hospital Management Forum,2016,33(8):43-45.
[18]Simpson K,Kautzman L,Dodd S.The effects of a pain management education program on the knowledge level and attitudes of clinical staff.Pain Manag Nurs,2002,3(3):87-93.
[19]王峻,陈仲,侯丽莉,等.护士参与联合疼痛管理在骨折患者中的应用.中华护理杂志,2012,47(12):1122-1123.Wang J,Chen Z,Hou LL,et al.Application of nurse participation in pain management in patients with fracture.Chin J Nurs,2012,47(12):1122-1123.
[20]Gleeson E,Carryer J.Nursing staff satisfaction with the acute pain service in a surgical ward setting.Nurs Prax N Z,2010,26(1):14-26.
[2]陈江霞,姜丽萍.外科护士疼痛管理现状及影响因素.护理研究,2015,29(5):1835-1838.Chen J X,Jia ng LP.St at u s quo of pai n management of surgical nurses and its influencing factors.Chinese Nursing Research,2015,29(5):1835-1838.
[3]Weiran L,Lei Z,Woo SM,et al.A study of patient experience and perception regarding postoperative pain management in Chinese hospitals.Patient Prefer Adherence,2013,8(7):1157-1162.
[4]段链,王晶桐,乔青,等.三级综合医院麻醉医师配置研究.中国医院管理杂志,2014,30(12):926-929.Duan L,Wang JT,Qiao Q,et al.A study on the anesthesiologist deployment at tertiary hospitals.Chin J Hosp Admin,2014,30(12):926-929.
[5]冯艺,张冉.多学科疼痛管理组织构建的专家共识.临床麻醉学杂志,2017,33(1):84-87.Feng Y,Zhang R.Exper t consensus on the construction of multidisciplinary pain management organization.J Clin Anesthesiol,2017,33(1):84-87.
[6]Argoff CE.Recent management advances in acute postoperative pain.Pain Pract,2014,14(5):477-487.
[7]Traeger AC,Hubscher M,Henschke N,et al.Effect of pr imar y care-based education on reassurance in patients with acute low back pain:systematic review and Meta-analysis.JAMAInternal Medicine,2015,175(5):733-743.
[8]Gregory J.The complexity of pain assessment in older people.Nursing Older People,2015,27(8):16-21.
[9]Phelan SM,Hardeman RR.Health professionals'pain management decisions are influenced by their role(nurse or physician)and by patient gender,age and ethnicity.EvidenceBased Nursing,2014,18(2):58.
[10]Innis J,Bikaunieks N,Petryshen P,et al.Patient satisfaction and pain management:an educational approach.J Nurs Care Qual,2004(19):322-327.
[11]李道佩.对2011年版卫生部三级综合医院评审标准实施细则的商榷.中国医院药学杂志,2013,33(13):1091-1092.Li DP.Discussion on the implementation details of the 2011 version of ministry of health's evaluation standard for tertiary general hospitals.Chin Hosp Pharm J,2013,33(13):1091-1092.
[12]Montpetit AJ,Sessler CN.Optimizing safe,comfortable ICU care through multi-professional quality improvement:just do it.Crit Care,2013,17(2):138.
[13]余婕,李小燕,周阳,等.基于格林模式构建以护士为主导的疼痛管理模式.护理学杂志,2015,30(19):20-23.Yu J,Li XY,Zhou Y,et al.Application and effect assessment of pain management based on Green's Precede Proceed Model and dominated by nurses.Journal of Nursing Science,2015,30(19):20-23.
[14]黄天雯,陈晓玲,谭运娟,等.疼痛护理质量指标的建立及在骨科病房的应用.中华护理杂志,2015,50(2):148-151.Huang TW,Chen XL,Tan YJ,et al.Effect of pain management quality indicators on improving quality of pain management in the orthopedic department.Chin J Nurs,2015,50(2):148-151.
[15]童莺歌,刘敏君,叶爱芬,等.以疼痛资源护士为媒介的在职疼痛护理培训.中国实用护理杂志,2013,29(20):28-30.Tong YG,Liu MJ,Ye AF,et al.Pain nursing training based on pain resource nurses.Chin JPrac Nurs,2013,29(20):28-30.
[16]张春玲,孙胜男,张春燕,等.创伤骨科以护士为主导的疼痛管理模式研究.护理学杂志,2014,29(2):25-27.Zhang CL,Sun SN,Zhang CY.Nurse-led pain management program in department of orthopaedic and trauma surgery.Journal of Nursing Science,2014,29(2):25-27.
[17]毕东军,施欢欢,陈冯琳,等.多学科疼痛管理在外科康复中的实践.医院管理论坛,2016,33(8):43-45.Bi DJ,Shi HH,Chen FL,et al.The practice of multidisciplinary pain management in surgical rapid recovery.Hospital Management Forum,2016,33(8):43-45.
[18]Simpson K,Kautzman L,Dodd S.The effects of a pain management education program on the knowledge level and attitudes of clinical staff.Pain Manag Nurs,2002,3(3):87-93.
[19]王峻,陈仲,侯丽莉,等.护士参与联合疼痛管理在骨折患者中的应用.中华护理杂志,2012,47(12):1122-1123.Wang J,Chen Z,Hou LL,et al.Application of nurse participation in pain management in patients with fracture.Chin J Nurs,2012,47(12):1122-1123.
[20]Gleeson E,Carryer J.Nursing staff satisfaction with the acute pain service in a surgical ward setting.Nurs Prax N Z,2010,26(1):14-26.