간호사와 의사의 악성종양성 통증관리 실태 = Survey on the Management of Cancer Pain in Nurses and Physcians

국문 초록 (Abstract)

목적 : 본 연구는 암환자의 통증사정과 관리에 대한 간호사와 의사의 지식을 파악하고 실제로 통증사정과 관리를 위해 실시한 방법을 분석하므로써 간호사와 의사를 위한 악성종양성 통증관리 교육프로그램 개발의 기초자료를 제공하기 위한 것이다.
대상 및 방법 : 연구대상은 대구시내 2개 종합병원에 근무하는 간호사 136명, 수련의사 46명이었으며 자료수집기간은 1995년 12월부터 1996년 3월까지였고 설문지를 사용하여 조사하였다. 연구도구는 June Dahl, McCaffery 등의 기존도구에 실제 수행하고 있는 통증사정과 관리에 대한 개방식 질문내용을 첨가하여 사용했으며 자료분석은 SAS program에 의해 두 집단간의 X^2 test를 하였다.
결과 : 암환자는 진단초기이던 진행된 상태이던 통증호소율이 상당히 높았다. 악성종양성 통증은 암자체로 인하며 통증을 가장 정확히 판단하는 사람은 환자자신이라고 하면서도 환자의 통증호소를 그대로 믿어야 한다는 관점에서는 간호사/의사 모두 지식정도가 낮았다. 또한 수면이나 안정을 통증완화와 동일시하거나 활력증상의 변화를 심한 통증때문으로 간주하는 등 잘못 알고 있었고 진통제사용에 대해서 간호사와 의사 모두가 어느 정도는 과소투약의 문제를 인식하고 있었으나 구강투여의 적절성이나 부작용, 최대용량 사용 시기 및 심리적 의존심 발생확률 등에 대한지식이 상당히 부족하여 마약성 진통제 사용에 대한 지나친 두려움이 있음을 볼 수 있었다. 현재 실무에서의 통증사정은 간호사와 의사 모두 환자행위 관찰을 위주로 하고 있고 통증관리는 대부분 진통제 사용에 의존하고있었다.
결론 : 악성종양성 통증 사정 및 관리에 대한 지식부족이 나타났으며 이로 인한 간호사 의사의 보수적인 태도와 편견이 있었으므로 이를 개선하기 위한 악성종양성 통증관리교육 프로그램을 실시하여 통증을 호소하는 암환자의 삶의 질을 높여야 할 것이다.

다국어 초록 (Multilingual Abstract)

The purpose of this study was to identify the knowledge and the parctice of cancer pain management in nurses and physicians. The subjects were 136 nurses and 46 residents working at two hospitals in Taegue from December, 1995 to march. 1996. The survey was done by self-reported method using questionnaires and data analysis by SAS.
The results were as follows;
1. The rate of patients with pain was 39% by nurses and 42% by physcians perceived at the time of cancer diagnosis. Nurses and physicians reported that the incidence rate of pain was 90% respectively in the cases of advanced cancer. The rate of patients complaining pain during one month or more was 72% by nurses and 75% by physicians.
2. Nurses and physicians knew well the fact that 'pain is due to cancer itself' and 'patient with pain is the best one who judges accurately its intensity'. However, there was low level of such knowledge as that 'cancer pain with treatment is relieved well' and 'medical professional must believe patient's report of pain'.
3. There was prevailed some misconcept like that 'sleep and sedation can be equated with pain relief', 'observable changes in vital sign must be relied upon to verify a patients's statement that he has severe', and 'giving patient placebo is useful test to determine if the pain is real' in most nurses and physicians.
4. Most nurses and physicians responded that 'cancer pain of hospitalized patient is rarely or never relieved'.
5. 56% of nurses and 79.% of physicians agreed in terms of undermedication of cancer pain management. About 50% or more of nurses and physicians showed that 'pain is better controlled when analgesics are administer around the clock'. In terms of oral route as the preferred administration of analgesics, constipation occurred frequently after repeated administration of narcotics, and prognosis less than 24 months as appropriate time to receive maximal doses of analgesics, nurses and physicians didn't know well.
6. Nurses and physicians knew little about the fact that the incidence of psychological dependence as a result of the legimate use of narcotics in cancer pateints with pain was less than 1%. Most of them knew psychological dependence as one of frequent side effects in cancer patients with pain and concerned it with one of their family who receiving narcotics.
7. Few of nurses and physicians knew accurately having patient's request of increasing amounts of analgesia due to increasing pain.
8. At the current practice for pain management, nurses used to administer analgesics(45%) and listening/psychological support/giving good environment(31%) to patients, physicians used to prescribe analgesics(77%) mainly.
9. The behavioral change of patients due to pain was observed as the assessment of pain patients by nurses923%) and physicians(61%).
As the above results, pain was not relieved completely although it was one of frequent symptoms in cancer patients at the clinical setting. Nurses and physicians had lack of knowledge of pain assessment and management. Particularly as the results of knowledge deficit for narcotic medication such as pharmacology, administration, side effect, psychological dependence and prescription about maximal doses, nurses and physicians had misconcepts and did misuse of analgesics besides they had conservative attitudes toward pain assessement and management.
Therefore it is necessary for nurses and physicians to be given an appropriate in-service education for pain management in clinical setting. After this education done for them, it is recommanded evaluative research of education program for improving quality care of cancer patient with pain.