臺灣博碩士論文加值系統

本研究目的旨在發展及驗證術後疼痛處置充能教育措施，對護理人員在術後疼痛處置的知識、態度、行為的成效，及病患在術後疼痛緩程度與疼痛滿意度的成效。
研究採類實驗設計，以立意取樣指定實驗組與對照組，研究對象以北部某醫學中心兩個骨科病房護理人員共39名，及行脊椎與髖關節置換之病患前測、後測1、後測2各120名，共360名。實驗組病房護理人員接受兩小時術後疼痛處置充能教育課程，在後測1與後測2的實驗組病患於術前接受術後疼痛衛教之個別指導。研究工具：護理人員部份為自擬之術後疼痛處置之知識、態度、技能、自我效能量表，病患部份為疼痛處置認知及疼痛處置滿意度問卷，以SPSS 12.0中文版進行資料分析與檢定。
研究結果顯示：1.接受充能教育的護理人員，對術後疼痛處置的知識與態度顯著高於對照組，但技能與自我效能則無差異。2.在後測1與2有接受術前疼痛衛教的實驗組病患，對術後疼痛處置的認知與滿意度顯著高於對照組，但術後疼痛程度與疼痛緩解程度則無差異。骨科病患對術後疼痛處置感到最滿意的部份為：醫師開刀技術的精湛、手術結果很成功、護理人員的照護態度與問題處理的即時性等。再者，病患和護理人員的疼痛信念均偏向術後疼痛是無法避免的，僅在劇烈疼痛感無法忍受時，才會施打嗎啡類止痛劑。
依照本研究結果建議分別以質性研究更深入瞭解醫師、護理人員、病患、及住院主要陪伴者對術後疼痛與止痛藥使用的信念，，進而發展具本土化疼痛信念的測量工具；其次，應推動術後疼痛處置的課程列入每年的外科護理人員常態在職教育課程內，定期舉辦術後疼痛處置相關的研討會，並增加疼痛評估技巧及非藥物性緩解疼痛措施的模擬實作練習等，使護理人員對術後疼痛處置的知識、態度、技能、及自我效能可正向增強。

This study aim at developing and verifying the effectiveness of an
empowering education program, to orthopedic nurses the postoperative
pain management of knowledge, attitude, behavior of result, and patient
of postoperative pain relief degree and pain management satisfaction.
The study design was a quasi-experimental.and specifies experiment set and matched control by purposive sampling, research object with certain medical center in the north two orthopedics sickroom nursing staff is total 39, and undergoing the patient of spine and hip joint replacement, pre-test
, post-test1, post-test2 total 360.Experimental nursing staff accept for two hours, the , at after the post-test 1 anf post-test2 accept with 2 patients before ache health education is individual to guide. With SPSS for Windows 12.0 Chinese versions carry on data to create file and analyze and make use of a description covariance (percentage, average value, Sigma) and reasoning covariance ( Mann-Whitney test, independent t-test and ANCOVA ) carry on analysis.
The results of the research are : 1. The knowledge and attitude in postoperative pain management presented by the nursing staff receiving empowerment education were significantly better than those in the control group. However, no differences were shown in their skills and self-efficacy. 2. The perception and satisfaction of post-op pain management presented the patients from post-test 1 and post-test 2 in the experiment group receiving pre-op health education for pain were significantly better than those in the control group. However, no differences in the degree of post-op pain and degree of pain relief were shown from both groups. The items which orthopedic patients were satisfied most were: physician’s excellent surgical skills, successful surgical result, nursing staff’s attitude to care and immediate response to problems. In addition, both patients and nursing staff thought that it was inevitable to feel painful after operation and no morphine would be given until it was too painful for the patients to bear.
