Study On Building Strategies Of Evidence-based Procedural Pain Management In Second Degree Burns

As the shortage of health care resources pressure increases,the global health decision model is transforming from the traditional empirical decision towards evidence-based decision.It is imperative to establish evidence-based health care services and management based on scientific evidence to make decisions for patient.Promoting the development of nursing research and deepening specialized nursing construction is the focus of discipline construction.Burn specialized pain management has always been an extremely challenging problem.A nurse is both a pain manager and a source of pain.Patients with second degree burn are more sensitive to pain.Meanwhile,they suffer from both physical and mental torture such as fear and anxiety.Procedural pain was not only caused by the dressing adherence,but also operator's technology,dressing selection,environmental preparation and other factors.In addition to pharmacological interventions,pain management must be combined with non-pharmacological nursing interventions.However,there are many non-pharmacological nursing interventions distributing scattered,and lacking of uniform standard between every unit is a problem.The content of some published studies were still short of evidence-based source,they implemented just followed the concept of "experience nursing".At the moment of increasing funds for health care and resource shortage,caregivers need to carefully and intelligently retrieve and apply the best evidence while having the ability to make core decisions and distinguish the applicability of evidence,providing evidence-based care for patients.In this study,patients' needs were used as an entry point,the procedural pain management strategy of second degree burns was constructed by combining the best evidence and expert opinion.Through literature analysis,this study learnt the frontier procedural pain intervention and management content such as the environment preparation,hydrotherapy,dressing selection,operation technology and patient education content.In addition,this study integrated the evidence-based concept into the practice of specialized nursing,provided scientific basis for the system to regulate the pain management of burn patients,and promoted the development of advanced nursing practice in the field of burns.The study used semi-structured interview to explore the management needs of patients with the procedural pain,and clearly clarify the core issues of evidence-based decision-making and the focus point of nursing care according to the interview outline.Then on the basis of evidence-based clinical practice guidelines methodology retrieval,3 valuators assessed the study quality from the scope and purpose of guide,participants,preciseness,clarity,applicability,independence and two independent scoring entries,then extracted high quality guidelines items and marked explicitly the level of evidence and recommendations.We further carried out the systematic and comprehensive retrieval of subject related randomized controlled trials.After intensive reading of the full text,we screened the literature word by word.Before that,we extracted general information such as published year,author,intervention measure,sample size,evaluation index and other information,the quality of literature is evaluated according to the unified evaluation standard.We conducted acomprehensive retrieve of non-randomized controlled trials including case report,case-control study,retrospective study,descriptive analysis to supplement the above.Finally,Delphi method was used to obtain clinical experts' evaluation of the importance and operability of each item.The indicators such as authority degree,motivation,coordination coefficient and coefficient of variation are calculated,and the reliability and representativeness of expert correspondence are tested.This paper established a procedural pain management strategy including pain assessment,technology of operation,non-pharmacological nursing interventions and burm dressing selection.The positive coefficient of the two rounds of expert consultation method correspondence is 100%and 95.2%respectively,the expert authority coefficient is 0.820 and 0.823,and the item importance variation coefficient between each item is 0.04-0.20,the operability variation coefficient is 0.00-0.23,the coordination coefficient of each item is 0.212-0.277,the significance test was P<0.05;all less than 0.3.The positive coefficient,authoritative coefficient and variation coefficient of the expert consultation method of Delphi have proved that the scheme has high credibility with widely representative,objective,accurate and reliable.