The Best Method in Managing Chronic Pain - Research Proposal Example

Proposal The Best Method of Managing Chronic Pain Among Older Adult Patients – - The Correlation between Pharmacological and NonpharmacologicalTreatment in Managing Chronic Pain with the Nurse-Patient Relationship – Terry C. Scott William Carey University, Hattiesburg, Mississippi Summer 2007 Title: ‘The Best Method in Managing Chronic Pain Among the Older Adult Patients’‘The Correlation between Pharmacological and Nonpharmacological Treatment in Managing Chronic Pain with the Nurse-Patient Relationship’ Purpose: The purpose of the research study is to highlight the impact of nurse-patient relationship in managing chronic pain based on literature review (Dewar, 2005) as well as determining the importance of quality care and pain management procedures based on a research study conducted on different locations and health care settings. The findings of the study will be used as a guide for nurses in terms of improving their management skills on older adult patients suffering from chronic pain. Purpose: For this study, the purpose will be to determine the most effective chronic pain management strategies perceived by elder patients. This information may be used to develop nursing education programs for improved pain management in this population. Problem Statement: This is intro/significance/lit review type stuff. A problem satement, often in the form of a question, is a broader expression of the problem to be studied in your study. Can those pain management strategies perceived as most effective by elderly patients with chronic pain be determinded. Chronic pain management among the older patients is one of the main responsibilities of the nurses that has a high prevalence of treatment failure among the older person. (Pitkala et al., 2002; Ferrell et al., 1990) The study will determine the different chronic pain management method provided in nursing homes and tertiary hospitals within the urban and rural areas. Problem Statement: Is nurse-client relationship in management of pain perceived by elderly patients to be the most effective pain management strategy with chronic pain? Significance of the Problem This is good. Chronic pain among the elderly patients could affect five dimensions in the life of the patient(s) including: physical, psychological, emotional, social, and spiritual. Thus, affecting their physical functioning such as: the ability to perform activities of daily living (ADLs) – an important form of exercise among the patients (Dewar, 2005); health and appetite (Bosley et al., 2004); and sleep (Ross and Crook, 1998; Ferrell et al., 1990). For this reason, chronic pain is considered as the major contributor of degraded quality life, reduced well-being, and physical disability among the elderly patients. (Schofield, Ryan, and Clarke, 2006; Kendig, Browning, and Young, 2000; Scudds and Robertson, 1998) Determining the best method on how to alleviate chronic pain among the older patients is important to the nursing profession. In line with finding the best method, the problem statement of the research study will give way for the author(s) to express and remind the nurses that building a good interpersonal relationship with the patients will help in managing the chronic pain among the elderly patients. Theoretical / Conceptual Framework A conceptual framework attempts to explain a phenomenon. You need to look at theorists that fit your study. I’d look at Orem, In a real study, you’d use a primary source but for this assignment, you can use a text to describe a theory. The research study will give emphasis on the different approaches to chronic pain management given to the elderly patients within the nursing homes and tertiary hospitals. Theoretical / Conceptual Framework Orem theory focuses on the uniqueness and nature of nursing. (Orem and Taylor, 1986) Orem emphases the importance of the theory of Nursing System (Eben et al., 1994); wherein the role of the nurse is to facilitate and increase in motivation and self-care abilities of the patient. (Chang, 1980) Since nurses take into consideration the health beliefs of the patient when planning nursing care, nurses could find the most appropriate way in motivating the patients to think positively concerning the patients’ illness or pain. The regular interaction between the nurse and the patient could eventually release the emotional burden from the patients. Terms to be Defined chronic pain – pain with unknown cause that lasts longer than 3 months. activities of daily living – routinary activities that people do everyday without needing assistance. i.e. bathing, dressing, toileting, walking, eating, etc. well-being – the state of being healthy and free from experiencing pain