The Effect Of Doctor-nurse-patient Cooperative Analgesic Linkage Program On Movement Evoked Pain After Laparotomy For Patients With Hepatobiliary And Pancreatic Disease

Objectives:1.To establish doctor-nurse-patient cooperative analgesic linkage program.2.Through clinical application research,to evaluate the effect of doctor-nurse-patient cooperative analgesic linkage program on movement evoked pain after laparotomy for patients with hepatobiliary and pancreatic diseaseMethods:This research was divided into two parts:Part Ⅰ The establishment of doctor-nurse-patient cooperativeanalgesic linkage program1.Based on literature review and clinical investigation results,initially make a doctor-nurse-patient cooperative analgesic linkage program through discussion in experts consensus meeting.2.Using Delphi method,determine the doctor-nurse-patient cooperative analgesic linkage program after two rounds consultation.Part Ⅱ Clinical application study of doctor-nurse-patient cooperative analgesic linkage program.Conduct non-randomized control study in corresponding period.80 patients from two wards which managed by the same medical and nursing team were divided into experimental and control group.Patients in the control group were received routine post-operative analgesia pump and analgesics,and functional rehabilitation,while ones in the experimental group were received doctor-nurse-patient cooperative analgesic linkage program.Observe pain at rest before rehabilitation and movement evoked pain within 3 days after surgery,degree of night pain,the time for first bowel movement,the time for the first ambulation,the process of function rehabilitation,adverse events during rehabilitation,patients’ satisfaction of pain control and nurses’ satisfaction of pain management.Perform statistical analysis by SPSS 21.0 software package.Numeric data were compared byχ2 test and continuous data were compared by t-test,data with abnormal distribution were analyzed by rank-sum test.P<0.05 means statistical difference.Results:1.The doctor-nurse-patient cooperative analgesic linkage program was constructed with 5 first level indicators,14 second level indicators and 21 third level indicators.2.The average of movement evoked pain within 3 days after surgery between two groups was significantly different(P<0.001),movement evoked pain in experimental group was less than control group.The incidence rate of pain above 4 during post-operative rehabilitation was statistically different between two groups(P<0.001),The incidence rate was lower in experimental group.The difference of the average of pain at rest before rehabilitation within 3 days after surgery between two groups was not significantly(P =0.600).3.The progresses of function training from 36hours to 66 hours after surgery were different between two groups(P<0.05).The progress in experimental group was earlier than control group.The types of functional training within 36 hours and beyond 66 hours after surgery were not different significantly(P>0.05).4.Nurses’ satisfaction of pain management were different statistically(P =0.008),satisfaction in experimental group was higher than control group.5.Patients’ satisfaction of pain control were not different significantly between two groups(P>0.05).6.The difference of the time for first bowel movement and the time for first ambulation between two groups were not statistically significant(P>0.05).7.Accompanying symptoms during rehabilitation,such as nausea and vomiting,were not different between two groups(P>0.05).8.Age,gender,diagnosis,length of surgery,the size of incision,local anesthesia of incision,the experience of pain,type of anesthesia and dosage of analgesics were the same between two groups(P>0.05).Conclusion:1.The doctor-nurse-patient cooperative analgesic linkage program is scientific,innovative and authoritative.2.Dynastat and Dezocine based doctor-nurse-patient cooperative analgesic linkage program is helpful for reducing movement evoked pain after laparotomy for patients with hepatobiliary and pancreatic disease and promoting progress of rehabilitation.3.The doctor-nurse-patient cooperative analgesic linkage program increase nurses’satisfaction of pain management.4.The doctor-nurse-patient cooperative analgesic linkage program is effective,safe and convenient to implement,and it will not increase economic input,so that it can be applied to other hospitals.