According to the results in this paper, it is suggested to employ qualitative research to further explore the perception of postoperative pain and use of analgesics shown from physicians, nursing staff, patients and caregiver during patients’ hospitalization. In that case, localization measurement tools for pain belief can be developed. Next, post-op pain management courses should be covered in the regular in-service educational programs held for surgical nursing staff every year. It is also recommended to regularly hold workshops in relating to post-op pain management. In addition, it is necessary to enhance pain evaluation techniques and strengthen simulation and practices of the measures taken for non-pharmacological method. As a result, the nursing staff will reach a positive advance in the knowledge, attitude, skills and self-efficacy concerning post-op pain management.

目 錄
指導教授推薦書…………………………………………………………………
口試委員會審定書………………………………………………………………
授權書…………………………………………………………………………….
誌謝………………………………………………………………………………. i
中文摘要…………………………………………………………………………… i i
英文摘要…………………………………………………………………………. i v
目錄………………………………………………………………………………. ix
第一章 緒論…………………………………………………………………….. 1
1.1 研究動機與重要性…………………………………………………… 1
1.2 研究目的………………………………………………………………… 7
1.3 研究假設………………………………………………………………… 8
1.4 名詞解釋………………………………………………………………… 9
第二章 文獻查證………………………………………………….. 11
2. 1疼痛的概念……………………………………………………………… 11
2.2 手術後疼痛的相關研究 ………………………………………………… 15
第三章 研究方法……………………………………………………………. 59
3.1前驅研究……………………………………………… 59
3.2正式研究………………………………………………... 71
3.3 研究場所、對象……………………………………………………… 80
3.4介入措施………………………………………………... 81
3.5研究工具………………………………………………... 83
3.6人權考量………………………………………………... 90
3.7資料收集過程………………………………………………... 91
3.8資料分析………………………………………………... 93

第四章 研究結果………………………………………………………. 94
4.1 研究對象之描述性資料……………………………………………... 94
4.2充能教育之介入成效…………………………………………………...123
第五章 討論 …………………………………………………………. 130
5.1影響充能教育措施在術後疼痛處置的成效因素…………………... 130
5.2術後疼痛處置的成效成效…………………………………………… .142第六章 結論與建議…………………………………………………………. 150
參考文獻…………………………………………………………………….…… 156
附錄 …………………………………………………………………………… 172
附錄一護理人員問卷………………………………………………………… 172
附錄二病患問卷 ………………………………………………………… 178
附錄三疼痛衛教手冊………………………………………………………… 182
附錄四專家效度 ………………………………………………………… 187

參考資料
王曼溪（2000）．如何製作好讀易懂的書面資料．台灣醫學，4（3），334-337。
王保進（2004）．視窗版SPSS與行為科學研究．台北：心理。
王淑蓉（1996）．骨科病患主訴疼痛及使用止痛針顧慮之探討．未發表的碩士論文，私立慈濟大學護理學研究所，花蓮市。
