The role of psychological distress in the relationship between the severity of pressure injury and pain intensity in hospitalized adults

Aims To examine the effect of psychological distress in mediating the relationship between the severity of pressure injury and pain intensity in hospitalized adults. Background Despite the prevalence of pressure injury (previously known as pressure ulcers) in hospitalized adults, the current knowledge of pain associated with pressure injury is limited and findings are inconsistent. There is also a lack of understanding of the relationship between psychological distress and pain from pressure injury. Design Retrospective cross‐sectional secondary analysis of data from electronic health records. Methods The data were retrieved from the third day of admission in the period between 2013 ‐ 2016 through the Integrated Data Repository (IDR). Electronic health records were reviewed to collect data as needed. The mediation effect was tested by using path analysis implemented through Mplus. Results Path analysis revealed that the severity of pressure injuries and psychological distress have significant direct effects on pain intensity in hospitalized adults. However, the relationship between the severity of pressure injury and pain intensity was not significantly mediated by psychological distress. Conclusion Hospitalized adults who have more severe pressure injury and more treatments for psychological distress experienced greater pain intensity. Healthcare providers must pay attention to treating psychological distress among hospitalized adults to manage pain. Further study is needed to validate these findings and it should incorporate more appropriate measures of psychological distress. The lack of standardized nursing documentation in electronic health records severely limits the usefulness of data from electronic health records for nursing research. 目的 探讨心理压力对调节成年住院病人压力性损伤严重程度与疼痛程度的关系的影响。 背景 尽管成年住院病人常受压力性损伤(以前称为压力性溃疡)的困扰,但目前对压力性损伤相关疼痛的认识有限,且调研结果不一致。对心理压力和压力性损伤的疼痛之间关系的理解也不足。 设计 对电子健康记录数据进行回顾性横断面二次分析。 方法 通过综合数据存储库(IDR)检索2013‐2016年期间入院病人第三天的数据。对电子健康记录进行了审阅,以便根据需要收集数据。调节效果将通过使用MPlus实现的路径进行分析测试。 结果 路径分析显示,压力性损伤和心理压力的严重程度对成年住院病人感受到的疼痛程度有显著的直接影响。 但压力性损伤的严重程度与疼痛程度之间的关系并不是由心理压力造成的。 结论 如果遭受更严重压力伤害和接受更多心理压力治疗,则成年住院病人的疼痛程度更大。医疗护理提供者必须注意治疗成年住院病人的心理压力从而控制疼痛。这些发现还需进一步研究证实,包括对更适当心理压力治疗措施的研究。由于电子病历缺乏标准化护理文档,严重限制了数据在护理研究中的实用性。