pharmacologic pain treatment – a complex and implies a variety of different compounds, from opioids to psychotropic medications like antidepressants and anti-convulsivants non-pharmacologic pain treatment – pain treatment options that do not use drugs such as relaxation techniques like yoga and meditation used to decrease muscle tension and reduce stress elderly – individuals more than 65 years of age perceived effectiveness – refers to personal and voluntary acceptance regarding the effectiveness of a treatment method Research Question What is the best chronic pain management for the elderly patients? Is there a difference between the chronic pain management practices provided by the nursing homes and tertiary hospitals situated within the urban and rural areas. Research Question What are the chronic pain management interventions perceived as the most effective by elderly patients with chronic pain? Literature Review You have to do a lit review. You did this under significance. Combine the two. The literature reviews will discuss concerning the nature of chronic pain, several reasons that makes the elderly patients more prone to such pain; the differences between the assessment and management method used in nursing homes and tertiary hospitals; and factors that contributes to such differences will be elaborated and discussed. Ranging from the most to the least important: (1) differences between the assessment and management method used in nursing homes and tertiary hospitals; (2) factors that contributes to such differences; (3) the nature of chronic pain; and (4) several reasons that makes the elderly patients more prone to such pain. Literature Review Chronic pain management among the older patients is one of the main responsibilities of the nurses with a high prevalence of treatment failure among the older person. (Pitkala et al., 2002; Ferrell et al., 1990) An estimated 176,950 chronic pain patients seek for treatment in pain centers within the United States each year. (Marketdata Enterprise, 1995) For many years, health care providers are using two ways in managing chronic pain: pharmacological and non-pharmacological treatment. Up to the present time, there is no single treatment use to provide a long-term improvement in pain management. (Flor, Fydrick, and Turk, 1992) Most of the elderly patients that are experiencing chronic pain are diagnosed with multiple diseases. Chronic pain among the elderly patients with diabetes could contribute to a lot of psychological distress and physical disability. (Stewart, 2003; Blair et al., 2003; Smith et al, 2001) Chronic pain experiences affects the lifestyle of the patients and are perceived barriers to their activities of daily living. (Bayliss et al., 2003) A study has shown that the use of ketamine in chronic pain management could cause a significant adverse side-effects on elderly patients. (Hocking and Cousins, 2003) It is proven that not all patients with nociceptive and/or neuropathic pain could respond with the use of ketamine. Younger patients with a shorter history of chronic pain responds better with the drug as compared with elderly patients. (Mathisen, Skjelbred, and Skoglund, 1995) For some patients, the use of this drug provides only a short-term solution in alleviating chronic pain. Concerning the use of pharmacologic treatment, some patients with chronic pain experience substance abuse and dependency on drugs. In most cases, these individuals are taking high doses of opioid and benzodiazepines. (Kouyanou, Pitcher, and Wessely, 1997) In line with the use of opioids, a research study has concluded that opioid therapy is associated with the loss of effectiveness over time. (Mouline et al., 1996) Nonpharmacologic alternatives are widely used as an alternative form of remedies to conventional analgesic drugs for the management of chronic pain. (White, Li, and Chiu, 2001) The practice of using electrical stimulation such as electroanalgesia in controling pain is proven to be effective. However, complication related to wound infection and epidural abscess, bleeding and equipment failure could affect the positive outcome with the use of this device. (Kumar et al., 1998) On the other hand, based on the clinical experience with the use of Percutaneous Electrical Nerve Stimulation (PENS) in back pain, sciatica, headaches, and diabetic neuropathic pain could improve the patients’ functional status and quality of sleep by decreasing the severity of postherpetic neuralgic symptoms. (Ahmed et al., 1998) Other nonpharmacological treatment includes the use of Transcutaneous Electrical Nerve Stimulation (TENS), Transcutaneous Acupoint Electrical Stimulation (TAES), H-Wave Therapy (HWT), Interferential Current Therapy (ICT), and Piezo-Electric Current