護理人員於癌症疼痛評估及處置之決策及其相關因素
The decision making of nurses for assessment and management of cancer pain and its related factors
中文摘要
本研究是採橫斷式描述性相關性設計，目的在了解護理人員於癌痛處置決策過程 中如何評估、處置癌症病患疼痛問題及其相關因素調查，研究對象以北部四家地 區醫院以上的一般癌症病房及腫瘤科病房之護理人員為主，採方便選樣，選取照 顧癌症病患的護理人員為主要研究對象。共收集 95 位符合研究條件，在 24 小時 內有處置癌症疼痛的護理人員，以 Ferrell(1991)所發展的護理人員決策過程問卷 表，收集所需資料，所得資料以平均數、標準差、百分比及卡方檢定等統計方式 進行分析。
研究結果發現護理人員對癌症疼痛之評估，最常使用的評估方式，為詢問病患有 多痛，但仍有 63.2%的護理人員未以詢問病患有多痛為主要疼痛評估方式。
護理人員表示影響癌症疼痛評估的主要障礙因子為病患或家屬知識，其次為病患 配合情形、護理人員知識及護理人員的時間，有 48.9%護理人員有使用疼痛評估 量表來測量病患疼痛強度，所使用的量表以字計算型量表(Numerical Rating Scale) 為主。
有關疼痛葯物性處置方面，在葯物種類選擇上以強效麻醉葯使用情形最多，止痛 葯使用途徑以口服方式最多，大部份的給葯頻率皆為定時給葯，對醫囑所開立葯 物及當日所給的葯物，有 45.6%的護理人員認為配合醫囑給葯即可，而護理人員 認為執行葯物性處置的障礙因子為病患配合情形，其次為病患或家屬知識，不合 適醫囑，及護理人員知識。
囑中開立使用非葯物性處置項目如熱敷、冰敷、電刺激、按摩，皆低於 10%。出 現於護理人員計劃中以按摩最多，病患實際使用也是以按摩最多，護理人員認為 執行非葯物性處置的障礙因子為病患配合情形，其次為病患或家屬知識，護理人 員知識，及護理人員時間。
在護理人員對癌症病患疼痛之決策上，依序為病患是否感到疼痛、決定病患有多 痛，何時給止痛藥，可使用那些非藥物性處置措施，而要給那些止痛藥則決策最 少，有 36.8%的護理人員已和醫師討論當日病人之疼痛問題，其中向醫師報告病 患疼痛改變情形最多，其次為和醫師討論是否增加病患止痛葯物劑量之需要。在 處理癌症病患疼痛問題時，護理人員最常感覺到的衝突為擔心病患未獲得合適疼 痛緩解，其次為擔心呼吸抑制，擔心給葯過多，懷疑病患疼痛是真的，及擔心成 癮。
本研究結果有助於了解護理人員對癌症疼痛評估、藥物及非藥物性處置方式及其 障礙因子，和臨床上常發生之專業性倫理衝突，可提供臨床實務及護理教育之參 考，並建議加強護理同仁有關癌痛藥物、非藥物處置知識並設立完整之疼痛評估
及處置記錄單，以加強臨床護理人員對病患疼痛評估及處置之能力及提昇癌痛之 照護品質。
英文摘要
The purpose of this descriptive study was to explore the decision making of nurses for assessment and management of cancer pain. Subjects were recruited from the
oncology and general med-surg ward of four hospitals, in Northern Taiwan.
Ninety-five nurses who were in charge with the care of patients with cancer pain in the last 24 hours . The instrument used in the study were originally developed by Ferrell(1991) to measure “ the decision making of nurses for management of cancer pain”. Data were analyzed by descriptive statistics and Chi-square.
Results of this study revealed the method for assessment of cancer pain of patient, that most commonly used was to ask patients about their pain intensity. However, still 63.2% of nursing staff didn’t use this method to assess cancer pain.
Nurses perceived that the most common barrier for assessment of cancer pain included the knowledge of cancer patients and their family, the patient compliance, the knowledge and time of nursing staff. Forty-nine percent of nursing staff used Numerical Rating Scale to measure the cancer pain intensity.
Nurses perceived that the most common barrier for pharmacological management of cancer pain was patient compliance, the knowledge of patient and its family,
unsuitable medical order and the knowledge of nursing staff.
The nonpharmacological methods in cancer pain management were below 10%. The most barriers for nonanalgesic of cancer pain were patient compliance, the knowledge of patient and its family, the knowledge and time of nursing staff. Thirty-seven
percent of nursing staff had discussed with the patient’s doctor about patient’s problem of pain. Most nursing staff worried about the patient pain wasn’t adequately managed, were worried about respiratory inhibition, giving too much medication and drug addiction.
The result of this study suggests the importance of improve the knowledge of nursing staff about cancer pain assessment and management.
