| Sažetak | Uvod: Proceduralna bol je neugodna akutna bol vezana uz brojne dijagnostičke (uzorkovanje krvi u laboratorijskoj dijagnostici, kolonskopija, gastroskopija) i intervencijske postupke (npr. prijevoji kirurških rana i opeklina, vađenje šavova, uzorkovanje acido-baznog statusa), kao i invazivne metode praćenja i liječenja bolesnika (npr. uspostava venskog puta, uvođenje urinarnog katetera, nazogastrične sonde, centralnog venskog i hemodijaliznog katetera i sl.). Ovisno o bolnosti samog postupka, intenzitet proceduralne boli može biti od blage i podnošljive, do jake i neugodne boli koju bolesnici pamte kao izrazito neugodno iskustvo. U bolesnika je redovito praćena prikrivenim strahom koji može rezultirati u njegovoj djelomičnoj ili potpunoj nesuradljivosti. Zbog toga se, u suvremenoj kliničkoj praksi, proceduralna bol nastoji izbjeći pravovremenom pripremom bolesnika uz primjenu premedikacije (tj. anksiolitika) i/ili pre-emptivne analgezije (tj. analgetika). U literaturi postoje podvojena mišljenja o rutinskoj prevenciji proceduralne boli, osobito za kratkotrajne postupke. Međutim, manje je poznata učestalost pozitivnih i negativnih iskustva samih bolesnika nakon bolnih procedura u svakodnevnoj kliničkoj praksi.
Svrha i ciljevi istraživanja: Utvrditi učestalost pozitivnih i negativnih iskustava ispitanika nakon najučestalijih bolnih postupaka u svakodnevnoj kliničkoj praksi, a sa svrhom uvida u opravdanost rutinske prevencije proceduralne boli.
Ispitanici: Istraživanjem je obuhvaćeno 150 odraslih ispitanika, oba spola, različite životne dobi i zanimanja, nakon iskustva s jednim od bolnih postupaka u svakodnevnoj kliničkoj praksi. Ispitanici su bili podijeljeni u dvije skupine: ispitivanu Skupinu P (sa prethodnim iskustvom proceduralne boli) i kontrolnu Skupinu BP (bez iskustva sa proceduralnom boli).
Metode istraživanja: Svi ispitanici su skalom od 1-5 ocijenili svoju osjetljivost na bol, a NMR skalom od 1-10 doživljeni intenzitet proceduralne boli. Također su se izjasnili o nelagodi i strahu te konačnom pozitivnom ili negativnom iskustvu s proceduralnom boli. Podatci su prikupljeni anonimnim anketnim upitnikom https://docs.google.com/forms/u/0/. Prikupljeni podatci su statistički obrađeni. Kvantitativni rezultati su prikazani kroz srednju vrijednost i standardnu devijaciju, a kvalitativni kao učestalost u postotku. Rezultati između ispitivane i kontrolne skupine prikazani su u tablicama. Značajna razlika po usporedbi rezultata prihvaćena je uz vrijednost P<0.05.
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Rezultati rada: Ispitanici sa iskustvom (P) i bez iskustva (BP) sa proceduralnom boli bili su komparabilni po spolu, dobi i obrazovanju. Ispitanici koji su već iskusili proceduralnu bol najčešće su je vezali uz bolničke uvjete liječenja (58%) i doživjeli je signifikanto učestalije u odnosu na bolesnike bez iskustva (58%P vs 39%BP)(P=0.00211) koji su bole procedure većinskim dijelom vezali uz hitni bolnički prijem (43%). Između dijagnostičkih postupaka, ispitanici su u obje skupine podjednako smatrali endoskopske zahvate (gastroskopija/kolonoskopija) najbolnijom i najneugodnijom proceduralnom boli (64%P vs 60%BP). Najbolnijim intervencijskim postupkom su svi ispitanici smatrali namještanje ulomaka (36%P vs 37%BP) i šivanje rane i/ili vađenje šavova (30%P vs 28BP%), a kao najbolniju metodu liječenja uvođenje urinarnog katetera (42%P) i nazogastrične sonde (34%BP). Svi ispitanici su potvrdili da objašnjenje postupka od strane medicinskog osoblja (93%P vs 82%BP) te strpljenje i ljubaznost (99%P vs 91%BP) uvelike utječu na smanjenje učestalosti očekivanog i doživljenog bolnog postupka. Bolesnici koji su iskusili proceduralnu bol smatraju uz statističku signifikantnost da je individualna prilagodba na reakciji bolesnika (35%P vs susretljivo osoblje 28%, primjena analgo-sedacije 19%, informiranje o postupku 18%; P=0.00158) najviše doprinijela ublažavanju doživljaja proceduralne boli. Za ispitanike bez iskustva u tome je susretljivo osoblje bez užurbanosti (42%) odigralo presudnu ulogu (P<0.0001.
