Study Of Burn Pain Management In Fujian Province And Build Of Its Model

Objective: 1. To develop questionnaire about the knowledge, attitude and behavior of pain management for medical staffs of burn units. 2. To investigate Fujian medical staffs’ knowledge, attitude and behavior of pain management so as to provide reference for the standard of pain control improvement. 3. To explore and describe patients’ real experience and their expectation for pain management. 4. To build burn pain management model preliminarily and formulate control programs of each stage.Methods: 1. The questionnaire about burn medical staffs’ knowledge, attitude and behavior of pain management was drawn up on the basis of in-depth interview with patients as well as advices from clinical specialists. The amendment of the questionnaire was on the account of Delphi technique. 2. 263 medical staffs from 11 third class A,hospitals with independent burn units were investigated by general selection, among which were 84 doctors and 179 nurses. 3. The semi-structured in-depth interview and participant observation method were adopted to conduct qualitative interview with burn patients. The content of the interview was arranged and analyzed by Triangulation method with the aid of Nvivo 10 software. 4. The initial burn pain management model was built on the basis of the qualitative study that described patients’ pain experience and requirements for pain management as well as the quantitative study that investigated pain management knowledge,attitude,behavior among medical staffs in burn units under the guide of correlative references and Delphi technique. Results: 1. The questionnaire about burn medical staffs’ knowledge, attitude and behavior of pain management was developed. It consisted of 31 specific items.The Cronbach’s alpha coefficient was 0.84, and the test-retest reliability coefficient was 0.85. 2. Results of investigation about Fujian medical staffs in burn units were:①The differences in the knowledge and application of pain tools between doctors and nurses of burn units were of statistic significance(P<0.05). ②Medical staff owed the inefficiency of burn management to patients own. Sorts were as follows: lack of pain assessment knowledge, lack of pain management knowledge, worry about the patient’s addiction to painkillers and the side effects of painkillers. ③The average precision rate of the questionnaire responses was 55.55%. The differences in hospitals, professional titles and pain education of doctors obtaining in school contributed to the statistical significance(P<0.05); The differences in age, professional titles, pain education of nurses acquired in school and workplace made for statistical significance(P<0.05). Multiple regression analysis showed that the accuracy of doctors’ drug function knowledge were positively correlated with working years and degree; The accuracy of doctors’ knowledge of non-drug pain knowledge were positively correlated with pain knowledge education acquired in workplace; The accuracy of nurses’ total questionnaire were positively correlated with job titles and pain education acquired in school; just the same as drug treatment knowledge accuracy of nurses and pain education acquired in school. ④25% doctors and 44.7% nurses assessed the patient’s pain intensity frequently; Only 30.2% nurses took corresponding analgesia measures to patients with mild-to-moderate pain; Only 30.2% nurses and 48.8% doctors taught patients who suffered intense pain when dressing change. 3. Results of qualitative research showed that patients experienced severe pain, the situation of burn pain management was not optimistic, support from family and medical staffs played an important role in relieving patients’ pain and and patients looked expectedly toward pain management. 4. The burn pain management model which was based on the holistic nursing care,was divided into 4 stages and 19 interventions with Manchester pain management model as a framework. Four stages respectively were preparation, assessment, intervention, and rehabilitation, including environment improvement, pain knowledge education, social support enhancement, psychological venting promotion and emotional guidance and so on. Conclusion: 1. The pain management about burn medical staffs’ knowledge, attitude and behavior questionnaire is of good reliability and validity as tool for test and evaluation 2. Fujian medical staffs in burn units have poor knowledge of pain management and inactive attitude and behavior. 3. The inadequate pain control results in burn patients’ adverse sequela both physically and psychologically. A normative burn pain management model should be established to provide convenient, safe and effective burn pain control strategies for patients, and further to relieve pain. 4. Burn pain management model with specific comprehensive contents and high performance is designed for burn patients from admission to discharge. It highlights holistic nursing theory and embodies the "patient-centered" concept of quality care services.