提升某區域醫院內科護理人員癌症疼痛評估之正確性

Improve the Accuracy of Cancer Pain Assessment from Staff Nurses in a Medical Unit

10.29494/LN.202303_24(1).0011

林莠美(Yu-Mei Lin)；郭麗琴(Li-Chin Kuo)；王彗文(Hui-Wen Wang)；陳芝文(Chih-Wen Chen)

癌症 ； 疼痛評估 ； cancer ； pain assessment

領導護理

24卷1期（2023 / 03 / 01）

142 - 157

繁體中文;英文

癌症疼痛能獲得良好控制是提供癌症照護重要的護理措施，護理人員在疼痛處理的知識及技能將會影響癌症病人的疼痛處置與生活品質。本專案旨在提升護理人員癌症疼痛評估之正確性，臨床發現主要問題為未定期修訂癌症病人疼痛評估標準、未制定癌症疼痛評估照護指引、缺乏癌症疼痛評估教育訓練課程、缺乏癌症疼痛評估稽核制度，透過修定癌症疼痛評估標準、制定癌症疼痛評估照護指引、製作癌症疼痛評估正確步驟多媒體影音光碟、舉辦癌症疼痛評估教育訓練、安排每週2次晨間會議案例教學、制定癌症疼痛評估稽核表與辦法，護理人員癌症疼痛評估正確性由38%提升至88%，已達本專案目的85%。經本專案的推行，使病人疼痛得到良好控制，提升照護品質。

Good management of cancer pain is an important nursing intervention when provide cancer care. The knowledge and skills of pain management from nursing staff will influence pain management and quality of life for cancer patients. This project aims to improve the accuracy of cancer pain assessment from nursing staff. The main problems found clinically include lack of pain assessment standard for cancer patients, insufficient revision; inadequate clinical practice guideline on pain control, poor education program in cancer pain assessment, and inadequate cancer pain assessment audit system. Through the revision of cancer pain assessment standard, establish clinical practice guideline on pain control, making multimedia audio-visual education CDs for procedures of proper cancer pain assessment; organize cancer pain assessment education and training; arrange case education in the morning meetings twice a week, develop a cancer pain assessment audit checklist and method. The accuracy of cancer pain assessment by nursing staff has increased from 38% to 88%, which has reached the goal of 85% as this project is target to. After the implementation of this project, the patient's pain is well under control and the quality of care has improved.

1. 曲幗敏,蔡玉鳳,蘇僅涵,林聿品,黃金瑩,陳美碧(2019)。探討護理人員與癌症病人對病人之症狀困擾、情緒困擾及靈性安適評估之一致性。源遠護理，13(1)，29-40。
   連結：
2. 呂欣衿,邱存梅,王斐雯(2016)。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。長庚護理，27(3)，353-367。
   連結：
3. 張雅玲,黃惠玲,林雅玲,陳秀琍,翁淑媛,郭秋雅,陳怡呈(2017)。運用多元策略提升護理人員執行疼痛評估正確率之專案。長庚護理，28(1)，47-59。
   連結：
4. 黃綉雲,林佩昭,周碧玲,曾月美,吳麗娟(2019)。醫學中心推動癌症無痛學院之經驗與成效。腫瘤護理雜誌，19，183-193。
   連結：
5. Adam, R.,Burton, C. D.,Bond, C. M.,De Bruin, M.,Murchie, P.(2017).Can patient-reported measurements of pain be used to improve cancer pain management? A systematic review and meta-analysis.BMJ Supportive & Palliative care,7(4),373-382.
6. Carlson, C. L.(2016).Effectiveness of the world health organization cancer pain relief guidelines: An integrative review.Journal of Pain Research,9,515-534.
7. Chellappan, S.,Rajkumar, R.,Jeyapal, M.(2017).Cancer pain management: Teaching program for terminally ill cancer patients.Asian Journal of Nursing Education and Research,7(2),151-154.
8. dos Santos Ferreira, F.,dos Santos, J.,Meira, K. C.(2016).Knowledge of resident nurses on the management of cancer pain: A cross-sectional study.Online Brazilian Journal of Nursing,15(4),694-703.
9. Eaton, L. H.,Meins, A. R.,Mitchell, P. H.,Voss, J.,Doorenbos, A. Z.(2015).Evidence-based practice beliefs and behaviors of nurses providing cancer pain management: A mixed-methods approach.Oncology Nursing Forum,42(2),165-173.
10. Fallon, M.,Giusti, R.,Aielli, F.,Hoskin, P.,Rolke, R.,Sharma, M.,Ripamonti, C. I.,ESMO Guidelines Committee(2018).Management of cancer pain in adult patients: ESMO clinical practice guidelines.Annals of Oncology : Official Journal of the European Society for Medical Oncology,29(Suppl 4),iv166-iv191.
11. Gretarsdottir, E.,Zoëga, S.,Tomasson, G.,Sveinsdottir, H.,Gunnarsdottir, S.(2017).Determinants of knowledge and attitudes regarding pain among nurses in a university hospital: A cross-sectional study.Pain Management Nursing,18(3),144-152.
12. 吳淑芬,林貴珍,陳正彥,蘇浩博,李來涼,洪俊傑(2014)。提升疼痛護理指導之成效。北市醫學雜誌，11(4)，84-94。
13. 胡文郁,陳宛榆,羅淑芬,陳書毓,黃翰心,陳幼貴(2011)。成人癌症疼痛臨床照護指引。腫瘤護理雜誌，11，87-127。
14. 衛生福利部（2021，11 月 13 日）．109 年國人死因統計結果 ．https://www.mohw.gov.tw/cp-5017-61533-1.html