The Application Study Of Stages Of Change Model On Nursing Needs And Coping Strategies In Patients With Chronic Pain

Objective: We applied the stages of change model to the processes of pain self-management so as to get some knowledge about distributions of patient's pain self-management, the intensity, nursing needs and coping strategies of the pain, and the differences between the intensity, nursing needs and coping strategies of the pain at various stages of pain self-management. To explore the relationship between the nursing needs and coping strategies of the pain, and the affecting factors of pain intensity in the sample of Chinese patients with chronic pain.Methods:A cross-sectional study was used. By the method of convenient sampling, 271 patients with chronic pain from eleven III-A grade hospitals in Wuhan were recruited into this study. The formal questionnaires included the demographic questionnaire, Chinese version of the Brief Pain Inventory (BPI-C), Pain Stages of Change Questionnaire (PSOCQ), Nursing Needs Questionnaire of Chronic Pain Patient, and Chronic Pain Coping Questionnaire. The database was established by Epidata3.1 and the data were analyzed by SPSS17.0. Descriptive analysis, Spearman Rank Correlation, Nonparametric tests, Canonical Correlation, and Multiple Regressive Analysis were used for data analysis. Results:1. 0.4% of patients in the last week felt no pain, while mild, moderate, severe degree of chronic pain accounted for 22.9%, 24.4%, 52.4% respectively.2. Patients with chronic pain may go through specific―stages of change‖: Precontemplation, Contemplation, Action, and Maintenance. In this study, the majority of patients (43.2%) were classified as precontemplators, 42.8% of patients were classified as being in the Contemplation stage, and there were 7.4% of patients in the Action stage and 6.6% of patients were classified in the Maintenance stage.3. The patients with chronic pain had a higher level of nursing care needs, especially the―Physiological Needs‖(4.60±1.00).4.―Limiting Activity‖was one of the most commonly used coping strategies(4.20±1.40),―Taking Action‖was the least frequently used coping strategyies taken by the patients with chronic pain(2.00±1.50).5. Some variables of general information of patients with chronic pain affected the stage-distribution.5.1 There was a correlationship between the age and stage-distribution, older patients were more likely to stay at lower stages(r=-0.173,P<0.01).5.2 Statistical significance was found in the stages-distribution of the residence in different place(P<0.05), city dwellers stayed at higher stages than the patients from countryside.5.3 Statistical significance was found in the stages-distribution of different level of education(P<0.01).5.4 Statistical significance was found in the stages-distribution of different occupation(P<0.01).6. Nursing needs of the patients at various stages had significant differences(P<0.01). 6.1 Compared to the patients at Contemplation and Action stage, the patients at Precontemplation stage had significantly less demands for Pain Knowledge, Pain Self-management and Psychological Care.6.2 Patients at Precontemplation stage had significantly less demands for Social Support than patients at Contemplation stage.7. Pain-coping strategies of the patients at different stages had significant differences(P<0.01 or P<0.05).7.1 Compared to patients at other stages, the patients at Precontemplation stage were less likely to take―Positive Attitude‖and use―Distraction‖as the methods of releasing pain.7.2 Compared to the patients at other stages, patients at Precontemplation stage were more likely to take the method of―Limiting Activity‖to release pain than that of―Ignoring Pain‖or―Taking Action‖. Compared to the patients at Action and Maintenance stages, patients at Contemplation stage were more likely to take the method of―Limiting Activity‖to release pain than that of―Ignoring Pain‖or―Taking Action‖.7.3 Compared to the patients at Contemplation stage, the patients at Precontemplation stage were less likely to seek for the social support as a method of releasing pain.8. The correlationship between Pain nursing needs and Pain coping strategies had differences of the patients at different stages.8.1 There was a correlation between nursing needs and coping strategies at Precontemplation stage patients. The canonical correlation coefficients were as follows: r1=0.564(P<0.01), r2=0.463(P<0.01). There was a positive correlation between―Physiological Needs‖and―Limiting Activity‖, but patients'demands for Pain self-management was negatively correlated with―Limiting Activity‖. There was a positive correlation between patients'demands for social support and―Seeking Social Support‖. 8.2 At Contemplation stage, patients'nursing needs and coping strategies produced a significant canonical correlation coefficien(tr1=0.537,P<0.01). There was a positive correlation between―Physiological Needs‖and―Limiting Activity‖, but it was negatively correlated with―Ignoring Pain‖and―Taking Action‖.8.3 There was no significant relationship between nursing needs and coping strategies of the patients at Action and Maintenance stage.9. The factors which affected the intensity of pain includes as follows:―Ignoring Pain‖,―Negative Attitude‖and demands for social support.Conclusions:1. Pain self-management of the patients with chronic pain is not so effective nowadays. Most of the patients experience severe pain. Medical staffs should eliminate the passive affecting factors, such as―Negative Attitude‖, and help the patients to seek social support to relieve pain.2. The Pain Stages of Change Questionnaire is a useful instrument, it classifies patients with chronic pain into specific stages. Large numbers of patients with chronic pain in our country stay at Precontemplation and Contemplation stages, while a few stay at Action and Maintenance stages. Nurses should provide targeted nursing interventions to impel patients to stride from Precontemplation stage to Action and Maintenance stages.3. Nursing needs, Pain-coping strategies, the relationship between nursing needs and coping strategies of the patients at various stages have significant differences, so different nursing intervention should be applied to patients at different stages.4. Patients have a keen desire to relieve pain, but pain-coping strategies are not so effective nowadays. The medical staffs should pay much attention to pain self-management, nursing needs, and pain-coping strategies of the patients with chronic pain.Taking measures to improve cognition of the patients, changing their behaviors and attitudes, helping them manage pain with their own efforts, and improving the quality of the patients.