{"id":21596,"date":"2024-11-12T09:47:08","date_gmt":"2024-11-12T07:47:08","guid":{"rendered":"https:\/\/blogit.lab.fi\/labfocus\/?p=21596"},"modified":"2024-11-12T09:47:10","modified_gmt":"2024-11-12T07:47:10","slug":"kivunhoidon-haasteet-ensihoidossa","status":"publish","type":"post","link":"https:\/\/blogit.lab.fi\/labfocus\/kivunhoidon-haasteet-ensihoidossa\/","title":{"rendered":"Kivunhoidon haasteet ensihoidossa"},"content":{"rendered":"\n

Kipu m\u00e4\u00e4ritell\u00e4\u00e4n kansainv\u00e4lisen kivuntutkimusyhdistyksen (International Association for the Study of Pain) mukaisesti ep\u00e4miellytt\u00e4v\u00e4ksi tunne- tai aistikokemukseksi, joka liittyy todelliseen tai oletettuun kudosvaurioon (IASP 2020). Jenny Kurjen kandidaatintutkielmaa varten tehdyss\u00e4 kirjallisuuskatsauksessa havaittiin, ett\u00e4 ensihoitajat aliarvioivat usein potilaidensa kipua eik\u00e4 kivunhoidollinen osaaminen ole riitt\u00e4v\u00e4\u00e4 (Kurki 2024). Kipu on kuitenkin yksi yleisimmist\u00e4 ongelmista ensihoitoa tarvitsevilla potilailla (Ferri ym. 2022; Gunnvall ym. 2018; Handyside ym. 2021; Holmstr\u00f6m ym. 2019; Matthews ym. 2017; Vilance, ym. 2023; Wennberg ym. 2020; Whitley ym. 2022), joten on hyvin huolestuttavaa, etteiv\u00e4t potilaat saa aina omien kokemustensa mukaan riitt\u00e4v\u00e4\u00e4 kivunlievityst\u00e4 (Ferri ym. 2022, Wennberg ym. 2020). Lis\u00e4ksi kivunhoidon toteutumisen on osoitettu vaihtelevan suuresti; esimerkiksi traumapotilaat saavat tehokkaampaa kivunlievityst\u00e4 kuin muun tyyppisest\u00e4 kivusta k\u00e4rsiv\u00e4t potilaat (Ferri ym. 2022).<\/p>\n\n\n\n

Avainasemassa ensihoitaja<\/h2>\n\n\n\n

Ensihoitajien vahva ammatillinen osaaminen ja kokemus tukevat laadukasta kivunhoitoa (Bohm ym. 2014; Handyside ym. 2021; Jakopoviz ym. 2014; Vilcane ym. 2023). Lis\u00e4ksi merkityksellinen osa hyvin toteutunutta kivunhoitoa on ensihoitajan kyky olla l\u00e4sn\u00e4 ja huomioida potilas sek\u00e4 h\u00e4nen toiveensa. Tutkimusten mukaan potilaat ovat eritt\u00e4in tyytym\u00e4tt\u00f6mi\u00e4 saamansa kivunhoitoon, mik\u00e4li ensihoitajat eiv\u00e4t ymm\u00e4rr\u00e4 potilasta, ota riitt\u00e4v\u00e4sti kontaktia tai osoita kuuntelevansa potilaan mielipiteit\u00e4 (Aronsson ym. 2014; Bohm ym, 2019; Wennberg, ym. 2020). My\u00f6s ensihoitajat itse kokevat onnistuneensa kivunhoidossa, mik\u00e4li yhteisty\u00f6 potilaan kanssa on sujunut hyvin (Aronsson ym. 2014; Bohm ym. 2019; Holmstr\u00f6m ym. 2019; Wennberg ym. 2020). <\/p>\n\n\n\n

LAB-ammattikorkeakoulussa ensihoitajat aloittavat kivunhoitoon liittyv\u00e4t opinnot jo osana sairaanhoitajan perusopintoihin kuuluvia l\u00e4\u00e4kehoidon sek\u00e4 farmakologian kokonaisuuksia, mutta sit\u00e4 syvennet\u00e4\u00e4n viel\u00e4 ensihoitoon sopivaksi sek\u00e4 perus- ett\u00e4 hoitotason ensihoito-opintojen yhteydess\u00e4. Huomioitavaa kuitenkin on, ettei tarkasti m\u00e4\u00e4ritelty opetussuunnitelma mahdollista syventymist\u00e4 holistiseen kivunhoitoon ensihoidossa, vaikka sit\u00e4 pyrit\u00e4\u00e4nkin opetuksessa mahdollisuuksien mukaan huomioimaan.<\/p>\n\n\n\n

