腫瘤護理人員對癌痛之評估及處置與相關因素探討

Assessment and Management of Cancer Pain and its Related Factors by the Oncology Nurse

本研究之主要目的在了解護理人員如何評估及處置病患疼痛問題及過程中和醫師、病患、家屬及護理人員的知識與態度相關性調查。本研究採橫斷式敘述性相關研究，以Ferrell （1991）所發展的護理人員對癌痛評估及處置過程問卷表，對95位癌症病房護理人員作調查。本研究結果主要發現（1）有63.2%的護理人員未能以詢問病患有多痛為個人最主要疼痛評估方式，護理人員表示主要障礙因素為病患或家屬對癌痛之知識。（2）葯物處置以強效麻醉的使用情形最多，15.2%的護理人員認為應再多給一些止痛藥，護理人員認為執行的物處置的障礙因素主要為病息的配合情形。（3）非葯物處置以執行按摩最多，執行非葯物性處置的障礙因素主要為病患的配合情形。（4）在處理癌症病患疼痛問題時，護理人員最常感覺到的衝定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。本研究建議加強護理人員有關癌痛藥物處置及非藥物處置之知識，及設立適合臨床使用之疼痛評估及處置記錄單，以提昇癌痛之照護品質。The purpose of this study was to explore the nurses in the assessment and management of cancer pain, and the role of patients and their family, doctors, and other nursing staff in this process. Ninety-five nurses in the oncology ward were recruited to complete a questionnaire originally developed by Ferrell. The results were as follows : ( 1 ) 63.2% of nursing staff didn't ask the patients about their pain intensity to assess cancer pain. The most common barrier to assessment of cancer pain was the knowledge of cancer patients and their families; (2) the most common pharmacological management of cancer pain included strong opioid analgesics. About fifteen percent of nursing staff agreed that higher opioid analgesic dosage was required to release the cancer pain. The most common barrier for analgesic management was patient's comp1iance; (3 ) the most common analgesic management was massage. Again, The most common barrier was patient compliance; (4) Most nursing staff worried about the patient's pain not being adequately managed, respiratory inhibition, giving too much medication, whether pain is real, and drug addiction. This study suggests that setttingup pain assessment record sheets and enhancement of the knowledge and skill of nursing staff will improve the assessment and management of cancer pain.