英文摘要 |
Purposes: The purpose of the pain care improvement project was to improve the pain care completion rate by hemodialysis nurses. The prevalence of pain is high in dialysis patients,frequently resulting in termination of dialysis treatments and reducing the quality of dialysis. Therefore, hemodialysis unit nurses attempt to alleviate the painful sensation,achieve adequate dialysis treatments, and improve the quality of dialysis, quality of life, and survival by providing complete pain care measures. Methods: We analyzed the indicators of quality of dialysis using the Hope System and found that the urea nitrogen clearance (Kt/V) was < 1.2 in 20 patients. The primary cause for the low Kt/V was a shortened duration of dialysis treatment; in fact, one-third of the patients had pain-related early termination of dialysis treatment. Based on a review of the medical charts, there were 30 patients (26.8%) with early termination of dialysis treatment because of pain, resulting in an inadequate duration of dialysis and reduced clearance, which together affected the quality of dialysis. Therefore, we initiated the pain care improvement project to manage this issue. Before the project, the pain care completion rate was 24.9% and the accurate pain perception rate was 50.9%. An analysis of causes of the pain care completion and accurate pain perception rate revealed the following: 1. the nursing staff was not well-trained in pain perception; 2. no standard pain care guidelines; 3. no system of pain assessment; 4. no pain care nursing records; and 5. no auxiliary health education tools. The recommended measures included: 1. organizing pain care in-service education; 2. performing a 'fifth vital sign' assessment; 3. implementing audits, rewards, and punishments; 4. developing pain care nursing records; 5. formulating nursing instructions; and 6. making pain care health education videos. Results: The pain care completion rate increased from 24.9% to 96.4%, and the pain perception rate increased from 50.9% to 98.3%. Conclusions: After implementing the project, we found that organizing regular pain care in-service education could improve the pain perception rate pain of the nursing staff. Formulating hemodialysis pain care nursing instructions, incorporating pain assessment as a 'fifth vital sign', and providing appropriate pain care health education appliances could raise the pain care completion rate of the nursing staff significantly. |