病人主訴術後疼痛強度與護理人員評估結果差異之比較

Postoperative Pain: Comparative Differences Between That Reported by Patients and Nurses

背景：手術後疼痛長久以來被忽視且處置不足，而疼痛評估為提供適當疼痛處置第一個最重要的步驟，國外文獻指出醫護人員疼痛評估與病人主訴缺乏一致性，而國內相關文獻則仍少見。
目的：本研究旨在比較術後病人主訴的疼痛強度與護理人員評估之間的差異。
方法：為前瞻性描述性研究，採立意取樣，自民國97年4月1日至民國97年7月31日間，於中部某區域教學醫院外科病房，病人接受腹部手術後第一天，以0－10分數字疼痛評估量表評估病人主訴之疼痛強度，共收案216個配對的病人主訴及評估其疼痛強度的病歷記錄。
結果：研究結果發現：(1)病人主訴疼痛強度分佈介於0~10分，而護理人員評估介於0~6分之間；差距值最小為1分、最大達8分，護理人員低估病人疼痛者佔53.7%，有高估者佔31.5%，病人主訴疼痛強度顯著高於護理人員評估（p < .01）；(2)護理人員有無與病人直接溝通疼痛強度，並不影響與病人主訴的一致性。
結論：實務應用 與病人主訴相較，護理人員顯著低估病人的術後疼痛，且多數沒有與病人直接溝通疼痛。建議加強疼痛評估與疼痛溝通之在職訓練，使用數字疼痛評估量表指導病人主訴疼痛，疼痛評估如實記錄病人的主訴，以改善病人主訴與護理人員評估結果間之一致性。

Background: Pain management after surgery has long been ignored or managed inadequately. Pain assessment is the first and most important step toward adequate pain relief. While many studies have shown significant differences between pain reported by patients and that reported by care providers, little has been reported on this issue in Taiwan.
Purposes: The purpose of this study was to investigate differences in pain intensity following surgery as self-reported by patients and assessed by nurses.
Methods: This prospective and descriptive study was based on a purposive sampling conducted between April 1 and July 31, 2008 in the surgical wards of a regional teaching hospital in central Taiwan. Subjects recruited were in their first postoperative day. Their assessed pain intensity was rated on a numeric rating scale of 0 to 10. This study included 216 pairs of pain records (patient self-reports and nurse assessments).
Results: Two major findings included: (1) Pain intensity scores self-assessed by patients ranged from 0 to 10. Scores assigned by nurses ranged between 0 and 6. Thus, patient scores were significantly higher than those assigned by nurses (p < .01). There was a discord in scoring between the two groups, with the gap ranging from 1 to 8. About 53.7% of nurses underestimated patient pain, while 31.5% overestimated it; and (2) The factor of nurse communication about pain with the patients had a negligible impact upon results.
Conclusions / Implications for practice: Nurses significantly underestimated patient pain, as compared to patient self-reporting. This demonstrates that most nurses do not query their patients about subjective pain perception. Study results recommend that pain assessment and communication should be added to the in-service training curriculum for staff in order to facilitate nurse communication of pain intensity using a numeric rating scale and patient self-report records. The objective should be to improve consistency between patient self-reporting on and nursing assessments of pain.