Wann und wie berücksichtigen Intensivpflegende Schmerz im Behandlungsprozess von Patientinnen und Patienten auf der Intensivstation?
Eine qualitative Studie
Abstract
Zusammenfassung. Hintergrund: Das Schmerzmanagement ist bedeutend im Therapiespektrum der Intensivstation, doch Leitlinienempfehlungen werden nicht konsequent umgesetzt. Strategien der klinischen Argumentation und Entscheidungsfindung in Bezug auf Schmerz sind kaum beschrieben. Fragestellung und Ziel: Geleitet von der Frage „Wann und wie berücksichtigen Intensivpflegende Schmerz im Behandlungsprozess von Patientinnen und Patienten mit Bewusstseins- und kognitiven Einschränkungen?“ wollten wir deren Denk- und Handlungsmuster im Schmerzmanagement explorieren. Methode: Im Rahmen eines Mixed Methods-Forschungsprogramms zum Schmerzassessment bei nicht auskunftsfähigen Intensivpatientinnen und -patienten führten wir eine Sekundäranalyse von Daten aus der qualitativen Teilstudie mittels qualitativer Inhaltsanalyse nach Mayring durch. Ergebnisse: Schmerz spielt im Behandlungsprozess eine wichtige, aber untergeordnete Rolle. Nachdem primär Vitalfunktionen stabilisiert sind, prüfen Intensivpflegende Bewusstsein und Kognition, um von der Patientin bzw. vom Patienten Informationen zu erhalten. Intensivpflegende differenzieren dann zwischen Schmerz, Angst, Stress und Unwohlsein. Sie stützen ihre Entscheidung auf Erfahrung und Intuition. Schlussfolgerung: Fortbildungen fördern Wissen und Bewusstsein der Intensivpflegenden zum Schmerzmanagement. Fremderfassungsinstrumente für Schmerz bieten valide Informationen. Sie unterstützen ein analytisches Vorgehen und damit den Kompetenzaufbau in der klinischen Argumentation und Entscheidungsfindung.
Abstract. Background: Pain management is important in the therapeutic spectrum of the intensive care unit. However, guideline recommendations are not consistently implemented. Strategies in clinical reasoning and decision-making regarding pain are hardly described. Aim: Guided by the question “When and how do intensive care nurses consider pain in the treatment process of patients with impaired consciousness and cognition?”, we wanted to explore their patterns of thought and decision-making in the context of pain management. Methods: As part of a Mixed Methods research program on pain assessment in nonverbal intensive care patients we performed a secondary analysis of data from the qualitative substudy using qualitative content analysis according to Mayring. Results: Pain plays an important but subordinate role in the treatment process. After vital functions have been initially stabilized, intensive care nurses assess patients’ consciousness and cognition in order to receive further information directly from them. Intensive care nurses differentiate between pain, anxiety, stress and discomfort. Their decisions are based on experience and intuition. Conclusions: Education promotes intensive care nurses’ knowledge and awareness in pain management. Observational pain assessment instruments provide valid information. They support an analytical approach and thus the development of competence in clinical reasoning and decision-making.
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