王湘玲（2006）．重症護理人員對疼痛知識態度與障礙因素之探討．未發表的碩士論文，私立長庚大學護理學研究所，桃園縣。
台中榮民總醫院麻醉科（2006）．術後止痛．2007年4月6日，取自http://dotweb.vghtc.gov.tw/onweb.jsp?webno=3333333045
何菊修、陳宗鷹（2005）．急性術後疼痛．慈濟醫學雜誌，17（supple 6），43-50。
李英春（2004）．疼痛管理對病人手術後疼痛控制之成效--以某醫學中心全膝關節置換術病人為例．未發表的碩士論文，私立高雄醫學大學公共衛生研究所，高雄市。
李梅琛、賴裕和、陳美伶、劉淑娟（2001）．病人疼痛特質與疼痛信念對手術後使用止痛藥的影響．護理雜誌，48（2），49-57。
阮玉梅、胡月娟（2007）．醫療保健體系與護理人員的角色功能．於蘇麗智、阮玉梅、胡月娟、林明珍、李引玉、羅筱芬等編著，最新護理學導論（五版，189-190頁）．台北：華杏。
林笑、蔡美月（1995）．影響手術後病患首次下床的因素初探．榮總護理，12（1），71-77。
林碧珠、林瓊珠、姚吟蓮（2001）．脊椎手術後疼痛控制-必要時每四小時靜脈低注 Demerol 之效果探討．護理雜誌，48（2），49-58。
林麗英（2002）．術前疼痛護理對腹部手術個案術前焦慮、認知與術後疼痛之成效．未發表的碩士論文，私立高雄醫學大學護理學研究所，高雄市。
林麗君（2001）．手術病患疼痛處置品質之探討．未發表的碩士論文，私立長庚大學護理學研究所，桃園縣。
林麗君（2006）．外科病房護理人員的急性疼痛知識與態度之探討．光田醫學雜誌，1（1），31-38。
林麗君、陳美伶、林佳靜、蔡培葵、陳秀娟（2006）．手術病患疼痛
處置品質之探討．長庚護理，17（1），1-10。
林瓊珠、姚吟蓮、廖素滿、莊淑娟、林金燕、林碧珠（2002）．探討不同給藥方式對脊椎手術病患疼痛控制的成效．榮總護理，19（1），21-33。
侯重光（2005）．急診室的疼痛處置．臨床醫學，56（3），212-219。
胡益進、姚振華、姜逸群、黃松元、葉國樑、林珠莉等人．（2007）．學校口腔健康促進推廣模式探討研究成果．未出版．（研究計畫編號：DOH96-HP-1303）．台北市：國民健康局。
施素梅（2004）．評估麻醉前衛教對全身麻醉脊椎手術患者之成效探討．未發表的碩士論文，私立臺北醫學大學護理學研究所，台北市。
徐秀琹（2004）．紀錄．於曹麗英等人編著，新編基本護理學（初版，93-126頁）．台北：新文京。
黃庭紅（2004）．兒科護理人員對兒童癌症疼痛處置之認知及學習需求．未發表的碩士論文，國立臺灣大學護理學研究所，台北市。
陳淑如、林佳靜、鄭綺、何善台（1998）．探討手術後病人對疼痛護理及疼痛控制的滿意度及其影響因素．護理雜誌，6（6），475-488。
崔子軒（2005）．探討不同止痛方式對病患手術後疼痛控制之成效- 以南部某一區域醫院為例．未發表的碩士論文，國立中山大學醫務管理研究所，高雄市。
隋善中（2003）．手術後疼痛影響因素及疼痛管理之探討---以某醫學中心為例．未發表的碩士論文，國立臺灣大學醫療機構管理研究所，台北市。
張靜瑛（2002）．在職教育對護理人員的癌症疼痛評估觀念及技巧之改變．未發表的碩士論文，私立義守大學管理科學研究所，高雄。
郭素娥（2007）．從病人安全權利探討手術前之「告知後同意」執行成效．未發表的碩士論文，私立東海大學工業工程與資訊學系研究所，台中市。
詹秀妹、吳麗玲（2003）．病患急性疼痛定義性特徵與 Demerol 使用相關性探討．新臺北護理期刊，5（1），15-23。
詹廖明義（無日期）．疼痛治療與護理．2007年4月6日，取自台灣疼痛治療資訊網http://www.pain-manage.org.tw/city/city16.files/frame.htm
鄒貴峰、鄒美勇（2004）．病患自控式止痛 ( PCA ) ．臨床醫學，53（3），197-200。
賴裕和（2000）．病人對癌痛及麻醉性止痛藥之信念探討-量表發展與現況．護理研究，8（5），557-567。
蔡鳳琴（2004）．急診護理人員對疼痛處置的知識及態度障礙因素之探討．未發表的碩士論文，私立長庚大學護理學研究所，桃園縣。
蔡佩珊（2004）．病患自控式止痛． 2007年4月6日，取自新竹馬偕紀念醫院麻醉科
http://www.hc.mmh.org.tw/Knowledge/Knowledge_Detail.asp?Csdp=7581&Writing_No=20&Page_No=001
鄭玉華（2005）．手術前疼痛衛教對改善脊椎術後病人疼痛經驗之成效探討．未發表的碩士論文，私立臺北醫學大學護理學研究所，台北市。
顧淑芳（2005）．探討鬆弛訓練對外科加護病房術後病患急性疼痛及焦慮緩解之成效．未發表的碩士論文，私立輔仁大學護理學系碩士班，台北縣。
盧奕丞（2004）．病人自控式疼痛控制--手術後的止痛良方．高醫醫訊，24(7)，25。
盧孳豔（1996）．護理之國際共通語言－ICNP．護理新象，62（2），313-319。
顏慧芳、邱麗文（2005）重症醫護人員的疼痛處理知識與態度及其相關因素．實證護理，1（4），294-301。
蘇輕感、鍾玉珠、曾秋蘭、汪志雄（2006）．手術後患者使用病患自控式止痛之認知、止痛成效滿意度及影響因素．台灣醫學，10（5），557-565。
