Hemşireler İle Hastaların Ağrı Değerlendirmesi Arasındaki Uyumlarının ve Hemşirelerin Ağrı İnanışlarının Belirlenmesi

Abstract

Amaç: Hemşireler ile hastaların ağrı değerlendirmeleri arasındaki uyumun ve hemşirelerin ağrı inançlarının belirlenmesidir. Gereç ve Yöntem: Tanımlayıcı tipteki araştırma, 150 travma hastası ve bu hastalara bakım veren13 hemşire ile Ekim 2018-Mayıs 2019 tarihlerinde gerçekleştirilmiştir. Veriler, Tanıtıcı Bilgiler Formu, Ağrı İnançları Ölçeği (AİÖ), Visual Analog Skala (VAS) ve Ağrı Takip Formu ile toplanmıştır. Tanımlayıcı istatistikler, t testi, ANOVA, Paired Sample t test, Pearson Korelasyon testi ve Intraclass Correlation Coefficient (ICC) testleri ile veriler analiz edilmiştir. Bulgular: Hastaların ve hemşirelerin ortalama ağrı şiddeti 1. günde en yüksek düzeyde saptanmış ve izleyen günlerde istatistiksel olarak anlamlı bir azalma göstermiştir (p<0.001). Hemşire-hasta ağrı değerlendirmeleri arasındaki uyum yüksek olmakla birlikte (ICC: 0.81–0.98; p<0.001), hastaların bildirdiği ağrı puanının hemşirelerin bildirdiği ağrı puanından fazla olduğu saptanmıştır. Hemşirelerin AİÖ Organik İnançlar (AİÖ-Oİ) puan ortalamasının 3.17±1.05, Psikolojik İnançlar (AİÖ-Pİ) puan ortalamasının 2.40±0.33 olduğu, AİÖ-Oİ ile AİÖ-Pİ arasında pozitif bir ilişkinin olduğu saptanmıştır. Sonuç: Hastalarda en şiddetli ağrının 1. günde olduğu ve zamanla giderek azaldığı, ağrı değerlendirmesinde hasta-hemşire uyumunun yüksek olduğu ancak hemşirelerin hastalara göre ağrıyı daha düşük değerlendirdiği ve hemşirelerin ağrı inançlarının daha çok organik kökenli olduğu saptanmıştır.

Keywords

• Ağrı
• Ağrı Değerlendirmesi
• Hemşire
• İnanç
• Travma

Determination of the Congruence Between Nurses and Patients' Pain Assessment and Nurses' Pain Beliefs

Abstract

Aim: To determine the consistency between nurses' and patients' pain assessments and to identify nurses' beliefs about pain. Materials and Methods: This descriptive study was conducted between October 2018 and May 2019 with 150 trauma patients and 13 nurses caring for these patients. Data were collected using the Demographic Information Form, Pain Beliefs Scale (PBS), Visual Analog Scale (VAS), and Pain Follow-up Form. Data were analyzed using descriptive statistics, t-test, ANOVA, Paired Sample t-test, Pearson Correlation test, and Intraclass Correlation Coefficient tests. Results: The average pain intensity of patients and nurses was found to be highest on day 1 and showed a statistically significant decrease on the following days (p<0.001). Although the agreement between nurse and patient pain assessments was high (ICC: 0.81–0.98; p<0.001), it was found that patients reported higher pain scores than nurses. The mean PBS Organic Beliefs (PBS-OB) score for nurses was 3.17±1.05, and the mean Psychological Beliefs (PBS-PB) score was 2.40±0.33. A positive correlation was found between PBS-OB and PBS-PB. Conclusion: It was determined that the most severe pain in patients occurred on the first day and gradually decreased over time, that patient-nurse agreement in pain assessment was high but nurses rated pain lower than patients, and that nurses' beliefs about pain were more organic in origin.

