| Objective:Patient participation in decision-making is a key factor to achieve high-quality pain management.Understanding the status of breast cancer patients involving in postoperative pain management and health education,to found a theoretical and practical foundation for health education services for postoperative pain patients undergoing breast cancer surgery,and to build a postoperative pain health education program involve surgery patient with breast cancer.Methods:First Part,Quantitative Research:Using convenient sampling methods,selected 230 patients undergoing breast cancer surgery from two tertiary level hospital.On the first day after admission,the patient were investigated with General Information Questionnaire,and Patients with Breast Cancer Involving Postoperative Pain Management requirement Questionnaire(IPPMRQ),to collect demographic data of patients undergoing breast cancer surgery,and patient's requirement for postoperative pain management and health education.Assessed participants' pain intensity and its interferes with daily activities using the Brief Pain Inventory(BPI)every 24 hours until 7days after surgery.Frequency,mean,percentage of general demographic survey data for breast cancer surgery patients;breast cancer surgery patients seven days postoperative pain,seven days postoperative pain grading and other pain conditions;breast cancer surgery patients involved in postoperative pain health education The demand status is statistically described.Non-parametric rank sum test analyzes five dimensions of postoperative pain management in breast cancer patients;Using single-factor analysis of variance and non-parametric K independent sample tests,analysis the relationship between the general demographic characteristics of patients and the needs of breast cancer patients involved in postoperative pain management.Second Part,Qualitative Research:Using phenomenological research method,formed the semi-structured interview outline about breast cancerpatients' requirement participating in postoperative pain health education.11 patients were involved in this study.Colaizzir analysis method was used to analyze the interview data,summarize and summarize the patient's demand for postoperative pain management and health education.Results:Quantitative findings:1.Thestatus of postoperative pain:Patients experienced intense postoperative pain.Patients with moderate pain intensity or above of.worst pain,least pain,average pain and current pain in the past 24 hours during postoperative 7 days respectively were:The first day was 100%?64.0%?84.0%?96.0%?the second day was 78.0%?84.0%?74.0%?86.0%?the third day was 76.0%,70.0%,76.0%and 84.0%;the fourth day was 60.0%,52.0%,56.0%and 54.0%;the fifth day was 56.0%,48.0%,44.0%and 46.0%;the sixth day was 54.0%,46.0%,42.0%and 36.0%;the seventh day was 52.0%,40.0%,32.0%,and 24.0%.2.The result of IPPMRQ:.All five dimensions have higher requirements.Descriptive statistical analysis of each dimension was:(1)In satisfaction dimension,the highest proportion of completely demand with the item "You need medical staff to seek and value your advice when choosing treatment options",accounting for 81.3%,and the lowest percentage of demanding completely about the item "You need to say what you care about in pain treatment and responsibility" was 69.1%.(2)In trust-friendly dimension,the highest proportion of completely demand "You need to be treated with respect,positive,warm-hearted and friendly"was 84.3%,and the lowest proportion of completely demand "You need your doctor's assistance to identify your own pain needs",accounting for 60.4%.(3)In patient participation dimension,the highest proportion of completely demand "You need to know how you are involved in managing pain management education"accounted for 82.6%,and the lowest proportion demanding entirely with"You need to know that in participating in medical decisions,it is important to you to express your opinion" was 65.2%.(4)In the dimension of pain knowledge demand,the highest percentage of completely demand about "You need to know how to tell the location and nature of the pain to your health professional",accounted for 78.3%,and the lowest percentage of completely demand "You need to know how to assess postoperative pain(Brief Pain Scale)was 41.5%.(5)In the dimension of pain health education requirement,the highest percentage of completely demand "You need to know how to communicate with medical staff about your postoperative pain",accounted for 78.3%,the lowest percentage of completely demand "The analgesic method you need is physical therapy(such as traditional Chinese medicine)"accounted for 32.2%.(6)The five dimensions are higher demand.3.The relation between pain invensity and IPPMRQ:the result of Non-parameter test of multiple-comparison of multiple samples:(1)In trust-friendly dimension,the most important requirement was respect,kindness,enthusiasm and enthusiasm from the medical staff,followed by that the health care workers kept confidential,medical staff gave understand and sympathy,take initiative to ask medical staff about the pain,health care workers encourage patients to participate in pain management education,etc.(p= 0.000).