Çocuk Hastaların Ağrısını Değerlendirmede Kanıta Dayalı Uygulama Önerilerine Uyumun Arttırılması İçin Kullanılan Stratejiler

Abstract

Çocuk Hastaların Ağrısını Değerlendirmede Kanıta Dayalı Uygulama Önerilerine Uyumun Arttırılması İçin Kullanılan Stratejiler 

 

Özet 

Amaç:Bu derlemenin amacı, hemşirelerin, çocuk hastaların ağrısını değerlendirmede kanıta dayalı önerileri kullanmalarını sağlamak için uygulanan stratejilerin etkinliğini değerlendirmek üzere yayınlanan çalışmaların sonuçlarını incelemektir. Gereç ve Yöntem: İlgili çalışmalara “Cochrane Library, OVID, EBSCO, PubMed, Elsevier Science Direct” veri tabanlarında tarama yapılarak ulaşılmıştır. Bulgular: Tarama sonucunda yedi çalışma incelemeye alınmıştır. Kanıta dayalı uygulama rehberinin kullanımı ve yararları hakkında sağlık profesyonellerine grup eğitimi verilmesi en yaygın kullanılan profesyonel stratejidir. Organizasyonel yapıda değişim, kalite iyileştirme ve/veya performans ölçüm sistemlerinde değişim en çok kullanılan örgütsel stratejiler arasında yer almaktadır. Çocuk hastaların ağrılarının değerlendirilmesinde, uygulanan stratejilerden sonra; ağrı değerlendirme oranı %13 ile %30 arasında, tekrar değerlendirme oranı ortalama %4.25 ile %30 arasında artmıştır. Sonuç: Çocuk hastaların ağrı değerlendirmesinde kanıta dayalı uygulama önerilerinin uygulama alanına aktarılması için farklı stratejiler kullanılmaktadır. Profesyonel ve örgütsel girişimlerin bir arada kullanıldığı stratejiler 

uyumu olumlu yönde artırmaktadır. 

Anahtar Kelimeler:Hemşirelik, çocuk hasta, ağrı değerlendirme, tekrar değerlendirme, rehbere uyum.

 

Strategies on Compliance to Evidence-Based Practice Recommendations Regarding Pain Assessment in Pediatric Patients 

 

Abstract 

Objective: The aim of this review is to analyze the results of studies published to assess the effectiveness of strategies applied to ensure that nurses use evidence-based recommendations to assess the pain in pediatric patients. Material and Methods: The related studies were accessed by screening the databases of “Cochrane Library, OVID, EBSCO, PubMed and Elsevier Science Direct”. Findings: As a result of the screening, seven studies were reviewed. Providing group training for health professionals on the use and benefits of the evidence-based practice guidelines is the most widely used professional strategy. Alterations in the organizational structure, in quality improvement and / or performance measurement systems are among the most used organizational strategies. After the implementation of the strategies, in the assessment of pediatric patients’ pain, the pain assessment rate increased between 13% and 30%, and the re-assessment rate increased between 4.25% and 30% on average. Conclusion: In the assessment of 

pediatric patients’ pain, different strategies are used to put evidence-based practice recommendations into practice. Strategies in which professional and organizational interventions are used together contribute to compliance positively. 

Keywords: Nursing, child patient, pain assessment, re-evaluation, compliance to guidelines.

Keywords

• Hemşirelik,çocuk hasta,ağrı değerlendirme,tekrar değerlendirme,rehbere uyum

References

1. Agency of Health Care Policy and Quality-AHCPQ. Acute pain management infants, children and adolescents: operative and medical procedures. Clinical Practice guideline. 1995. AHCPR, Publication no92-0020.
2. Rockville, MD:AHCPR. American Pain Society. (1995). Quality improvement guidelines for the treatment of acute and cancer pain.American Pain Society Quality of Care Commitee. Journal of the American Medical Association, 274(3):1874-1880.
3. Ang, E. & Chow, Y.L. (2010). General pain assessment among patients with cancer in an acute care setting: a best practice implementation project. International Journal of Evidence Based Healthcare, 8(2), 90-6.
4. Batalden, P.B. & Stoltz, P.K. (1993). A framework for the the continual improvement of healthcare: building and applying professional and improvement knowledge to test change in daily work. The Joint Commission Journal on Quality Improvement, 19, 424-447. Bucknall, T., Manias, E., & Botti, M. (2001). Acute pain management: implications of scientific evidence for nursing practice in the postoperative context. International Journal of Nursing Practice, 7, 266-273.
5. Carlson, C. (2010). Use of Three Evidence-Based Postoperative Pain Assessment Practices by Registered Nurses. Pain Management Nursing, 10(4), 174-187.
6. Chaudhry, B., Wang, J., Wu, S., Maglione, M., Mojica, W., Roth E. et al. (2006). Systematic Review: Impact of Health Information Technology on Quality, Efficiency, and Costs of Medical Care. Annals of Internal Medicine, 144, 742-752.
7. Czarnecki, M.L., Simon, K., Thompson, J.J., Armus, C.L., Hanson T.C., Berg K.A, et al. (2011). Barriers to pediatric pain management: A nursing perspective. Pain Management Nursing,12(3), 154–162.
8. Dulko, D., Hertz, E., Julien, J., Beck, S., & Mooney, K. (2010). Implementation of cancer pain guidelines by acute care nurse practitioners using an audit and feedback strategy. Journal of the American Academy of Nurse Practitioners, 22(1), 45–55.

