护士对非交流重症患者疼痛管理的认知：现象学研究

IF 1.1 Q3 NURSING

Enfermeria Intensiva Pub Date : 2025-07-03 DOI:10.1016/j.enfi.2025.500560

Gemma Robleda RN, MSc, PhD , Marta Benet PT, MPH, PhD , Helena Cebrià-Fondevila MD , Xavier Robleda-Font BA, MSc , Olga Canet-Vélez RN, MSc, PhD , Josep-Eladi Baños MD, PhD

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引用次数: 0

摘要

尽管伦理原则和护理标准旨在确保适当的疼痛管理，不适当的疼痛治疗是常见的。目的探讨ICU护士对非沟通重症患者疼痛管理的信念、态度和伦理观点，重点探讨善、无害、自主和公正的生物伦理原则的应用。方法定性研究采用描述现象学方法。我们通过有目的抽样，对11名具有3年以上ICU工作经验的护士进行了半结构化访谈。将主题元素和内容元素结合起来进行分析。我们医院的伦理委员会批准了这项研究，所有的参与者都提供了书面的知情同意书。发现护士对非交流患者疼痛管理的信念、态度和伦理观点分为15类。沟通型和非沟通型患者管理的不公平主要源于专业人员的敏感度不足、管理非沟通型患者的挑战和个人信仰。护士报告了在管理非交流患者的疼痛方面的重大伦理困境，突出了在充分应用仁慈、非恶意和正义原则方面的挑战。研究结果表明，疼痛往往被低估和治疗不足，部分原因是误解、高工作量和疼痛评估工具的可变性。参与者还表示，自主权经常被忽视，因为决策往往没有患者或家人的参与。时间不足和工作量大等制度因素被确定为公平疼痛管理的障碍，限制了生物伦理原则的一致应用。结论：结果强调需要标准化的ICU疼痛评估方案，包括经过验证的非语言工具，以及持续的道德决策培训和疼痛管理。更好的制度支持，包括更明确的指导方针和改进的资源分配，可以帮助ICU护士提供更一致的、合乎道德的、以患者为中心的护理，解决公正、仁慈、无害和自主的生物伦理原则。

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Nurses’ perceptions of pain management in non-communicative critically ill patients: A phenomenological study

Background

Despite ethical principles and standards of care aiming to ensure proper pain management, inadequate pain treatment is common.

Aim

To explore ICU nurses’ beliefs, attitudes, and ethical perspectives regarding pain management in non-communicative critically ill patients, focusing on applying the bioethical principles of beneficence, non-maleficence, autonomy, and justice.

Methods

This qualitative study used descriptive phenomenology. We conducted semi-structured interviews with 11 nurses with ≥3 years’ ICU experience selected through purposive sampling. Thematic and content elements were combined for the analysis. Our hospital's ethics committee approved the study, and all participants provided written informed consent.

Findings

Nurses’ beliefs, attitudes, and ethical perspectives regarding pain management in non-communicative patients into 15 categories. Inequities in managing communicative and non-communicative patients arose mainly from professionals’ inadequate sensitivity, challenges of managing non-communicative patients, and personal beliefs. Nurses reported significant ethical dilemmas in managing pain of non-communicative patients, highlighting challenges in adequately applying principles of beneficence, non-maleficence, and justice. Findings indicate pain is often under-assessed and undertreated, partly due to misconceptions, high workload, and variability in pain assessment tools. Participants also expressed autonomy is frequently overlooked, as decisions are often made without patient or family input. Institutional factors like insufficient time and heavy workload, were identified as barriers to equitable pain management, limiting the consistent application of bioethical principles.

Conclusions

Results underscore the need for standardized ICU pain assessment protocols incorporating validated non-verbal tools, alongside ongoing ethical decision-making training and pain management. Better institutional support, including clearer guidelines and improved resource allocation, could help ICU nurses deliver more consistent, ethical, and patient-centered care, addressing bioethical principles of justice, beneficence, non-maleficence, and autonomy.

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来源期刊

Enfermeria Intensiva NURSING-

CiteScore

2.50

自引率

23.10%

发文量

期刊介绍： Enfermería Intensiva es el medio de comunicación por antonomasia para todos los profesionales de enfermería españoles que desarrollan su actividad profesional en las unidades de cuidados intensivos o en cualquier otro lugar donde se atiende al paciente crítico. Enfermería Intensiva publica cuatro números al año, cuyos temas son específicos para la enfermería de cuidados intensivos. Es la única publicación en español con carácter nacional y está indexada en prestigiosas bases de datos como International Nursing Index, MEDLINE, Índice de Enfermería, Cuiden, Índice Médico Español, Toxline, etc.