Objective To systematically evaluate the attitudes and experiences of paramedics and patients towards pre-hospital pain management,identify the influencing factors,and provide references for formulating improvement measures. Methods The PubMed,Embase,CINAHL,Web of Science,Cochrane Library,CNKI,Wanfang and CBM were searched to retrieve the qualitative studies on pain management of paramedics and patients. The search limit was from the inception of each database until May 31,2023. The quality of included literature was evaluated according to the Joanna Briggs Institute（JBI） Quality Evaluation Criteria for Quality Research in Evidence-Based Health Care Centers. Meta-integration was employed to integrate the research results. Results A total of 70 research findings were extracted from 22 literature sources and categorized into 15 categories. Five synthesis results were summarized,including paramedics‘ factors,organizational factors,patients‘ factors,environmental factors,and scarcity of analgesic resources. Conclusion The influencing factors of prehospital pain management involve multiple dimensions and levels. It is necessary to comprehensively consider various factors such as paramedics,organizations,patients,environment,and analgesic resources in order to develop effective strategies for improving pre-hospital pain management.
[1] Raja SN,Carr DB,Cohen M,et al.The revised International Asso-ciation for the Study of Pain definition of pain:concepts,challenges,and compromises[J]. Pain,2020,161(9):1976-1982.
[2] Rosenberg A,Uwitonze E,Dworkin M,et al. Pain in the prehospital setting in Rwanda:results of a mixed-methods quality improvement project[J]. Pain Res Manag,2020,2020:3284623.
[3] European Society for Emergency Medicine. Guidelines for the management of acute pain in emergency situations[EB/OL].(2020-03-06)[2024-03-16]. https://www.eusem.org/images/EUSEM_EPI_GUIDELINES_MARCH_2020.pdf.
[4] 魏建梅,王志剑,刘韦辰,等. 疼痛评估管理体系的构建及应用[J]. 中国护理管理,2023,23(10):1447-1451.
Wei JM,Wang ZJ,Liu WC,et al.Establishment and application of pain assessment and management system[J]. Chin Nurs Manag,2023,23(10):1447-1451.
[5] Carnesten H,Asp M,Holmberg M.Caring approach for patients with chest pain-Swedish registered nurses‘ lived experiences in emergency medical services[J]. Int J Qual Stud Health Well-being,2021,16(1):1901449.
[6] Teoh SE,Loh CYL,Chong RIH,et al.A scoping review of qualitative studies on pre-hospital analgesia administration and practice[J]. Am J Emerg Med,2022,57:81-90.
[7] Whitley GA,Wijegoonewardene N,Nelson D,et al.Patient,family member,and ambulance staff experiences of prehospital acute pain management in adults:a systematic review and meta-synthesis[J]. J Am Coll Emerg Physicians Open,2023,4(2):e12940.
[8] Lockwood C,Munn Z,Porritt K.Qualitative research synthesis:methodological guidance for systematic reviewers utilizing meta-aggregation[J]. Int J Evid Based Healthc,2015,13(3):179-187.
[9] Wihlborg J,Svensson A,Ivarsson B,et al.Ambulance nurses‘ experiences of pain management with Penthrox In Swedish ambulance care:a mixed method study[J]. Int Emerg Nurs,2023,68:101275.
[10] Whitley GA,Hemingway P,Law GR,et al.Improving ambulance care for children suffering acute pain:a qualitative interview study[J]. BMC Emerg Med,2022,22(1):96.
[11] Ulrich Hansen M,Vejzovic V,Zdravkovic S,et al.Ambulance nurses‘ experiences of using prehospital guidelines for pa-tients with acute chest pain:a qualitative study[J]. Int Emerg Nurs,2022,63:101195.
[12] Lourens A,Parker R,Hodkinson P.Emergency care providers‘ perspectives of acute pain assessment and management in the prehospital setting,in the Western Cape,South Africa:a qualitative study[J]. Int Emerg Nurs,2021,58:101042.
[13] Handyside B,Pocock H,Deakin CD,et al.An EXploration of the facilitators and barriers to paramedics‘ assessment and treatment of pain in PAediatric patients following Trauma (EX-PAT)[J]. Br Paramed J,2021,6(2):10-18.
[14] Tegelberg A,Muntlin,Juhlin C,et al.Engagement under difficult conditions:caring for patients with acute abdominal pain across the acute-care chain:a qualitative study[J]. Int Emerg Nurs,2020,52:100910.
[15] Evans BA,Brown A,Bulger J,et al.Paramedics‘ experiences of administering fascia iliaca compartment block to patients in South Wales with suspected hip fracture at the scene of injury:results of focus groups[J]. BMJ Open,2019,9(2):e026073.
[16] Evans BA,Brown A,Fegan G,et al.Is fascia iliaca compartment block administered by paramedics for suspected hip fracture acceptable to patients? A qualitative study[J]. BMJ Open,2019,9(12):e033398.
[17] Bohm K,Lund R,Nordlander J,et al.Ambulance nurse‘s experience to relieve pain in patients with addiction problems in Sweden[J]. Int Emerg Nurs,2019,46:100779.
[18] Holmström MR,Junehag L,Velander S,et al.Nurses‘ experiences of prehospital care encounters with children in pain[J]. Int Emerg Nurs,2019,43:23-28.
[19] Gunnvall K,Augustsson D,Lindström V,et al.Specialist nurses‘ experiences when caring for preverbal children in pain in the prehospital context in Sweden[J]. Int Emerg Nurs,2018,36:39-45.
[20] Vlahaki D,Vlahaki E,Welsford M.Paramedic perceptions of barriers to prehospital oral analgesia administration[J]. Australas J Paramed,2016,13:1-9.
[21] Jakopovic D,Falk AC,Lindström V.Ambulance personnel‘s experience of pain management for patients with a suspected hip fracture:a qualitative study[J]. Int Emerg Nurs,2015,23(3):244-249.
[22] Murphy A,Barrett M,Cronin J,et al.A qualitative study of the barriers to prehospital management of acute pain in children[J]. Emerg Med J,2014,31(6):493-498.
[23] Aronsson K,Björkdahl I,Wireklint Sundström B.Prehospital emergency care for patients with suspected hip fractures after falling-older patients‘ experiences[J]. J Clin Nurs,2014,23(21/22):3115-3123.
[24] Walsh B,Cone DC,Meyer EM,et al.Paramedic attitudes regarding prehospital analgesia[J]. Prehosp Emerg Care,2013,17(1):78-87.
[25] Iqbal M,Spaight PA,Siriwardena AN.Patients‘ and emergency clinicians‘ perceptions of improving pre-hospital pain management:a qualitative study[J]. Emerg Med J,2013,30(3):e18.
[26] Williams DM,Rindal KE,Cushman JT,et al.Barriers to and enablers for prehospital analgesia for pediatric patients[J]. Prehosp Emerg Care,2012,16(4):519-526.
[27] Berben SAA,Meijs THJM,van Grunsven PM,et al. Facilitators and barriers in pain management for trauma patients in the chain of emergency care[J]. Injury,2012,43(9):1397-1402.
[28] Jones GE,Machen I.Pre-hospital pain management:the parame-dics‘ perspective[J]. Accid Emerg Nurs,2003,11(3):166-172.
[29] 王钰炜,周帅帅,王飒,等. 一站式创伤复苏单元整合5G技术的建设及应用研究[J]. 中华急危重症护理杂志,2022,3(4):300-304.
Wang YW,Zhou SS,Wang S,et al.The construction and practice of a “one-stop” trauma resuscitation unit integrating with 5G technology[J]. Chin J Emerg Crit Care Nurs,2022,3(4):300-304.