謝麗鳳、林佳靜、賴裕和、鄒宗山（1998）．家屬對止痛劑的擔心與癌症病人疼痛控制的相關性．護理研究，6（4），327-336。
潭名媛（2006）．足部按摩對腰椎手術後患者之成效探討．未發表的碩士論文，國立台北護理學院護理學研究所，台北市。
Acute pain mamagement : Operative or medical procedures and trauma (1992). AHCPR Publication No. 92-0032. Retrieved March 2 2007, from http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat6.chapter.89911
AHCPR archived clinical practice guidelines - process of pain assessment and reassessment (1992). Retrieved March 2, 2007, from http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat6.section.9137
American Association Society Quality of Care Committee (1995). Quality improvement guidelines for the treatment of acute pain and cancer pain. Journal of American Medical Association, 274(23),
, 1874-1880.
Bandura, A. (1977). Social Learning Theory. Englewood Cliffs, N. J. : Prentice-Hall.
Bandura, A. (1986). Social Foundations of Thought and Action: A Cognitive Theory. Englewood Cliffs, N. J. : Prentice-Hall.
Bandura, A. (1997). Self-efficacy : The exercise of control. New York :
W. H. : Freeman.
Bardiau, F. M. , Taviaux, N. F. , Albert, A. , Boogaerts, J. G., & Stadler, M. S. (2003). An intervention study to enhance postoperative pain management. Anesthesia Analgesia , 96(1), 179-185.
Bonnet, F., & Marret, E. (2007). Postoperative pain management and outcome after surgery. Best Practice & Clinical Anaesthesiology,
21(1),99-107.
Brown, S. T., Browman, J. M., & Eason, F. R. (1999). Assessment of Nurses’ attitudes and knowledge regarding pain management. The Journal of Continuing Education in Nursing, 30(3), 132-139.
Canadian Pain Society (2007). ‘ Pain Relief－A Basic Human Right’ Retrieved May 2, 2007, from http ://www.candianpainsociety.ca/call-for-abstracts.pdf
Cashman, J. N. & Dolin, S. J. (2004). Respiratory and haemodynamic effects of acute postoperative pain management : Evidence from published data. British Journal of Anaesthesia, 93(2), 212-223.
Cepeda, M. S. & Carr, D. B. (2003). Women experience more pain and morphine than men to achieve a similar degree of analgesia. Anesthesia Analogy, 97, 1464-1648.
Charman, R. A. (1989). Pain Theory and Physiotherapy. Physiotherapy,
75(5), 246 - 254.
Chelly, J. E., Ben-David, B., Williams, B. A., & Kentor, M. L. (2003). Aneathesia and Postoperative Analgesia : Outcomes Following Orthopedic Surgery. Orthopedic, 26 (8 supple), s865-s871.