Therapy (PECT). (White, Li, and Chiu, 2001) There are instances wherein the patients are having difficulty in understanding the importance of pain management treatment which makes them less participative with engaging in new treatments. In order to minimize the gap between the patients’ reluctance in participating in treatment, it is necessary to optmize the interaction and relationship between the nurses and the patients in order to solve the problem in pain management. (Gask, 2006) Research Design As part of a larger study, developing and testing the pain management practices done among the older adult patients within twelve different health settings – six nursing homes and six tertiary hospitals will be conducted. (Clark, Jones, and Pennington, 2004) Half of the nursing homes and tertiary hospitals will come from urban areas and the other half will be conducted in the rural areas. (Clark, Jones, and Pennington, 2004) Using group interview and questionnaire survey forms, the study will gather relevant data to come up with a qualitative and descriptive design in studying the existing pain assessment within the different health settings. Use a descriptive correlational design. Go to a couple of nursing homes. Get permission to conduct your study. Interview nurses to find out which patients have chronic pain and what is done for them. Interview the patients to see which ones they perceive as most effective. Ask them how to rate the pain on a numeric scale when it’s at its worst. Ask to rate the pain after the interventions and how it effects ADLs. Use descriptive statistics to describe your sample. Use correlational statistics to make decisions on which are perceived as more effective in terms of pain relief and improvement in ADLs. Research Design A descriptive correlational design will be used to measure the effectiveness of the different pain management practices applied to the older adult patients in two separate nursing homes. Permission to conduct the study will be obtained from the person-in-charge of the nursing home. Chronic pain can either be classified as general somatic pain – pain from outer body particularly the skin; visceral pain – pain from internal organs; bone pain such as bone cancer, osteoporosis, and osteomyelitis; muscle pain such as muscle cramps; peripheral neuropathy – pain related to nerves, circulatory problems such as rheumatoid arthritis, and headaches. As part of the study, the researcher will interview nurses to determine which among the patients have chronic pain and what is done for them. Using a questionnaire survey forms, the study will conduct a personal interview with the patients to identify which pain treatment method they perceive as the most effective. Patients that are experiencing chronic pain will be ask to rate the pain on a numeric scale of 1 – 10 including the instances when they experience the worst pain. Using the same numeric scale, patients will be requested to rate the pain after the nursing interventions particularly the use of pharmacological treatment and non-pharmacological treatment such as a good nurse-client relationship and how it affects their activities of daily living. The study will use a descriptive statistics to describe the sample gathered. Based on the correlational statistics result, the researcher will make decisions regarding which among the pain chronic management treatments are perceived as more effective in terms of pain relief and improvement in ADLs. Data Collection Method / Instrument(s) See above but must comment on pain scale used and validity/reliability. A total of twelve different health settings – six nursing homes and six tertiary hospitals will be randomly selected to participate in the research study. Half of the nursing homes and tertiary hospitals will come from urban areas and the other half will be conducted in the rural areas. Collecting the data from nursing homes and tertiary hospitals within the urban areas and rural areas will be accomplished within 40 days. It will enable the researchers to determine the quality care, nurse-patient relationship in managing chronic pain, and pain management procedures conducted from different location and health settings. The data collection for the study will be divided into two processes: (a) initial group interview with the organization staff; and (b) selecting qualified patients to answer the survey questionnaires. During the first day of meeting, the research team will conduct a group interview with the organization staff to discuss about the pain management conducted within the health setting. The entire interview will be recorded to ensure that the research team has every detail of the interview. It will also provide the research team the step-by-step management