(2)In the dimension of satisfaction,what the patient most needs was that when choosing a treatment plan,medical staffs seek and attach importance to patient opinion,and the second was the patient needs to participate in the discussion,patient declaim about the issues of concern and responsibility in the treatment of pain(p =0.003).(3)In patient participation dimension,what the patient most needs was the implementation method and significance of education in pain management,followed by the doubts and perceptions of pain control,time spent in pain management education,how medical resources are used,family support,the implementer of education,the location of education,it's important to express your opinions(p=0.000).(4)In the dimension of pain knowledge requirement,the most needed was how to inform the medical staff of pain,followed by communication about postoperative pain,the physical and psychological harm caused by pain,the side effects of analgesics,the effect of analgesic drugs on wound healing etc.(p=0.000).(5)In the health education demand dimension,the most demanding way of health education was individualized guidance,followed by vivid brochure,peer education who had received pain education,the bullet in boards in the wards,intensive classes,and video or slide on about postoperative pain(p=0.000);The health education time which patient's most needed was from admission to discharge,followed by postoperative,preoperative(p=0.000);Patient's most need about non-drug analgesic methods were listening to music,massage,relaxing,narrating,diverting attention,physical therapy(such as Chinese physiotherapy),meditation(p=0.000).There was no difference among the requirement of four types of pain educators:doctors,pain specialist nurses,responsible nurses,anesthesiologists(p=0.985).4.One-way analysis of variance:Breast cancer patients age,education level,occupation,analgesic treatment,education method,education content,education time,improvement of pain on breast cancer patients need to participate in postoperative pain health education(P<0.05),but different religion,income status,marital status,ethnic status,health insurance type,different types of clinical diagnosis of breast cancer,different clinical surgical methods,different hospitalizations,different education,whether the analgesic treatment,there was no statistically significant difference(P>0.05)in the need for cancer surgery patients to participate in postoperative pain education.5.Non-parametric K independent sample tests:(1)Whether or not the education is divided into groups shows that the patients who have been educated have a significant difference(P<0.05)between their needs for postoperative pain management and health education and those who have not been educated(P<0.05).The average rank further infers that the educated patients have significantly higher demand for postoperative pain management and health education than those who have not been educated.(2)Whether or not to group educational effectiveness evaluations shows that there is a statistically significant difference in the dimensions of trust-awareness-friendly dimensions and satisfaction(P<0.05).According to the average rank ratings,the education effect evaluation group in trust perception is conducted.The dimensions of friendship and satisfaction were both higher than those of the non-implemented education evaluation group.(3)Whether or not there was surgery grouping showed that there were statistically significant differences between patients who had surgery and those who had not undergone surgery.(P<0.05),further deducing from the average rank,the patients who have undergone surgery have a higher demand in the trust-awareness friendly dimension than those who have not undergone surgery.6.Qualitative Results:A total of 6 topics were refined:lack of trust;lack of postoperative pain-related knowledge;incapable of coping with pain;over-reliance on healthcare professionals;psychological care were needed;lack of family support.Conclusion:1.Postoperative analgesia is poor in breast cancer patients.2.Patients with breast cancer surgery have high demand for participating in postoperative pain management and health education.In the management of postoperative pain,medical staff should involve the patient in pain management related to oneself and play a role as an important member of the pain management team.3.The factors affecting the patient's participation in pain management were:The results of quantitative studies showed that included the age,education level,occupation,analgesic treatment,education method,education content,education time,the improvement of pain;and the results of the qualitative study showed that included lacks of trust;lack of postoperative pain-related knowledge;In capable of coping with pain;over-reliance on health care professionals;psychological care were needed;lack of family support.4.It is suggested that in the management of postoperative pain,the medical staff should involve the patient in their pain management and build pain education program to improve patients'participation,to demonstrate the important role of the patient in the pain management team. |
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