Chia, Y. Y., Chow, L. H., Hung, C. C., Liu, K., Ger, L. P., & Wang, P. N. (2002). Gender and pain upon movement are associated with the requirements for postoperative patient-controlled iv analgesia : A prospective survey of 2298 Chinese patients. Canadian Journal of Anaesthesia. 49(3), 249-255.
Cohen, M. Z., Easley, M. K., Ellis, C., Hughes, B., Ownby, K., Rashad, B. G., Rude, M., Taft, E., & Westbrooks, J. B. (2003). Cancer pain management and the JCAHO’s pain standards: An institutional challenge. Journal of Pain and Symptom Management, 25(6), 519-527.
Comley, A. L., & DeMeyer, E. (2001). Assessing patient satisfaction with pain management through a continuous quality improvement effort. Journal of Pain Symptom Managemen, 21(1), 27-40.
Conn, D. A. (2005). Assessment of acute and chronic pain. Anaesthesia and Intensive Care Medicine, 6(1), 14-5.
Conger, J. A. & Kanungo, R. N. (1988). The empowerment process : Integrating theory and practice. Academy of Management Review, 13(3), 471-482.
Conger, J. A. (1989). Leadership: The art of empowering to others. The Academy of Management Executive, 3(1), 17-24.
De Rond, E. J. M., de Wit, R., van Dam, F. S. A. M., & Muller, M. J. (2000). A pain monitoring program for nurse : Effects on communication,assessment and documentation of patients’ pain. Journal of Pain Symptom Management , 20(6), 424-439.
De Rond, M., de Wit, R., & van Dam, F. (2000). The implementation of a pain monitoring programme for nurses in daily clinical practice : Results of a follow-up study in five hospitals. The Journal of Advanced Nursing, 35(4), 590-598.
Dihle, A., Bjolseth, G., & Helseth, S. (2006). The gap between saying and doing in postoperative pain management. Journal of Clinic Nursing, 15(4), 469-479.
Devine, E. C. (1992). Effects of psychoeducational care for adult surgical patient – a metaanalysis of 191 studies. Patient Education & Counseling, 19(2), 129-142.
Emanuel, E. J., & Emanuel, L. L. (1992). Four model of the physician-
patient relationship. Journal of American Meicine Association, 267
(16), 2221-2226.
Ene, K. W., Nordberg, G., Bergh, I., Johansson, F. G., & Sjostrom, B. (2008). Postoperative pain management-the influence of surgical wards nurses. Journal of Clinical Nursing, 17 (15), 2042-2051.
Erkes, E. B., Parker, V. G., Carr, R. L., & Mayo, R. M. (2001). An examination of critical care nurses’ knoeledge and attitudes regarding pain management in hospitalized patients. Pain Management Nursing
, 2(2), 47-53.
Field, L. (1996). Are nurses still underestimating patients’ pain postoperatively? British Journal of Nursing, 5, 778-784.
Francke, A., Garssen,B., Abu-Sadd,H., & Grypdonck, M. (1996). Qualitative needs assessment prior to a continuing education program. Journal of Continuting Education in Nursing, 27, 34-41.
Gavin, M., Litt, M., Khan, A., Onyiuke, H., & Kozol, R. (2006).
A prospective, randomized trial of cognitive intervention for postoperative pain. The Americian Surgeon, 72(5), 414-418.
Ger, L. P., Chang, C. Y., Ho, S. T., Lee, M. C., Chiang, H. H., Chao, C. S., et al. (2004). Effect of a continuing education program on Nurses’ practices of cancer pain assessment and their acceptance of patients’ pain reports. Journal of Pain Symptom Management, 27(1), 61-71.
Gibson, C. H. (1991). A concept analysis of empowerment. Journal of Advanced Nursing, 16, 345-361.
Gordon, D. B., Dahl, J. L., Miaskowski, C., McCarberg, B., Todd, K. H., Judith, A., et al. (2005). Americian Pain Society recommendations for improving the quality of acute and cancer pain management. Archives of Internal Medicine, 165, 1574-1580.