9. Duncan, K. & Pozehl, B. (2001). Effects of Individual Performance Feedback on Nurses’ Adherence to Pain Management Clinical Guidelines. Outcomes Management for Nursing Practice, April/June, 5(2), 57-62.
10. Ekim, A. & Ocakçı, A.F. (2013). Knowledge and attitudes regarding pain management of pediatric nurses in Turkey, Pain Management,1-6.
11. Ellis, J.A., McCleary, L., Blouin, R., Dube, K., Rowley, B., MacNeil, M, et al. (2007). Implementing best practice pain management in a pediatric hospital. Journal for Specialists in Pediatric Nursing, 12(4), 264–277.
12. Estabrooks, C.A., Hutchinson, A.M., Squires, J.E., Birdsell, J., Cummings, G.C., Degner, L, et al. (2009). Translating research in elder care: an introduction to a study protocol series. Implementation Science,4:51, 1-18.
13. Finley, G.A., Forgeron, P., & Arnaout, M. (2008). Action Research: Developing a Pediatric Cancer Pain Program in Jordan. Journal of Pain and Symptom Management, 35, 447-454.
14. Flodgren, G., Rojas-Reyes, M.X., Cole, N., & Foxcroft, D.R. (2012). Effectiveness of organisational infrastructures to promote evidence-based nursing practice. Cochrane Database Systematic Reviews,(CD000125).
15. Franck, L. & Bruce, E. (2009). Putting pain assessment into practice: Why is it so painful? Pain Research Management, 14, 13–20.
16. Frasco, P.E., Sprung, J., & Trentman, T.L. (2005). The impact of the joint commission for accreditation of healthcare organizations pain initiative on perioperative opiate consumption and recovery room length of stay. Anesthesia and Analgesia, 100, 162–168.
17. Forsetlund, L., Bjorndal, A., Rashidian, A., Jamtvedt, G., O’Brien, M.A., Wolf, F, et al. (2009). Continuing education meeting and workshops: effects on professional practice and healthcare outcomes. Cochrane Database Systematic Reviews (2), (CD003030).
18. Grimshaw, J.M., Eccles, M., Lavis, M., Hill, S., & Squires, J. (2012). Knowledge translation of research findings. Implementation Science, 7(50), 1-17.
19. Grimshaw, J.M., Thomas, R.E., MacLennan, G., Fraser, C., Ramsay, C.R., Vale, L, et al. (2004). Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technology Assessment, 8(6), 1–72.
20. Grol, R. & Grimshaw, J. (2003). From best evidence to best practice: effective implementation of change in patients’ care. Lancet, 362(9391), 1225–1230.
21. Habich, M., Wilson, D., Thielk, D., Melles, G.L., Crumlett, H.S., Masterton, J, et al. (2011). Evaluating the Effectiveness of Pediatric Pain Management Guidelines. Journal of Pediatric Nursing,1-10.
22. Ista, E., Dijk, M., & Achterberg, T. (2013). Do implementation strategies increase adherence to pain assessment in hospitals? A systematic review. International Journal of Nursing Studies,50, 552–568.
23. Johnston, C.C., Gagnon, A., Rennick, J., Rosmus, C., Patenaude, H., Ellis, J, et al. (2007). One-on-one coaching to improve pain assessment and management practices of pediatric nurses. Journal of Pediatric Nursing, 22(6), 467–478.
24. Joint Commission on Accreditation of Healthcare Organizations. Pain Assessment and Management: An Organizational Approach. Oakbrook Terrace: Joint Commission Resources, 2001.
25. Jordan-Marsh, M., Hubbard, J., Watson, R., Deon-Hall, R., Miller, P., & Mohan, O. (2004). The social ecology of changing pain management: do I have to cry? Journal of Pediatric Nursing, 19(3), 193–203.
26. Lago, P., Guadagni, A., Merazzi, D., Ancora, G., Bellieni, C.V., & Cavazza, A. (2005) Pain management in the neonatal intensive care unit: anational survey in Italy. Pediatric Anesthesia, 15, 925–931
