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2009, vol. 66, br. 2, str. 156-162
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Procena kvaliteta zdravstvene nege u tretmanu akutnog postoperativnog bola
Assessment of quality of care in acute postoperative pain management
aUniverzitet u Novom Sadu, Medicinski fakultet bVojnomedicinska akademija, Beograd cKlinički centar Vojvodine, Novi Sad dInstitute for public health of Vojvodina, Novi Sad
e-adresa: milutind@uns.ns.ac.yu
Sažetak
Uvod/cilj. Značajan interes za sve hospitalne ustanove trebalo bi da bude rešavanje akutnog postoperativnog bola kao jednog od ključnih pokazatelja zadovoljstva bolesnika, kvaliteta zdravstvene nege i ishoda lečenja. Cilj ovog rada bio je da se izvrši procena kvaliteta zdravstvene nege u tretmanu akutnog postoperativnog bola i utvrde faktori koji utiču na procenu istog od strane bolesnika. Metode. Istraživanje je sprovedeno na uzorku od 135 bolesnika hospitalizovanih na hirurškim klinikama Kliničkog centra Vojvodine u Novom Sadu u obliku studije preseka, anketiranjem bolesnika drugog postoperativnog dana i prikupljanjem sociodemografskih podataka, vrste hirurškog zahvata i primenjene analgetičke terapije iz medicinske dokumentacije. Kao instrument istraživanja korišćen je modifikovani upitnik Strateški i klinički pokazatelji kvaliteta tretmana postoperativnog bola (Strategic and Clinical Quality Indicators in Postoperative Pain Management - SCQIPP). Podaci su obrađeni multivarijantnom analizom varijanse (MANOVA), Royovim testom i Piersonovim koeficijentom kontingencije. Rezultati. Prosečan skor na pojedinačnim obeležjima SCQIPP upitnika kretao se od 2 do 4,7 (veći skor označavao je bolji kvalitet nege), a procenat odgovora bolesnika 'potpuno se slažem' varirao je od 4,4% do 77%. Bolesnici su dali najmanje pozitivnih odgovora na obeležje 'Da bi procenili jačinu bola, neko od osoblja me je najmanje jednom ujutro, posle podne i uveče molio da pokažem broj od 0-10'. Većina bolesnika (57%) su najjači bol u prethodna 24 sata ocenili kao umereno jak bol, što je značajno više od broja bolesnika, koji su se žalili na jak ili blag bol (p < 0,001). Analiza ocena bolesnika (MANOVA p < 0,05 i diskriminativna p < 0,05) ukazala je na značajnu razliku između procene kvaliteta zdravstvene nege u zbrinjavanju akutnog postoperativnog bola u odnosu na kliniku kao mesto zbrinjavanja bola, pol bolesnika i njegova očekivanja. Ocene iz supskale 'komunikacija' najviše su doprinosile razlici između posmatranih klinika, a ocene iz supskale 'postupak' razlici među polovima bolesnika u proceni kvaliteta nege. Zaključak. Rezultati ove studije pružaju korisne dokaze i identifikuju aspekte zdravstvene nege u zbrinjavanju akutnog postoperativnog bola koje treba poboljšati. Na osnovu rezultata testa najbolji način poboljšanja zdravstvene nege bio bi redovna procena jačine bola i provera analgetskog učinka datih lekova.
Abstract
Background/Aim. Managing of acute postoperative pain should be of great interest for all hospital institutions, as one of the key components of patients satisfaction, which indicates quality, as well as the outcome of treatment. The aim of this study was to assess the quality of nursing care in managing acute postoperative pain and to establish factors which influence patients assessment of the same. Method. The investigation was conducted on the sample of 135 patients hospitalized in surgical clinics of the Clinical center of Vojvodina in Novi Sad in the form of cross-sectional study, by interviewing patients during the second postoperative day and collecting sociodemographic variables, type of surgical procedure and applied analgesic therapy which were taken from their medical documentation. The modified questionnaire of the Strategic and Clinical Quality Indicators in Postoperative Pain Management (SCQIPP) was used as the instrument of the investigation. The data were processed with suitable mathematical statistics methods such as multivariate analyzes of variance (MANOVA), discriminative and other parametric procedures and methods. Roy's test, Pearson's coefficient contingency (χ), multiple correlation coefficient (R) were conducted amongst other invariant procedures. Results. The mean score for the individual items of SCQIPP questionnaire was between 2.0 and 4.7 (scale range 1-5) and the percentage of patients answers 'strongly agree' ranged from 4.4 to 77%. The smallest number of positive answers were given by the patients for the item 'In order to assess pain intensity, some of the staff asked me at least once in the morning, in the afternoon and in the evening to show the number from 0-10'. Most of the patients (57%) evaluated severe pain during the previous 24 hours, as moderate pain, which represents significantly greater number of patients which complain of severe pain and mild pain (p < 0.001). The analysis of patients evaluation (MANOVA p < 0.05 and discriminative p < 0.05) indicates the existence of significant difference between the assessment of nursing care quality in managing acute postoperative pain as regards to clinics as the place for pain management, patient's sex and his expectations. Evaluation from 'communication' subscale gives the greatest contribution (24.9%) to the difference between the observed clinics, and the greatest contribution (25.7%) to the difference in evaluation of nursing care quality as regards to patients' sex has the evaluations from 'procedure' subscale. Conclusion. The results of this study show a useful evidence and identify aspects of nursing care in postoperative management of acute pain which are still to be improved. According to the patients' answers the priority should be given to a regular assessment of the intensity of postoperative pain and evaluation of the effects of analgesic therapy.
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