Keywords

• Beliefs
• Nurse
• Pain
• Pain Assessment
• Trauma

References

1. 1. Tura İ, Erden S. Travma ağrısının kontrolü: Multimodal analjezi ve hemşirenin rolleri. Selçuk Sağlık Dergisi. 2021;2(2):151-167
2. 2. O’Hara NN, Isaac M, Slobogean GP, Klazinga NK. The socio economic impact of orthopaedic trauma: A systematic review and meta-analysis. PLoS One. 2020 Jan; 15(1):e0227907. doi:10.1371/journal.pone.0227907
3. 3. Prastika D, Kitrungrote L, Damkliang J. Pain-management strategies among hospitalized trauma patients: A preliminary study in a teaching hospital in Indonesia. Enfermería Clínica. 2018; 28(1):158-161. doi: 10.1016/S1130-8621(18)30058-5.
4. 4. Nischal N, Arulraja E, Shaheen SP. Pain management for orthopedic injuries. Emerg Med Clin North Am. 2020 Feb; 38(1):223-241. doi:10.1016/j.emc.2019.09.013
5. 5. Accardi-Ravid MC, Dyer JR, Sharar SR, Wiechman S, Jensen MP, Hoffman HG, Patterson DR. The nature of trauma pain and its association with catastrophizing and sleep. Int J Behav Med. 2018 Dec;25(6):698-705. doi: 10.1007/s12529-018-9751-y.
6. 6. Alavi NM, Aboutalebi MS, Sadat Z. Pain management of trauma patients in the emergency department: A study in a public hospital in Iran. Int Emerg Nurs. 2017 Jul;33:53-58. doi:10.1016/j.ienj.2016.10.005
7. 7. Firouzian A, Baradari AG, Alipour A, Zeydi AE, Kiasari AZ. Emadi SA. Kheradmand B, Hadadi K. Ultra–low-dose naloxone as an adjuvant to patient controlled analgesia (PCA) with morphine for postoperative pain relief following lumber discectomy: A double-blind, randomized, placebo-controlled trial. J Neurosurg Anesthesiol. 2018 Jan; 30(1):26–31.doi: 10.1097/ANA.0000000000000374.
8. 8. Wooldridge S, Branney J. Congruence between nurses’ and patients’ assessment of postoperative pain: A literatüre review. Br J Nurs. 2020 Feb;29(4):212-220. doi:10.12968/bjon.2020.29.4.212.