procedure – both pharmacologic and non-pharmacologic pain treatment approaches (Bernabei et al., 1998; American Pain Society, 1995) used within the health care setting. After the initial interview, the research team will collaborate and design a questionnaire for the patients based on the gathered data during the initial interview with the organization staff. The questionnaires will be designed using simple words to ensure that the patients understand each questions being asked in the questionnaire. The questions will focus more on the patients’ perception whether or not the pain assessment and management provided to them is effective or not. As soon as the questionnaire is ready, the research team will select qualified patients to fill-up the questionnaires. Participants that are not able to read and write will be guided by one of the research team through a personal interview. The recommended range of participants for the questionnaires is between 6 to 12 for each health care setting. (Stewart & Shamdasani, 1990) The research team will design the questionnaire after conducting the initial interview with the organization staff since it is possible that new ideas would arise after conducting the interview. This information would be useful for the completion of the study. The first designed questionnaire will be used for the rest of the health care settings within the urban and rural areas in order to maintain the uniformity of the information gathered. Keep it simple. Data Collection Method / Instrument(s) The data collection for the study will be divided into two processes: (a) initial group interview the nurses; and (b) selecting qualified patients to answer the survey questionnaires. First, the research team will conduct a group interview with the interview nurses to determine which among the patients have chronic pain and what is done for them. This will be recorded to ensure that the team has every detail of the interview. This information will provide the team the step-by-step management procedure – both pharmacologic and non-pharmacologic pain treatment approaches (Bernabei et al., 1998; American Pain Society, 1995) used in the nursing home. After the initial interview with the nurses, the research team will collaborate and design a questionnaire for the patients based on the gathered data during the initial interview with the organization staff. The types of chronic pain such as general somatic pain, visceral pain, bone pain, muscle pain, peripheral neuropathy, circulatory problems, and headaches will be included in the survey form in order to identify the types of pain these patients are experiencing. In a numeric scale of 1 – 10, the questionnaire the qualified participants will be asked to rate the instances when they experience the worst pain. Using the same numeric scale, patients will be requested to rate the pain after the interventions and how it affects their activities of daily living. Simple words to ensure that the patients understand each questions being asked in the questionnaire. The questions will focus more on the patients’ perception whether or not the pain assessment and management provided to them is effective or not. As soon as the questionnaire is ready, the research team will approach qualified patients to fill-up the questionnaires. Participants that are not able to read and write will be guided by one of the research team through a personal interview. The recommended range of participants for the questionnaires is between 6 to 12 for each health care setting. (Stewart & Shamdasani, 1990) A descriptive statistics will be used to describe the sample gathered. A correlational statistics will be used to measure the gathered information. Data Analysis See above. All data gathered will be analyzed using the SPSS. The descriptive data will be presented in percentage form using means and standard deviations. On the other hand, the differences in location and health care settings will be assessed using chi-square tests (ANOVA or ANCOVA). Data Analysis The researcher will analyze the correlational statistics result in making decisions regarding which among the pain chronic management treatments are perceived as more effective in terms of pain relief and improvement in ADLs. Cost / Feasibility Analysis The estimated cost analysis for the study is roughly US$ 2,200. (See Table I – Estimated Cost of Research Study below) Assumptions / Limitations Assumptions ar those things that researcher has to assume to be true so can conduct research. For the purposes of this study the following assumptions will be made. The patients will rate pain accurately. Patients will describe changes in ADLs accurately. Chronic pain can be managed more effectively. Inteventions are performed to