運用跨理論模式提升護理人員對重症病人疼痛評估處置完整性

Promoting Nurse Ability to Perform Integrity of Critical Patient’s Pain Assessment under Transtheoretical model

「疼痛」已列為第五生命徵象，台灣疼痛醫學會亦積極推動「無痛醫院」以期解決病人疼痛問題。本單位為神經外科加護病房，經調查發現護理人員對重症病人疼痛評估處置完整性僅48.9%，原因為：遺忘及無暇進行疼痛評估、執行疼痛評估及處理的態度被動。自2012年1月1日至9月30日止，專案成員參考文獻擬定改善方案，並以跨理論模式為基礎，將疼痛評估處置轉變成內化行為，設計相關策略，包含：(1)修訂疼痛評估量表；(2)疼痛評估資訊化；(3)修訂疼痛評估處置流程；(4)製作疼痛提醒標語；(5)「反疼痛」胸章佩戴；(6)舉辦「疼痛守護小天使」等。改善後護理人員對重症病人疼痛評估處置完整性由48.9%提升至98.9%，足見方案有效改善問題，期望藉此提升醫護團隊對疼痛評估的重視並提供適切的疼痛照護。

Pain has been listed as the fifth vital sign. Taiwan Pain Society has actively promoted the ""Painless Hospital"" in order to solve the pain problems of patients and enhance the quality of care. The project was conducted at a neurosurgical intensive care unit. Before this project, the completion rate of pain assessment was 48.9%. The reason included : overlooking, lack of time for pain assessment, and passive attitude toward conducting pain assessment and management. The improvement project time period was from January 1, to September 30, 2012. After analyzing the current procedures, according to literature review based on transtheoretical model to convert pain assessment and treatment to internal behaviors, the strategies included: (1) revising pain assessment tool; (2) providing information for pain assessment; (3) revising procedure of pain assessment and management; (4) posting pain slogans; (5) wearing paincontrol sign ; and (6) electing pain control angel to improve awareness. After the improvement project, the completion rate of pain assessment and management increased from 48.9% to 98.9%. The project has improved the pain assessment and management in clinical settings.