Zaključak: Svaka druga (58%P) ili treća odrasla osoba (39%BP) se suočava sa proceduralnom boli tijekom dijagnostike, intervencije ili lijeĉenja. Bolesnici sa ranijim iskustvom proceduralne boli imali su veći strah kod ponavljajućih postupaka (48%) u odnosu na osobe koje nisu imale to iskustvo (40%). Sama primjena analgo-sedacije (19%P vs 12%BP) je tek u niskom postotku doprinijela ublažavanju ove boli u svih ispitanika u odnosu na individualni pristup, susretljivost osoblja i pravovremenu informiranost o samom postupku. |
| Sažetak (engleski) | Introduction: Procedural pain is unpleasant acute pain associated with numerous diagnostic (blood sampling in laboratory diagnostics, colonoscopy, gastroscopy) and interventional procedures (e.g. dressings of surgical wounds and burns, removal of sutures, sampling of acid-base status), as well as invasive monitoring methods and treatment of patients (eg establishment of venous access, introduction of urinary catheter, nasogastric tube, central venous and hemodialysis catheter, etc.). Depending on the pain of the procedure itself, the intensity of procedural pain can range from mild and tolerable to strong and unpleasant pain that patients remember as an extremely unpleasant experience. In the patient, it is regularly accompanied by hidden fear, which can result in his partial or complete non-cooperation. This is why, in modern clinical practice, procedural pain is avoided by timely patient preparation with the use of premedication (ie anxiolytics) and/or preemptive analgesia (ie analgesics). There are divided opinions in the literature about the routine prevention of procedural pain, especially for short-term procedures. However, the frequency of positive and negative experiences of patients themselves after painful procedures in daily clinical practice is less known.
The aim of the research was to determine the frequency of positive and negative experiences of subjects after the most frequent painful procedures in daily clinical practice, with the purpose of insight into the justification of routine prevention of procedural pain.
Subjects: The research included 150 adult subjects, of both sexes, of different ages and occupations, after experience with one of the painful procedures in daily clinical practice. The subjects were divided into all groups: the tested Group P (patients with the experience of procedural pain) and the control Group BP (without the experience of procedural pain).
Methods: All subjects evaluated their sensitivity to pain on a scale of 1-5, and the intensity of procedural pain experienced on an NMR scale of 1-10. They also reported discomfort and fear and the final positive or negative experience with procedural pain. Dana were collected by anonymous questionnaire (https://docs.google.com/forms/u/0/.). The collected data were statistically processed. Quantitative results are presented through mean value and standard deviation, and qualitative results as frequency in percentage. The results between the tested and control groups are shown in the tables. A significant difference after comparing the results was accepted with a value of P<0.05.
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Results: Subjects with experience (P) and no experience (BP) with procedural pain were comparable in terms of gender, age and education. Respondents who had already experienced procedural pain most often associated it with hospital conditions of treatment (58%) and experienced it significantly more often compared to patients without experience (58%P vs 39%BP)(P=0.00211) who mostly experienced procedural pain associated with emergency hospital admission (43%). Among the diagnostic procedures, the respondents in both groups equally considered endoscopic procedures (gastroscopy/colonoscopy) to be the most painful and most unpleasant procedural pain (64%P vs 60%BP). The most painful intervention procedure was considered by all respondents to be the fixation of fragments (36%P vs 37%BP) and suturing of the wound and/or removal of sutures (30%P vs 28BP%), and the most painful method of treatment was the introduction of a urinary catheter (42%P) and nasogastric probe (34%BP). All respondents confirmed that the explanation of the procedure by the medical staff (93%P vs 82%BP) and patience and kindness (99%P vs 91%BP) greatly influence the reduction of the frequency of the expected and experienced painful procedure. Patients who have experienced procedural pain believe, with statistical significance, that individual adaptation to the patient's reaction (35%P vs friendly staff 28%, application of analgo-sedation 19%, information about the procedure 18%; P=0.00158) contributed the most to alleviating the experience of procedural pain . For respondents with no experience in this, accommodating staff without hurry (42%) played a crucial role (P<0.0001).
Conclusion: Every second (58%P) or third adult (39%PB) faces procedural pain during diagnosis, intervention or treatment. Patients with previous experience of procedural pain had a greater fear of repeated procedures (48%) compared to people who did not have this experience (40%). The application of analgo-sedation alone (19%P vs 12%BP) contributed only to a low percentage to the alleviation of this pain in all subjects compared to the individual approach, the friendliness of the staff and timely information about the procedure itself. |
