| Objective To understand the pain knowledge level of hepatobiliary surgery nurses,and explore the pain experience and analgesic needs of postoperative patients with liver cancer.On this basis,a scientific and standardized postoperative pain nursing management mode for patients with liver cancer was constructed,combined with literature review,so as to provide theoretical guidance for the development of clinical pain nursing.Methods1.Using the convenience sampling method,a questionnaire survey was conducted on 69 hepatobiliary surgery nurses in 4 tertiary Class A hospitals in Dalian,Liaoning province from June to July 2019.The Knowledge and Attitude Survey Regarding Pain as a research tool was used to investigate the pain knowledge level of nurses.Objective sampling method was adopted to conduct semi-structured interviews with 10 postoperative patients of hepatocellular carcinoma in the department of hepatobiliary surgery of a tertiary Class A hospital in Dalian,Liaoning province from June to August2019.The self-made semi-structured interview outline as the research tool was used to explore the pain experience and analgesic needs of patients.SPSS20.0 was used for statistical analysis of the questionnaire data,and Nvivo11.0 was used for sorting out semi-structured interview data to extract the research topic.Combined with literature review and group discussion,the postoperative pain nursing management mode for patients with liver cancer was preliminarily established.2.Drawing up the expert consultation questionnaire.Delphi method was applied to select experts including clinical nursing,nursing management,nursing education,clinical medicine,clinical pharmacy,clinical anesthesiology and clinical psychology to conduct two rounds of consultation.SPSS20.0 was used for statistical analysis of the questionaire data.By calculating the indicators such as expert positive coefficient,authoritative coefficient,degree of concentration and coordination,and combining expert opinions to modify the questionnaire items.Finally,the postoperative pain nursing management mode for patients with liver cancer was established.Results1.The average score of Knowledge and Attitude Survey Regarding Pain of hepatobiliary surgery nurses was(18.81±4.21)points,and the average accuracy was47.01%.The accuracy of each dimension was in descending order: general knowledge of pain(51.41%),knowledge of pain assessment(48.32%),knowledge of pain medication(46.10%),and knowledge of pain intervention(40.29%);2.The semi-structured interview concluded the following three themes: the patients experienced strong postoperative pain,the analgesic treatment could effectively relieve the pain of the patients,and the patients had high expectations for the development of pain nursing management;3.The expert consultation results showed that the expert positive coefficient of the two rounds of consultation is 86.96% and 90.00% respectively.The expert authority coefficient is 0.88.In the first round of consultation,the average value of the importance of the items range from 4.15 to 5.00,and the full mark rate ranges from 35%to 100%.In the second round of consultation,the average value of the importance of the items range from 3.94 to 5.00,and the full mark rate ranges from 11% to 100%;The coefficient of variation of the first round of consultation ranges from 0.000 to 0.296,with an average of 0.101.The coefficient of variation of the second round of consultation ranges from 0.000 to 0.192,with an average of 0.076.The first round of consultation dimensions,first-level items,second-level items,and third-level items have Kendall coordination coefficient values of 0.238,0.242,0.223 and 0.195,and the second round of consultation dimensions,first-level items,second-level items,and third-level items have Kendall coordination coefficient values of 0.333,0.290,0.253 and 0.221,P <0.05,indicating expert opinions tend to be consistent.After two rounds of consultation,the postoperative pain nursing management mode for patients with liver cancer was finally formed,including 4 dimensions,14 first-level items,43 second-level items and 105 third-level items.Conclusions1.The postoperative pain nursing management mode for patients with liver cancer constructed in this study can meet the common needs of hepatobiliary surgery nurses and liver cancer patients for postoperative pain nursing management;2.The constructed postoperative pain nursing management mode for patients with liver cancer has good reliability,science and practicability.It clearly defines the various pain nursing tasks that hepatobiliary surgery nurses should perform,which can regulate the nurses' pain nursing behavior and guide the development of clinical pain nursing work;3.The postoperative pain nursing management mode for patients with liver cancer includes 4 dimensions,14 first-level items,43 second-level items and 105 third-level items.Under the guidance of this mode,medical institutions can carry out pain knowledge training based on multi-disciplinary collaboration for nurses to improve their pain management level.And nurses can implement targeted pain nursing measures for patients according to their own conditions before surgery,after surgery and after discharge,so as to improve the analgesic effect and accelerate the patients' recovery. |
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