치매 환자의 통증관리를 위한 근거중심 실무지침 개발 및 효과검증

Abstract

Purpose: This study aimed to develop evidence-based nursing practice guidelines for pain management in patients with dementia and to verify their effects.

Methods: Guidelines were developed according to the Clinical Practice Guideline Adaptation Manual. Additionally the quality of six guidelines was evaluated using the AGREE (Appraisal of Guidelines for Research & Evaluation) tool. Subsequently, the guidelines were translated into Korean and a preliminary set of guidelines was established. After a group of experts confirmed the content validity of the guidelines, the Korean version was applied to clinical settings for 4 weeks, to examine their applicability. Data was collected from April to August 2017. The dependent variables were nurses' knowledge and attitudes about pain management in patients with dementia, pain assessment frequency, use of pharmacological and nonpharmacological intervention to reduce pain, and subjective and objective pain scores of patients with dementia. Data were analyzed using an independent t-test, Mann-Whitney U test, Wilcoxon Signed Ranks test, and analysis of covariance with SPSS/WIN 22.0.

Results: Nurses in the experimental group had a higher degree of knowledge and more positive attitudes regarding pain management, and they reported a higher frequency of pain assessment as compared to those in the control group. As compared to patients in the control group, those in the experimental group had more days of regular treatment with analgesics and were provided with a higher analgesics dose as well as more frequently received physical and relaxation therapies. The two groups did not show significant differences in subjective and objective pain scores.

Conclusion: The present findings indicates that the evidence-based guidelines for pain management developed in this study were effective in helping nurses and patients with dementia to resolve their pain for which they were currently seeking treatment.