Situation Of Pain Management And Its Intervention Research Among Nurses In Intensive Care Unit

Objective1 To develop an adaptive questionnaire assessing the Intensive Care Unit(ICU)nurses' knowledge regarding pain management.2 To investigate the knowledge level of pain management of the nurses in ICU and its practice status quo and influencing factors in order to provide bases for nurses' training on pain management knowledge.3 To evaluate the effects of pain management training program on ICU nurses' knowledge.Methods1 The questionnaire about ICU nurses' knowledge of pain management was drawn up on the basis of literature review and Delphi technique.2 Investegation: totally 420 nurses from 14 Class ?hospitals of Hu'nan,Guangdong,Beijing and Hebei were investigated from April to July 2017.3 Training: totally 40 nurses in the ICU of a Class ?Grade-A hospital,were given a four-week training(a total of 12 periods)for ICU pain management from January to February 2018.4 Evaluation: the study was quasi-experimental in design(pretest-posttest).Therefore,the same research instruments and approaches were used to collect nurses' and patients' materials before and after the training program.Then,the data before the training and the data after the training were compared to evaluate the effects of the training on the nurses' pain management knowledge and their behavior and the level of pain suffered by the patient.Results1 The questionnaire about ICU nurses' knowledge of pain management consists of 5 factors and 38 specific items.(1)Reliability test: the Cronbacha of the whole scale was 0.834 and the five factors were between 0.713~0.849.The test-retest reliability of the whole scale was 0.883 and the five factors were between 0.702~0.824 and it was statistically significant(P<0.01).The split reliability of the whole scale was 0.883 and the five factors were between 0.702~0.824.(2)Validity test: content validity evaluated using Content Validity Index(CVI)was 0.91.Five factors can explain 56.67% of the variance.The correlation coefficient between factors and their total scores was between 0.589~0.808,the correlation coefficient of factors was between 0.138~0.389,the correlation index of factors and items was between 0.182~0.689,all of which were statistically significant(P<0.01).2 A total of 420 valid questionnaires were collected.The average score of ICU nurses' knowledge of pain management was(23.01±5.58),and the average accuracy was 56.1%,which was at a low level.There were statistically significant differences for the pain management knowledge scores of ICU nurses among different ICU type,age,education degree,position,as well as frequence of pain management training(P<0.05),but not among different provinces,gender,work experience of ICU(P>0.05).3 The ICU pain management scores before and after the pain training programAfter the training,the total score of ICU pain management knowledge was(28.78±3.40),which was higher than that made before the training(20.70±3.00),and the difference was statistically significant(t=-11.327,P<0.01).After the training,the scores of basic knowledge of pain,pain assessment,non drug treatment of pain of ICU nurses were significantly higher than those before the training,whose differences were statistically significant(P<0.01);there was no significant difference in medication score and side effects score of ICU nurses of pain before and after training(P>0.05).4 The ICU nurses' hehavior before and after the pain training program(1)After the training,only 2.5% ICU nurses didn't perform the pain assessment,which was a significant decrease to be compared with the rate 17.5% before the training;pain assessment frequencies are mainly 2 x/shift(50%)and >2 x/shift(40%),which was largely improved than before the training,which had statistical significance(?2=35.509,P<0.01);before the training,ICU nurses mainly used subjective pain assessment tools based Faces Pain Scale(FPS)(55%),Numeric Rating Scale(NRS)(35%),and rarely used objective pain assessment tool Critical Care Pain Observation Tool(CPOT)(10%),however,after the training,objective pain assessment tool application increased by 62.5%,namely 72.5% of the nurses used CPOT as their pain assessment tool,and subjective pain assessment tool used was reduced to FPS(12.5%),NRS(15%),which had statistical significance(?2=32.843,P<0.01).(2)Before and after the training,there was no statistical significance in the highest level of pain suffered by patients between the two groups(Z=-1.569,P>0.05),and there was statistically significant in the level of pain(Z=-2.806,P<0.01).Conclusions1 The ICU nurses' knowledge of pain management questionnaire is of good reliability and validity as a tool for test and evaluation.2 The knowledge level of pain management in ICU nurses is low,and their clinical practice is insufficient.3 The pain training program can enrich ICU nurses' knowledge regarding pain management,improve their attitude toward pain management,promote their pain management practice and relief the pain suffered by patients.