Potilasta tai ymp\u00e4rist\u00f6\u00e4 ei voi valita<\/h2>\n\n\n\n

Kivunhoitoon vaikuttavat muun muassa potilaan sukupuoli, ik\u00e4, aiempi sairaushistoria, potilaan kertoman kivun alkupisteet sek\u00e4 kivun syy (Handyside ym. 2021; Lord ym. 2016). Potilaan ymm\u00e4rt\u00e4mist\u00e4 ja kommunikaatiota vaikeuttavia seikkoja ovat esimerkiksi kognitiiviset h\u00e4iri\u00f6t (Handyside ym. 2021; Wennberg ym. 2020), p\u00e4ihteiden k\u00e4ytt\u00f6 (Bohm ym. 2019) sek\u00e4 potilaan etninen tausta (Kennel ym. 2019). Valkoisten potilaiden on osoitettu saavan tehokkaampaa kivunlievityst\u00e4 traumakipuun kuin rotuv\u00e4hemmist\u00f6ihin kuuluvien potilaiden (Kennel ym. 2019). <\/p>\n\n\n\n

Lapsipotilailla taas paino ja sen arviointi on merkitt\u00e4v\u00e4 haaste kipul\u00e4\u00e4kkeit\u00e4 annosteltaessa (Holmstr\u00f6m ym. 2019). Lis\u00e4ksi ensihoitajien on vaikea erottaa lapsen kokemaa kipua pelosta, jos lapsi on itkuinen ja rauhaton (Kiavialaitis ym. 2020; Wennberg ym. 2020; Whitley ym. 2021; Whitley ym. 2022).\u00a0 Ensihoitajat kokevatkin merkitt\u00e4v\u00e4n usein ep\u00e4varmuutta etenkin hoitaessaan lapsipotilaiden (Gunnvall ym. 2018) ja p\u00e4ihderiippuvaisten potilaiden kipua (Bohm ym. 2019).<\/p>\n\n\n\n

\"[Alt-teksti:
Kuva 1. Ensihoidon toimintaymp\u00e4rist\u00f6 voi luoda haasteita laadukkaalle kivunhoidolle. (Kuva: Jenny Kurki)<\/figcaption><\/figure>\n\n\n\n

Lis\u00e4\u00e4 koulutusta<\/h2>\n\n\n\n

Useissa tutkimuksissa organisaatiol\u00e4ht\u00f6iset tekij\u00e4t, kuten koulutuksen puute koettiin laadukkaan kivunhoidon esteen\u00e4 (Gunnvall ym. 2018; Handyside ym. 2021; Holmstr\u00f6m ym. 2019; Murphy ym, 2014; Rahman ym. 2014; Whitley ym. 2017; Whitley ym. 2022).  Ammattikorkeakoulujen tulisikin tarttua t\u00e4h\u00e4n j\u00e4rjest\u00e4m\u00e4ll\u00e4 ensihoitoon suunnattuja kivunhoidon lis\u00e4koulutuksia. Simulaatiokoulutukset ovat tehokkaita ja turvallisia opetusmenetelmi\u00e4 erityisesti, kun harjoiteltavaan asiaan liittyy monia eri osa-alueita. Simulaatioiden avulla olisikin mahdollista harjoitella niin vuorovaikutusta kivuliaan potilaan kanssa kuin k\u00e4dentaitojakin.<\/p>\n\n\n\n

\n
\n

Kirjoittajat<\/p>\n\n\n\n

Jenny Kurki<\/strong> on ensihoitajaopiskelija LAB-ammattikorkeakoulussa.<\/p>\n\n\n\n

Outi Koivulahti<\/strong> on terveysalan lehtori LAB-ammattikorkeakoulussa.<\/p>\n<\/div><\/div>\n<\/div><\/div>\n\n\n\n