Gunningberg, L., & Idvall, E. (2007). The quality of postoperative pain management from the perspectives of patients, nurses and patient records. Journal of Nursing Management, 15, 756-766.
Hansson, E. , Fridlund, B., & Hallstrom, I. (2006). Effects of quality improvement program in acute care evaluated by patient, nurse, and physicans. Pain Management Nursing, 17(3), 93-108.
Harper, P., Ersser, S., & Gobbi, M. (2007). How military nurse rationalize their postoperative pain assement decisions. Journal of Advanced Nursing, 59(6), 601-611.
He, H. G., Pölkki, T, & Pietilä, A. M. (2005). A survey of Chinese nursres’ guidance to parents in children’s postoperative pain relief. Journal of Clinical Nursing, 14, 1075-1082.
Hicks, C. L., Baeyer, C. L., Spafford, P. A., Korlaar, I. V. & Goodenough, B. (2001). The Faces Pain Scale revised : Toward a common metric in pediatric pain measurement. Pain, 93(2), 173-183.
Hollinworth, H. (1994). No gains? Nursing Times, 90(1), 24-27.
Idvall, E., & Ehrenberg, A. (2002). Nursing documentation of postoperative pain management. Journal of Clinical Nursing, 11
(6), 734-742.
Innis, J., Biraunieks, N., Petrysben, P., Zellermeyer, V. ,& Ciccarelli, L. (2004). Patient satisfaction and pain management : An educational approach. Care Quality , 19(4), 322-327.
International Association for the Study of Pain (1986). Pain terms : A current list with definition and note on usage. Pain, 25(suppl.3)
, S217.
International Association for the Study of Pain, IASP. (2004). Pain relief as a human right. Retrieved April 25, 2007, from http://www.iasp-pain.org/AM/Termplate.cfm?Section=Home§ion=Pain_ clinical.
International Association for the Study of Pain (2003). IASP Pain terminology. Retrieved April 25,2007, from http://www.iasp-pain.org/terms-p.html.
Kalkman, C. J., Visser, K., Moen, J., Bonsel, D. E., & Moons, K. G. M.
(2003). Preoperative prediction of severe postoperation pain. Pain, 105, 415-423.
Kehlet, H., Jenaen, T. S., & Woolf, C. J. (2006). Persistent postsurgical pain :Risk factors and prevention. The Lancet, 367, 1618-1625.
Kim, S. (1980). Pain : Theory, research and nursing practices. Advances in Nursing Science, 2(2), 43-59.
Kinna, S. ,& Bass, S. (2003). Postoperative analgesia. Surgery (Oxford)
, 21(1), 21-24.
Kruis, M. R., van der Vegt, M. H.,Voorham, K., & Wegener, J. H. (2006). Pain education program for nurses improves the knowledge and attitude towards postoperative pain management. European Journal of Pain, 10(suppl S1), S236.
Lin, C. C., & Ward, S. E. (1995). Patient-related barriers to cancer pain management in Taiwan. Cancer Nursing, 18, 16-22.
Lin, P. C. (2000). Barriers to the analgesic management of cancer pain : A comparision of attutides of Taiwanese patients and their family caregivers. Pain, 88, 7-14.
Lin, P. C., Chiang, H. W., Chiang, T. T., & Chen, C. S. (2008). Pain management : Evaluating the effectiveness of an educational programme for surdical nursing staff. Journal of Clinical Nursing, 17(15), 2032-2041.
Loncaric-Katusin, M., Persoli-Gudeli, M. ,Simic-Korac, N. , Zunic, J.,
& Korac, Z. (2006). Acute postoperative pain therapy : Current
state-patient experience. Acta Clinic Croatic, 45(1), 15-19.