9. 9. Sucu Çakmak NC, Çalışkan N. Comparison of pain pain assessments made by patients and nurses in emergency services. Int J Human Sci. 2020;17(3):864-876. doi:10.14687/jhs.v17i3.5889
10. 10. Yıldırım M, Çizmeciyan ES, Kaya G, Başaran Z, Karaman FŞ, Dursun S. Perceptions of pain levels among orthopedic surgery patients, their relatives, and nurses. Agri. 2015;27(3):132-138. doi: 10.5505/agri.2015.50103
11. 11. Özveren H, Faydalı S, Gülnar E, Faydalı Dokuz H. Hemşirelerin ağrı değerlendirmesine ilişkin tutum ve uygulamaları. J Contemp Med. 2018; 8(1):60-66. doi: 10.16899/gopctd.388195.
12. 12. Dequeker S, Van Lancker A, Van Hecke A. Hospitalized patients’ vs. nurses’ assessments of pain intensity and barriers to pain management. J Adv Nurs. 2018 Jan; 74(1):160-171. doi:10.1111/jan.13395.
13. 13. Ruben MA, van Osch M, Blanch-Hartigan D. Health care providers’ accuracy in assessing patients’ pain: A systematic review. Patient Educ Couns. 2015 Oct; 98(10):1197-1206. doi:10.1016/j.pec.2015.07.009.
14. 14. Yang YE, Xiong C, Xia L, Kang SS. Jian JJ, Yang XQ., Chen L, Wang Y, Yu JJ, Xu XZ. Consistency of postoperative pain assessments between nurses and patients undergoing enhanced recovery after gynecological surgery. J Clin Nurs. 2020 Apr;29(7-8):1323-1331. doi: 10.1111/jocn.15200
15. 15. Nasir M, Ahmed A. Knowledge about postoperative pain and its management in surgical patients. Cureus. 2020 Jan;17;12(1): e6685. doi: 10.7759/cureus.6685.
16. 16. Giusti GD, Reitano B, Gili A. Pain assessment in the emergency department. Correlation between pain rated by the patient and by the nurse. An observational study. Acta BioMed. 2018 Feb;27:89(4-S):64-70. doi: 10.23750/abm.v89i4-S.7055.
17. 17. Latina R, Mauro L, Mitello L, D’Angelo D, Caputo L, De Marinis MG, Sansoni J, Fabriani L, Baglio G. Attitude and knowledge of pain management among Italian nurses in hospital settings. Pain Manag Nurs. 2015 Dec; 16(6):959–967. doi:10.1016/j.pmn.2015.10.002.
18. 18. Lidén Y, Olofsson N, Landgren O, Johansson E. Pain and anxiety during bone marrow aspiration/biopsy: Comparison of ratings among patients versus health-care professionals. Eur J Oncol Nurs. 2012 Jul;16(3):323-329. doi: 10.1016/j.ejon.2011.07.009.
19. 19. Pierik JGJ, IJzerman MJ, Gaakeer MI, Berben SA, van Eenennaam FL, van Vugt AB, Doggen CJM. Pain management in the emergency chain: the use and effectiveness of pain management in patients with acute musculoskeletal pain. Pain Med. 2015; 16(5):970-984. doi: 10.1111/pme.12668.
20. 20. Alemdar DK, Aktas YY. Comparison of nurses’ and patients’ assessments of postoperative pain. Int J Caring Sci. 2014;7(3): 882-888.
21. 21. Sertel Berk HÖ. Kronik ağrı yaşantısı ve ağrı inançları: Ağrı İnançları Ölçeği’nin Türkçe geçerlik ve güvenirlik çalışması. İstanbul; İstanbul Üniversitesi Sosyal Bilimler Enstitüsü: 2006. Erişim adresi: https://tez.yok.gov.tr/UlusalTezMerkezi/tezDetay.jsp?id=4lSq_4aK2hvxF9qeg16k2g&no=QRcsJh9HDR0qTRRO0xh0hQ
22. 22. Özdemir Ü, Tokaç Akdeniz A. Kanser hastalarının ağrı inançları ve ilişkili faktörler. Agri. 2023;35(4):244-253. doi: 10.14744/agri.2022.55798
23. 23. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977 Mar; 33(1):159-174.
24. 24. Disceken FM, Kose G. Association of preoperative pain beliefs with postoperative pain levels in abdominal surgery patients. J Clin Nurs. 2021 Nov; 30(21-22):3249-3258. doi:10.1111/jocn.15831.
25. 25. Griffioen MA, Greenspan JD, Johantgen M, Rueden KV, O’Toole RV, Dorsey SG, Renn CL. Acute pain characteristics in patients with and without chronic pain following lower extremity injury. Pain Manag Nurs. 2017 Feb;18(1):33-41. doi:10.1016/j.pmn.2016.10.002
26. 26. Kose G, Izci Y. Congruence of pain assessments between nurses and lumbar spinal surgery patients. Int J Car Sci. 2021;14(1):276-283
27. 27. Turkay Ü, Yavuz A, Hortu İ, Terzi H, Kale A. The impact of chewing gum on postoperative bowel activity and postoperative pain after total laparoscopic hysterectomy. J Obstet Gynaecol. 2020;40(5):705-709. doi: 10.1080/01443615.2019.1652891. 28. López-Alfaro MP, Echarte-Nuin I, Fernández-Sangil P, Moyano-Berardo BM, Goñi-Viguria R. Perception of pain in post-surgical patients in intensive care units. Enferm Intensiva. 2019 Jul-Sep;30(3):99-107. doi: 10.1016/j.enfi.2018.12.001.
28. 29. Erden S, Akçalı D, Bulut H, Babacan A. Cerrahi hemşirelerinin ağrı ve ameliyat sonrası ağrı yönetimine ilişkin bilgi düzeylerinin saptanması: Pilot bir çalışma. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi. 2015;4(1):54-69
29. 30. Martin KD, McBride T, Wake J, Van Buren JP, Dewar C. Comparison of visual analog pain score reported to physician vs nurse in nonoperatively treated foot and ankle patients. Foot Ankle Int. 2018 Dec;39(12):1444-1448. doi: 10.1177/1071100718788507.
30. 31. Daoust R, Paquet J, Piette É, Sanogo K. Bailey B, Chauny JM. Impact of age on pain perception for typical painful diagnoses in the emergency department. J Emerg Med. 2016 Jan;50(1):14-20. doi: 10.1016/j.jemermed.2015.06.074.
31. 32. Baird AJ, Haslam RA. Exploring differences in pain beliefs within and between a large nonclinical (woekplace) population and a clinical (chronic low back pain) population using the pain beliefs questionnaire. Phys Ther. 2013 Dec;93(12):1615-1624. doi:10.2522/ptj.20120429