L\u00e4hteet          <\/h2>\n\n\n\n

Aronsson, K., Bj\u00f6rkdahl, I. & Sundstr\u00f6m, B. 2014. Prehospital emergency care for patients with suspected hip fractures after falling \u2013 older patient\u00b4s experiences. Journal of Clinical Nursing, 23, 3115-3123. Viitattu 16.10.2024. Saatavissa doi 10.1111\/jocn.12550<\/p>\n\n\n\n

Bohm, K., Lund, R., Nordlander, J. & Vicente, V. 2019. Ambulance nurse\u00b4s experience to relieve pain in with addiction problems in Sweden. International Emergency Nursing, 46, 1-6. Viitattu 16.10.2024. Saatavissa https:\/\/doi.org.10.1016\/j.ienj.2019.06.002<\/a><\/p>\n\n\n\n

Ferri, P., Gambaretto, C., Alberti, S., Parogoni, P., Rovesti, S., Di Lorenzo, R., Sollami, A. & Bargellini, A. 2022. Pain management in a prehospital emergency setting: A retrospective observational study, 15, 3433-3445. Viitattu 16.10.2024. Saatavissa doi https:\/\/www.dovepress.com\/<\/p>\n\n\n\n

Gunnvall, K., Augustsson, D., Lindstr\u00f6m, V. & Vicente, V. 2018. Specialist nurses\u2019 experiences when caring for preverbal children in pain in the prehospital context in Sweden. International Emergency Nursing, 36, 39-45. Viitattu 16.10.2024. Saatavissa http:\/\/dx.doi.org\/10.1016\/j.ienj.2017.09.006<\/p>\n\n\n\n

Handyside, B., Pocock, H., Deakin, C. D. & Rodriguez-Bachiller, I. 2021. An EXploration of the facilitators and barriers to paramedics\u2019 assessment and treatment of pain in PAediatric patients following Trauma (EX-PAT). British Paramedic Journal, 6(2), 10-18. Viitattu 16.10.2024. Saatavissa https:\/\/orcid.org\/0000-0002-8526-064X<\/p>\n\n\n\n

Holmstr\u00f6m, M. R., Junehag, L., Velander, S., Lundberg, S., Ek, B., & H\u00e4ggstr\u00f6m, M. (2019). Nurses\u2019 experiences of prehospital care encounters with children in pain. International Emergency Nursing, 43, 23-28. Viitattu 16.10.2024. Saatavissa https:\/\/doi.org\/10.1016\/j.ienj.2018.07.004<\/a><\/p>\n\n\n\n

IASP. 2020. Announces Revised Definition of Pain. International association for the study of pain. Viitattu 4.4.2024. Saatavissa https:\/\/www.iasp-pain.org\/publications\/iasp-news\/iasp-announces-revised-definition-of-pain\/<\/a><\/p>\n\n\n\n

Jakopoviz, D., Falk, A. C. & Lindstr\u00f6m, V. 2014. Ambulance personnel\u2019s experience of pain management for patients with a suspected hip fracture: A qualitative study. International Emergency Nursing, 23, 244-249.<\/p>\n\n\n\n

Kennel, J., Withers, E., Parsons, N. & Woo, H. 2019. Racial\/Ethnic disparities in pain treatment: Evidence from Oregon emergency medical services agencies. Medical care, 57(12), 924\u2013929. Viitattu 16.10.2024. Saatavissa doi 10.1097\/MLR.0000000000001208<\/p>\n\n\n\n

Kiavialaitis, G. E., M\u00fcller, S., Braun, J., R\u00f6ssler, J., Spahn, D. R., Stein, P. & Kaserer, A. 2020. Clinical practice of pre-hospital analgesia: An observational study of 20,978 missions in Switzerland. American Journal of Emergency Medicine, 38, 2318-2323. Viitattu 16.10.2024. Saatavissa https:\/\/doi.org\/10.1016\/j.ajem.2019.10.033<\/a><\/p>\n\n\n\n

Kurki, J. 2024. Kivun kivunhoidon toteutuminen ja siihen vaikuttavat tekij\u00e4t ensihoidossa. Kandidaatintutkielma. It\u00e4-Suomen yliopisto. Julkaisematon.<\/p>\n\n\n\n

Lord, B., A Jennings, P. & Smith, K. 2016. The epidemiology of pain in children treated by paramedics. Paediatric emergency medicine, 28, 319-324. Viitattu 16.10.2024. Saatavissa 10.1111\/1742-6723.12586<\/p>\n\n\n\n