Lui, L. Y. Y., So, W. K. W., & Fong, D. Y. T. (2008). Knowledge and attitudes regarding pain pain management among nurses in Hong Kong medical units. Journal of Clinical Nursing, 17(15), 2014-2021.
McCaffery, M., & Beebe, A. (1989). Pain : Clinic manual for nursing
Practice. St. Louis : C. V. Mosby.
MaCaffery, M. (2001). Controlling pain overcoming barriers to pain
management. Nursing, 31(4), 18.
MaCaffery, M., & Robinson, E. S. (2002). Pain here’s how you respond？Nursing, 32(10), 37-45.
McDond, D. D., McNulty, J., Erikson, K., & Weiskopf, C. (2000). Communicating pain and pain management needs after surgery. Applied Nursing Research, 13(2), 70-75.
McNeill, J. A., Sherwood, G. D., Starck, P. L., ＆ Thompson, C. J. (1998). Assessing clinical outcomes : Patient satisfaction with pain management. Journal of Pain and Symptom Management, 16 (1), 29-40.
Manias, E. (2003). Medication trends and documentation of pain management following surgery. Nursing and Health Science, 5
,85-94.
Manias, E., Botti, M., ＆ Bucknall, T. (2002). Observation of pain assessment and management-the complexities of clinical practice. Journal of Clinical Nursing, 11 (6), 724–733.
Manias, E., Botti, M., ＆ Bucknall, T. (2006). Patients’ decision making
straties for management postoperative pain. The Journal of Pain, 7(6), 428-437.
Manias, E., Bucknall, T., ＆ Botti, M. (2004). Assessment of patient in the postoperative context. Western Journal of Nursing Research
, 26(7), 751-769.
Manias, E., Bucknall, T., ＆Botti, M. (2005). Nurses’ strategies for
managing pain in the postoperative setting. Pain Management Nursing, 6(1), 18-29.
Matthews, E. & Malcolm, C. (2007). Nurses’ knowledge and attitudes in pain management practice. British Journal of Nursing, 16(3)
, 174-179.
Mertin, S., Sawatzky, J. V., Diehl-Jones, W. L., & Lee, T. W. R. (2007).
Roadblock to recovery : The surgical stress response. Spring,
18(1), 14-21.
Millen, S., & Sheikh, C. (2003). Anesthesia and surgical pain
relief-managing post-operative pain. Hospital Pharmacist,10
, 442-450.
Molony, S. L. , Kobayashi, M., Holleran, E. A., & Mezey, M. (2005).
Assessing Pain as Fifth Vital Sign in long-term care factilities :
Recommendations from the field. Journal of Gerontological
Nursing, 31(3), 16-24.
Myles, P. S., & Power, I. (2007). Clinical update : Postoperative analgesia. The Lancet, 369, 810-812.
Naser, E., Sinwan, S., & Bee, W. H. (2005). Nurses’ knowledge On pain
management. Singpore Nursing Journal, 32(2), 29-36.
Patiraki-Kourbani, E., Tafas, C. A., McDonald, D. D., Papathanassoglou,
E. D., Katsaragakis, S., & Lemonidou, C. Personal and professional pain experiences and pain management knowledge among Greek nurses. International Journal of Nursing Studies, 41(4), 345-54.
Pasero, C. & McCaffery, M. (2007). Orthopaedic postoperative pain
management. Journal of PeriAnesthesia Nursing, 22(3), 160-174.
Phillips, D. (2000). JACHO pain management standards are unveiled.
Journal of American Medicine Association , 284, 428-429.
Premkumar, J. (2006). Pain as the Fifth Vital Sign. Nursing Journal of India, 97(10), 225-227.
Power, I. (2005). Recent advances in postoperative pain therapy. British Journal of Anaesthesia, 95(1), 43-51.
Rejeh, N., Mohammadi, E., Anooshen, M., & Kazemnejad, A. (2008). Barriers to, and facilitators of post-operative pain management in Iranian nursing: a qualitative research study. International Nursing Review, 55(4), 468-75.