standard. Limitations will be as follows. Patients may not report data accurately. Small sample size. Patient mortality. The research study will provide a better idea on how nurses from different health care settings could effectively participate in managing chronic pain among the older patients. However, the study is limited in terms of addressing the effects of the identified best method in managing chronic pain effects on older patients with that are cognitively impaired. Assumptions / Limitations For the purposes of this study the following assumptions will be made. The patients will rate pain accurately. Patients will describe changes in ADLs accurately. Chronic pain can be managed more effectively. Nursing interventions are performed within the accepted standard. The limitation of the study includes the fact that patients may not report data accurately. Considering the small sample size of the data, the study is limited in addressing the concerns of elderly patients pain management within a different health care setting. Specifically the patient mortality rate related to chronic pain is subject to further study. Conclusion In conclusion, the researcher proposed a study will correlate the difference between the use of pharmacological and nonpharmacological treatment in managing chronic pain with the nurse-patient relationship in order to determine the significant effect of nurse-patient relationship in alleviating pain among the elderly patients. eferences: American Pain Society Quality Care Committee (1995) ‘Quality Improvement Guidelines for the Treatment of Acute Pain and Cancer’ Journal of the American Medical Association, 274(23), 1874 – 1880. Bernabei et al. (1998) ‘Management of Pain in Elderly Patients with Cancer’ Sage Study Group. Systematic Assessment of Geriatric Drug use via Epidemiology. Journal of the American Medical Association, 279, 1877 – 1882. Bosley, B.N. et al. (2004) ‘Is Chronic Non-malignant Pain Associated with Decreased Appetite in Older Adults: Preliminary Evidence’ Journal of the American Geriatric Society, 52(2): 247 – 251. Clark L., Jones K., and Pennington K. (2004) ‘Pain Assessment Practice with Nursing Home Residents’ Western Journal of Nursing Research, 2004, 26(7), 733 – 350. Dewar, A. (2005) ‘Assessment and Management of Chronic Pain in the Older Person Living in the Community’ Australian Journal of Advanced Nursing. 2006, Vol. 24, No.1. pp. 33 – 38. Ferrell et al. (1990) ‘Pain in the Nursing Home’ Journal of the American Geriatric Society, 38(4); 409 – 414. Kendig H., Browning C.J., and Young A.E. (2000) ‘Impacts of Illness and Disability on the Well-being of Older People’ Disability and Rehabilitation, 22, 15 – 22. in Edwards, R. (2006) ‘Age Differences in the Correlates of Physical Functioning in Patients with Chronic Pain’ Journal of Ageing and Health, Vol. 18, No. 1, February 2006, pp. 56 – 69. Pitkala et al. (2002) ‘Management of Nonmalignant Pain in Home-Dwelling Older People: A Population-based Survey’ Journal of the American Geriatrics Society, 50(11): 1861 – 1865. in Dewar, A. (2005) ‘Assessment and Management of Chronic Pain in the Older Person Living in the Community’ Australian Journal of Advanced Nursing. 2006, Vol. 24, No.1. pp. 33 – 38. Ross, M.M. and Crook, J. (1998) ‘Elderly Recipients of Home Nursing Services: Pain, Disability, and Functional Competence’ Journal of Advanced Nursing, 27(6):1117 – 1126. Schofield P., Ryan T., and Clarke A. (2006) ‘The Experiences of Older adults in Pain: A Literature Review’ Journal of Community Nursing. November 2006, Vol. 20, Issue 11. pp. 4 – 9. Scudds, R.J. and Robertson, M.D. (1998) ‘Empirical Evidence of the Association between the Presence of Musculoskeletal Pain and Physical Disability in Community-Dwelling Senior Citizens’ Pain, 75, 229 – 235. in Edwards, R. (2006) ‘Age Differences in the Correlates of Physical Functioning in Patients with Chronic Pain’ Journal of Ageing and Health, Vol. 18, No. 1, February 2006, pp. 56 – 69. Stewart, D.W. & Shamdasani, P.N. (1990) ‘Focus Groups: Theory and Practice’ Newbury Park, CA: Sage. in Clark L., Jones K., and Pennington K. (2004) ‘Pain Assessment Practice with Nursing Home Residents’ Western Journal of Nursing Research, 2004, 26(7), 733 – 350. References: Ahmed, H.E. et al. (1998) ‘Percutaneous Electrical Nerve Stimulation: An Alternative to Antiviral Drugs for Acute Herpes Zoster’ Anesth Analg 1998;87:911 – 914. American Pain Society Quality Care Committee (1995) ‘Quality Improvement Guidelines for the Treatment of Acute Pain and Cancer’ Journal of the American Medical Association, 274(23), 1874 – 1880. Bernabei et al. (1998) ‘Management of Pain in Elderly Patients with Cancer’ Sage Study Group. Systematic Assessment of Geriatric Drug use via Epidemiology. Journal