Matthews, R., McCaul, M., & Smith, W. (2017). A description of pharmacological analgesia administration by public sector advanced life support paramedics in the City of Cape Town. African Journal of Emergency Medicine, 7, 24-29. Viitattu 16.10.2024. Saatavissa http:\/\/dx.doi.org\/10.1016\/j.afjem.2017.01.002<\/p>\n\n\n\n

Rahman, A., Curtis, S., DeBruyne, B., Sookram, S., Thomson, D., Lutz, S. & Samina, A.  2014. Emergency Medical Services Provider Comfort with Prehospital Analgesia Administration to Children. Prehospital and Disaster Medicine, 30(1), 66-71. Viitattu 16.10.2024.  Saatavissa 10.1017\/S1049023X14001277<\/p>\n\n\n\n

Vilcane, S., Scharonow, O., Weilbach, C. & Scharonow, M. 2023. Application of analgesics in emergency services in Germany: a survey of the medical directors. BMC Emergency Medicine, 23(104), 2\u201311. Viitattu 16.10.2024.  Saatavissa https:\/\/doi.org\/10.1186\/s12873-023-00878-8<\/p>\n\n\n\n

Wennberg, P., M\u00f6ller, M., Sarenmalm, E. K. & Herlitz, J. 2020. Evaluation of the intensity and management of pain before arrival in hospital among patients with suspected hip fractures, 49, 1\u20138. Viitattu 16.10.2024. Saatavissa https:\/\/doi.org.10.1016\/j.ienj.2019.100825<\/a><\/p>\n\n\n\n

Whitley, D.E., Li, T., Jones, C., Cushman, J. T., Williams, D. M. & Shah, M. N. 2017. An Assessment of Newly Identified Barriers to and Enablers for Prehospital Pediatric Pain Management. Pediatric Emergency Care, 33(6), 381-387.<\/p>\n\n\n\n

Whitley, G. A., Hemingway, P., Law, G. R. & Siriwardena, A. N. 2021. Ambulance clinician perspectives of disparity in prehospitalchild pain management: A mixed methods study. Health Science Reports, 1-11. Viitattu 16.10.2024. Saatavissa doi 10.1002\/hsr2.261<\/p>\n\n\n\n

Whitley, G. A., Hemingway, P., Law, G. R. & Siriwardena, A. N. 2022. Improving ambulance care for children sufering acute pain: a qualitative interview study. BMC Emergency Medicine, 22(96), 2\u201311. Viitattu 16.10.2024. Saatavissa https:\/\/doi.org\/10.1186\/s12873-022-00648-y<\/p>\n","protected":false},"excerpt":{"rendered":"

Kipu m\u00e4\u00e4ritell\u00e4\u00e4n kansainv\u00e4lisen kivuntutkimusyhdistyksen (International Association for the Study of Pain) mukaisesti ep\u00e4miellytt\u00e4v\u00e4ksi tunne- tai aistikokemukseksi, joka liittyy todelliseen tai oletettuun kudosvaurioon (IASP 2020). Jenny Kurjen kandidaatintutkielmaa varten tehdyss\u00e4 kirjallisuuskatsauksessa havaittiin, ett\u00e4 ensihoitajat aliarvioivat usein potilaidensa kipua eik\u00e4 kivunhoidollinen osaaminen ole riitt\u00e4v\u00e4\u00e4 (Kurki 2024). Kipu on kuitenkin yksi yleisimmist\u00e4 ongelmista ensihoitoa tarvitsevilla potilailla (Ferri ym. […]<\/p>\n","protected":false},"author":17,"featured_media":21598,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[15],"tags":[9904,690,718,6220],"class_list":{"0":"post-21596","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-health_fi","8":"tag-artikkeli-d1","9":"tag-ensihoito","10":"tag-kipu","11":"tag-kivunhoito","12":"czr-hentry"},"yoast_head":"\nKivunhoidon haasteet ensihoidossa - LAB Focus<\/title>\n<meta name=\"description\" content=\"Kokonaisvaltainen kivunhoito on t\u00e4rke\u00e4\u00e4 ensihoitotilanteissa. Kivun kokemiseen vaikuttavat monet tekij\u00e4t. 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