Roth, W., Kling, J., Gockel, I., Rűmelin, A., Hessmann, M. H., Meurer, A., et al. (2005). Dissatisfaction with post-operative pain management : A prospectine analysis of 1071 patients. Acute Pain, 7, 75-85.
Rosseland, L. A., & Stubhaug, A. (2004). Gender is a factor in pain trials : Women report more pain than men after arthroscopic surgery. Pain, 112, 248-253.
Simpson, K., Kautzman, L., & Dodd, S. (2002). The effects of a pain management education program on the knowledge level and attitudes of clinical staff. Pain Management Nursing, 33(3), 87-93.
Shang, A. B., & Gan, T. J. (2003). Optimising postoperative pain
management in the ambulatory patient. Drugs ,63(9), 855-67.
Shen, Q., Sherwood, G. D., McNeill, J. A., & Li, Z. (2008). Postoperarive
pain management outcome in Chinese Inpatients. Westen Journal of Nursing Research, 30(8), 975-900.
Schafheutle, E., Cantril, J., & Noyce, P. (2001). Why is pain management
suboptimal on surgical ward? The Journal of Advanced Nursing ,
33(6), 728-737.
Stomberg, M. W.; Wickstrom, K., Joelsson, H., Sjostrom, B. & Haljamae, H. (2003). Postoperative pain management on surgical wards - do quality assurance strategies result in long-term effects on staff member attitudes and clinical outcomes? Pain management nursing, 4(1), 11-22.
Svensson, I., Sjostrom, B., & Haljamae, H. (2001). Influence of expectations and actual pain experiences on satisfaction with postoperative pain management. European Journal of Pain
, 5, 125-135.
Terry, R. A. (2000). Pain Assessment:The Fifth Vital Sign. Retrieved March 2, 2007, from http://www.rn.ca.gov/practice/pdf/npr-b-27.pdf
Tse, M. M. Y., & Chan, B. S. H. (2004). Knowledge and attitudes in pain management: Hong Kong nurses’perspective. Journal Palliative Care Pharmacother, 18(1), 47-58.
Tzeng, J. I., Chou, L. F., & Li. C. C. (2006). Concerns about reporting pain and pain analgesics among Taiwanese postoperative patients. Journa of Pain, 7(11), 860-866.
Uchiyama, K., Kawai, M., Tani, M.; Ueno, M.; Hama, T., & Yamaue, H. (2006). Gender differences in postoperative pain after laparoscopic cholecystectomy. Surgical Endoscopy, 20(3), 448-451.
Van Niekerk, L. M.,& Martin, F. (2001). Tasmanian nurses’ knowledge of pain management. International Journal of Nursing Studies
, 38 ,141-152.
Watts, G. (2004). Global Year Against Pain. Retrieved March 2, 2007, from http://www.iasp-pain.org/AM/Template.cfm?Section=2004_2005_Right_to_Pain_Relief1&Template=/CM/HTMLDisplay.cfm&ContentID=2847
Williamson, A., & Hoggart, B. (2005). Pain : A review of three commonly use Pain Rating Scales. Journal of Clinical Nursing, 14, 798-804.
Wu, C. L., & Fleisher, L. A. (2000). Outcomes research in regional anesthesia and analgesia. Anesthesia and Analgesia, 91, 1232-1242.
World Health Organization (2007). WHO’s pain ladder. Retrieved March 2, 2007, From http://www.who.int/cancer/palliative/painladder/en/
Zalon, M. L. (1997). Pain in frail, elderly women after surgery. Journal of Nursing Scholarship, 29(1), 21-6.
Zhang, C. H., Zou, B. R., Li, J. F., & Huang, J. (2008). Effedt of pain program on nurse’ pain knowledge, attitudes and pain assessment practices in China. Journal of pain sysptom management, 36(6), 616-627.