27. Leasure, A.R., Stirlen, J., & Thompson, C. (2008). Barriers and facilitators to the use of evidence-based best practices. Dimensions of Critical Care Nursing, 27(2), 74-82.
28. Malek, C. & Oliveri, R.J. (1999). Pain management: documenting the decision making process. Nursing Case Management,1, 64-74.
29. Mazza, D., Bairstow, P., Buchan, H., Chakraborty, S., Hecke, O., Grech, C, et al. (2013). Refining a taxonomy for guideline implementation: results of an exercise in abstract classification. Implementation Science, 8(32), 1-10.
30. Needleman, J. & Hassmiller, S. (2009). The role of nurses in improving hospital quality and efficiency: real world results. Health Affairs. 28(4), 625-633.
31. Niederhauser, V.P. & Kohr, L. (2005). Research endeavors among pediatric nurse practioners study. The Journal of Pediatric Health Care, 19, 80-89.
32. Oakes, L.L., Anghelescu, D.L., Windsor, K.B., & Barnhill, P.D. (2008). An institutional quality improvement initiative for pain management for pediatric cancer inpatients. Journal of Pain and Symptom Management, 35(6), 656–669.
33. Oxman, A.D., Thomson, M.A., Davis, D.A., & Hayes, J.E. (1995). No magic bullets: A systematic review of 102 trials of interventions to improve professional practice. Canadian Medical Association Journal,153, 1423-1431.
34. Özer, S., Akyürek, B., & Başbakkal, Z. (2005). Hemşirelerin ağrı ile ilgili bilgi, davranış ve klinik karar verme yeteneklerinin incelenmesi. Ağrı, 18(4), 36-43.
35. Q’Brien, M.A., Rogers, S., Jamtvedt, G., Oxman, A.D., Odgaard, J.J., Kristoffersen, D.T, et al. (2007). Educational outreach visits: effects on professional practice and health care outcomes. The Cochrane Database of Systematic Reviews, (CD000409).Registered Nurses Association of Ontario (RNAO) Nursing best practice guideline. Assessment and management of pain. Revised, 2007. http://rnao.ca/sites/rnao-ca/files/AssessAndManagementOfPain2007.pdf. Erişim tarihi:12.03.2012.
36. Registered Nurses Association of Ontario (RNAO) Nursing best practice guideline. Assessment and management of pain. Revised, 2009. http://rnao.ca/sites/rnao-ca/files/ Assess And Management Of Pain 2009.pdf. Erişim tarihi:12.03.2012.
37. Royal College of Nursing (RCN). The recognition and assessment of acute pain in children Recommendations: revised. London: RCN Publishing, 2009.
38. Scott-Findlay, S. & Estabrooks, C. A. (2006). Knowledge translation and pain management. In G. Finley, P. McGrath, & C. Chambers (Eds.), Bringing Pain Relief to Children (pp. 199-226). New Jersey: Humana Press.
39. Shrestha-Ranjit, J.M., & Manias, E. (2010). Pain assessment and management practices in children following surgery of the lower limb. Journal of Clinical Nursing,19, 118–128.
40. Solberg, I.L., Brekke, L.M., Fazio, J.C., Jacobsen, N.D., Fowles, J., Kottke, E.T, et al. (2000). Lessons from experienced guideline implementers: Attend to many factors and use multiple strategies. Journal on Quality Improvement, 26(4), 171–188.
41. Stevens, B., Yamada, J., Estabrooks, C.A., Stinson, J., Campbell, F., Scott, S, et al. (2013). Pain in hospitalized children: Effect of a multidimensional knowledge translation strategy on pain process and clinical outcomes. Pain, 155, 60-68.
42. Taylor, E.M., Boyer, K., & Campbell, F.A. (2008). Pain in hospitalized children: A prospective cross-sectional survey of pain prevalence, intensity, assessment and management in a Canadian pediatric teaching hospital. Pain Research and Management, 13(1), 25–32.
43. Treadwell, M.J., Franck, L.S., & Vichinsky, E. (2002). Using quality improvement strategies to enhance pediatric pain assessment. International Journal for Quality in Health Care, 14(1), 39–47.