ผลของโปรแกรมการจัดการความปวดโดยใช้หลักฐานเชิงประจักษ์ต่อผลลัพธ์การจัดการความปวดในผู้ป่วยบาดเจ็บทรวงอก

Abstract

This quasi-experimental study was conducted to examine the effects of an evidence-based pain management program on pain outcomes in chest trauma patients. Data collection was conducted on chest trauma patients who met the inclusion criteria and were admitted at the trauma ward in Songklanagarind Hospital between February and June 2017. One group of patients was assigned into the experimental group and received the evidence-based pain management program. Another group of patients was assigned into the control group and received regular nursing care. Each group consisted of 21 patients. The research instruments were composed of: 1) evidence-based pain management program for a chest trauma patient (AGREE II 86.66- 96.53%); 2) multidimensional pain assessment tool for chest trauma patients; 3) pain management outcomes evaluation form (S-CVI = 1.00, test-retest reliability = .90-1.00); 4) documentation of daily pain intensity and pain management; and 5) spirometer measurements (volume accuracy ± 2.27-2.80). Demographic data, health information, pain, and pain management information were analyzed using descriptive statistics, chi-square, and independent t-test. One-way repeated measures ANOVA, two-way repeated measures ANOVA with repeated measure on one factor, independent t-test, and Mann-Whitney U Test were used to test the hypothesis of this study. The study results revealed that after receiving the pain management program, the mean scores of least pain, worst pain, severe pain, and effects of pain on activity and sleep in the experimental group were statistically significantly lower than the scores before receiving the program (p <.001). The mean score of drowsiness after receiving opioids was also significantly lower than before receiving the program (p <.01). The mean scores of pain relief, satisfaction on pain management, perceived benefit of information given regarding pain management, ability to participate in decision-making to select pain management strategy, and lung vital capacity in the experimental group were statistically significantly higher than those before receiving the program (p < .001). Receiving information of pain management, non-pharmacological pain management, and encouragement to use non-pharmacological pain management were also significantly higher than those before receiving the program (p < .05). Accordingly, the mean scores of least pain, worst pain, severe pain, and the mean rank score of effect of pain on falling asleep in the experimental group after receiving the pain management program were statistically significantly lower than the scores in the control group (p < .05). The mean rank score of effects of pain on activity in the experimental group after receiving the pain management program was also statistically significantly lower than in the control group (p < .01). The mean score of ability to participate in decision-making to select pain management strategy in the experimental group was statistically significantly higher than in the control group (p = .000). The mean score of lung vital capacity and the mean rank score of perceived benefit of information given regarding pain management in the experimental group were statistically significantly higher than in the control group (p <.05). The mean rank scores of pain relief and satisfaction on pain management were also statistically significantly higher in the experimental group (p < .01). The mean scores of drowsiness after receiving opioids were not different between the two groups (p > .05). However, the chest trauma patients in the experimental group received statistically significantly more information on pain management, non- pharmacological pain management, and encouragement to use non-pharmacological pain management than the chest trauma patients in the control group (p < .01). Implementation and utilization of this evidence-based pain management program to manage pain in hospitalized chest trauma patients in acute phase is highly recommended to achieve adequate pain management outcomes.