of the American Medical Association, 279, 1877 – 1882. Bayliss, E.A. et al. (2003) ‘Descriptions of Barriers to Self-Care by Persons with Comorbid Chronic Diseases’ Ann Fam Med. 2003;1:15 – 21. Blair, M.J. et al. (2003) ‘Depression and Pain Comorbidity: A Literature Review’ Arch Intern Med. 2003;163:2433 – 2445. Bosley, B.N. et al. (2004) ‘Is Chronic Non-malignant Pain Associated with Decreased Appetite in Older Adults: Preliminary Evidence’ Journal of the American Geriatric Society, 52(2): 247 – 251. Chang, B. (1980) ‘Evaluation of Health Care Profesisonal in Facilitating Self-Care: Review of the Literature and a Conceptual Model’ Advances in Nursing Science 3(1):43 – 58. Dewar, A. (2005) ‘Assessment and Management of Chronic Pain in the Older Person Living in the Community’ Australian Journal of Advanced Nursing. 2006, Vol. 24, No.1. pp. 33 – 38. Eben, J.D. et al. (1994) ‘Self-Care Deficit Theory of Nursing’ in Nursing Theorists and their Work. 3rd Ed. Marriner-Tomey, A. (Ed.) Mosby, St. Louis, pp. 181 – 198. Edwards, R. (2006) ‘Age Differences in the Correlates of Physical Functioning in Patients with Chronic Pain’ Journal of Ageing and Health, Vol. 18, No. 1, February 2006, pp. 56 – 69. Ferrell et al. (1990) ‘Pain in the Nursing Home’ Journal of the American Geriatric Society, 38(4); 409 – 414. Flor H., Fydrick T., and Turk, D. (1992) ‘Efficacy of Multidisciplinary Pain Treatment Centers: A Meta-Analytic Flow’ Pain 1993;49:221 – 230. Gask, L. (2006) ‘Qualitative Study of an Intervention for Depression among Patients with Diabetes: How Can We Optimize Patient-Professional Interaction?’ Chronic Illness. 2006;Vol.2,No.3:231 – 242. Hocking, G. and Cousins, M. (2003) ‘Ketamine in Chronic Pain Management: An Evidence-Based Review’ Anesth Analg 2003;97:1730 – 1739. Kendig H., Browning C.J., and Young A.E. (2000) ‘Impacts of Illness and Disability on the Well-being of Older People’ Disability and Rehabilitation, 22, 15 – 22. in Kouyanou K., Pitcher C.E., and Wessely S. (1997) ‘Medication Misuse, Abuse, and Dependence in Chronic Pain Patients’ J.Psychosom Res. 1997;43:497 – 504. Kumar, K. et al. (1998) ‘Epidural Spinal Cord Stimulation for Treatment of Chronic Pain: Some Predictors of Success – a 15 – year Experience’ Surg Neurl 1998;50:110 – 121. Marketdata Enterprise (1995) ‘Chronic Pain Management Programs: A Market Analysis’ Valley Stream, NY: Market Data Enterprises, 1995. Mathisen L.C. et al. (1995) ‘Effect of Ketamine, and NMDA Receptor Inhibitor in Acute and Chronic Orofacial Pain’ Pain. 1995;61:215 – 220. Mouline, D.E. et al. (1996) ‘Randomized Trial of Oral Morphine for Chronic Non-Cancer Pain’ Lancet 1996;347:143 – 147. Orem, D.E. and Taylor, S.G. (1986) ‘Orem’s General Theory of Nursing’ in Case Studies in Nursing Theory of Winstead-Fry P. (Ed.). National League of Nursing, New York, pp. 37 – 71. Pitkala et al. (2002) ‘Management of Nonmalignant Pain in Home-Dwelling Older People: A Population-based Survey’ Journal of the American Geriatrics Society, 50(11): 1861 – 1865. in Dewar, A. (2005) ‘Assessment and Management of Chronic Pain in the Older Person Living in the Community’ Australian Journal of Advanced Nursing. 2006, Vol. 24, No.1. pp. 33 – 38. Ross, M.M. and Crook, J. (1998) ‘Elderly Recipients of Home Nursing Services: Pain, Disability, and Functional Competence’ Journal of Advanced Nursing, 27(6):1117 – 1126. Schofield P., Ryan T., and Clarke A. (2006) ‘The Experiences of Older adults in Pain: A Literature Review’ Journal of Community Nursing. November 2006, Vol. 20, Issue 11. pp. 4 – 9. Scudds, R.J. and Robertson, M.D. (1998) ‘Empirical Evidence of the Association between the Presence of Musculoskeletal Pain and Physical Disability in Community-Dwelling Senior Citizens’ Pain, 75, 229 – 235. in Edwards, R. (2006) ‘Age Differences in the Correlates of Physical Functioning in Patients with Chronic Pain’ Journal of Ageing and Health, Vol. 18, No. 1, February 2006, pp. 56 – 69. Smith, B.H. et al. (2001) ‘The Impact of Chronic Pain in the Community’ Fam Pract;2001:18:292 – 299. Stewart, W.F (2003) ‘Lost Productive Time and Cost Due to Common Pain Conditions in the U.S. Workforce’ JAMA. 2003;290:2443 – 2454. Stewart, D.W. & Shamdasani, P.N. (1990) ‘Focus Groups: Theory and Practice’ Newbury Park, CA: Sage. in Clark L., Jones K., and Pennington K. (2004) ‘Pain Assessment Practice with Nursing Home Residents’ Western Journal of Nursing Research, 2004, 26(7), 733 – 350. White P.F., Li S., and Chiu J.W. (2001) ‘Electroanalgesia: Its Role in Acute and Chronic Pain Management’ Anesth Analg, 2001;92:505 – 513. Title/Purpose/Problem Statement…. 12/15 Lit Review/Conceptual Framework…22/25 Research Design componentws… 25/30 Data Collection/Analysis/Cost.. 12/15 APA 13/15 Grade 84 Read More