Construction And Application Of Evidence-based Management Program For Wound-related Procedural Pain In Chronic Wound Patients

Objective:1.To understand the current situation of wound-related procedural pain management and the barriers to effective management of pain by wound treatment and nursing staff.2.Guided by evidence-based theory,evidence-based management program for wound-related procedural pain in chronic wound patients was constructed.3.To verify the effectiveness and feasibility of evidence-based pain management program on the pain level,anxiety score,duration of dressing change for chronic wound patients,in order to provide a standardized,systematic and comprehensive wound-related procedural pain management program to improve the quality of clinical wound care and patients′ wound dressing change experience.Methods:1.Base on literature review,qualitative interviews,expert meetings and pre-investigation to develop the wound-related procedural pain management status questionnaire,using convenience sampling method,selected the national certified wound specialists for the survey,the survey contents included the wound-related pain management system,wound-related procedural pain cognition,wound-related procedural pain assessment,wound-related procedural pain nursing and management and the barriers to wound-related procedural pain management.2.Follow the "6S" evidence model,a systematic search of relevant domestic and foreign guideline websites,professional association websites and databases for clinical practice guidelines,clinical decisions,expert consensuses,evidence summaries,recommended practices and systematic reviews on the nursing and management of wound-related procedural pain in chronic wounds.The first draft of the evidence-based pain management program was formed by 2 researchers independently evaluating the quality of the included literature,extracting and summarizing relevant evidence.Expert meeting method was adopted to invite experts in the field of wound care and pain management to assess the first draft of the evidence-based pain management program and further improve it through pre-test,finally formed the evidence-based management program for wound-related procedural pain in chronic wound patients.3.A convenience sample of 73 chronic wound patients from the wound care specialist clinic at a tertiary hospital in Shanxi Province were selected as the study population.On the basis of the time they entered,they were classified into the experimental group(37 cases)and the control group(36 cases).Aseptic wound dressing changes routine care in the control group,while the experimental group used evidence-based pain management program on this basis.To compare the pain score,heart rate change,anxiety level,length of dressing change,degree of wound healing,adverse effects and satisfaction with pain management at the time of wound dressing changes before and after the 1st to 3rd interventions in both groups.Results:1.A total of 228 certified wound specialists were investigated in this study,44.3%were working for hospitals that had established wound-related pain management systems and procedures;64.0% thought wound-related procedural pain was inevitable;51.3%always performed wound-related procedural pain assessment during dressing change;31.6% always took measures to control the wound-related procedural pain;85.5%believed that there was insufficient analgesia during dressing change.The main barriers to wound-related procedural pain management included the following aspects: patients thought they could endure pain and didn′ t want to report the pain truthfully;they were reluctant to use painkillers attributable to worry about painkillers addiction,inability to control its side effects;the wound dressing-change staff lacked knowledge of pain assessment and management;flawed pain management system in hospitals or departments.2.The best evidence for the nursing and management of wound-related procedural pain in chronic wound patients based on the 17 pieces of literature,including 2guidelines,1 expert consensus,3 clinical decisions,6 evidence summaries,2recommended practices,3 systematic reviews.A compilation of the best evidence in 9areas including basic principles,pain assessment and recording,replacement and selection of the wound dressing,wound cleaning,wound debridement,negative pressure wound therapy,drug intervention modalities,non-drug intervention modalities,education and training,and 36 articles.The authority coefficient of 12 experts was 0.84,with high authority,and 15 suggestions were revised during the meeting,including 8 modifications,2 additions,3 deletions and 2 dimensional adjustments;and 10 chronic wound patients were selected for pre-test,the feedback and existing problems of the implementation process were improved and adjusted.The final evidence-based management program for wound-related procedural pain in chronic wound patients with 5 dimensions and 32 specific operational items,including general principles,pain assessment,operation techniques,intervention modality,education and training.3.A total of 73 chronic wound patients were admitted,all of whom were eligible for enrolment and exemption in this study,37 in the experimental group and 36 in the control group.General data and pain score,heart rate change,anxiety score,length of change and PUSH score during dressing changes before the intervention were balanced and comparable by test of equilibrium between the two study groups,and the difference has no statistical significance(all P > 0.05).Following the 1st to 3rd interventions,the two groups compared pain score,heart rate change(remove dressing,debridement and dressing heart rate),anxiety level and length of wound dressing change during wound dressing changes.These indicators were reduced in the experimental group compared to the control group(all P < 0.05),and the repeated-measures ANOVA results revealed a between-group effect,a time effect and an interaction effect in both groups.PUSH scores were slightly lower in the experimental group than the control group,but there was no significant difference(P > 0.05).Both groups of patients showed significant discomfort during the implementation,and the satisfaction scores for pain management were significantly higher in the experimental group than the control group(P < 0.05).Conclusion:1.The investigation found that the wound-related pain management system needs to be improved,certified wound specialists′ knowledge on the wound-related procedural pain and the pain management procedures need to be enhanced and standardized,the barriers to pain management need to be solved.It is suggested to further improve the organizational system of wound-related procedural pain management and construct a standardized wound-related procedural pain management program that is in line with national conditions and closely related to clinical practice.2.Based on evidence-based methodology,expert meeting method and pre-test,the evidence-based management program for wound-related procedural pain in chronic wound patients is specific and comprehensive,suitable and practical,and has a strong guide to clinical nursing practice.3.The application of evidence-based pain management program for the chronic wound patients can decrease the pain level,reduce the anxiety level and shorten the duration of wound dressing change,which is safe and reliable,and has good scientific and clinical applicability.