Nursing in a Day Surgery - Essay Example

Reflective Assignment - Nursing in a Day Surgery: Nursing is wrought with conflicting duties, in the first instance a nurse must preserve life and dignity but also fulfil the wishes of the patient. In respect to pain management in the patients in a day surgery there is various legal, moral and social implications for a nurse. The following discussion is going to consider the procedural problems of dealing with pain relief whilst ensuring a fast and efficient operation. It is going to ask whether nurses should administer pain relief without the patient's consent; as well as discussing exactly what pain relief is. In order to do this the discussion will first of define pain, because it not objective as many nurses and health practioners may believe. In fact it is a very subjective term. The discussion will end by considering the problems in the UK when dealing with patient's whose wishes are hard to discern and whether we should be administering pain relief methods without proper consent. It is this balance between whether nurses, as myself, should be acting on the wishes of the doctors and the establishment or the patient's wishes and concerns. This is because speed and cost efficiency should not be a determining factor in a patient's health, rather if a person who has varicose vein surgery is more suited for overnight care this should be considered. Pain was found to be the major concern for patients undergoing surgery and they wanted access to information both verbally and through written communication (Taylor. H. 2001). Patients have evinced interest in knowing the details of their recovery and realistic accounts of discomfort that they can expect. Addressing the cognitive component of pain is easily done through patient education (Carr C.J. Ellois. 2001). An audit at the Warwick Hospital found that although patient education booklets were available, the APS refrained from giving out this information. Besides, patients were not consulted in the development of the services (Taylor). H. 2001). Patients usually felt better and less anxious when they knew the cause of the pain (Carr C.J. Ellois. 2001), (Taylor. H. 2001). Research has shown that patients have scant knowledge of pain following a surgery or treatment modalities. In a study 85% claimed that they learnt of pain from friends and family and only 5% indicating getting informed by a nurse professional. Many used past experiences as reference for their expectations. Some studies found that patients had lower expectations of post-surgical pain. Patients also had a number of misconception related to the use of analgesia. This led to under usage of drugs and poor pain management. Understanding these factors can help nurses develop educational manuals for patients and help in better pain management (Taylor). H. 2001). The NIH has given Guidelines for the preparation of patient education and state the all communication must be, "clear, cost-effective, straightforward, modern, accessible, honest and respectful."(DoH, 2001) The Royal College and the Anaesthetic Association reported that 44% of hospitals had some form acute care services and 79% used modern analgesic techniques to manage pain (Carr C.J. Ellois. 2001.) A study of hospital services declares pain prevention to be one of the 10 most important indicators of care quality. (Susan M, 2003) While the need for management is acknowledged, the resources allocated for the function were found to be inadequate. In a significant finding, the Clinical Standards Advisory Group found that although 81% of the functions involve nursing care and 7% of these were headed by nurses there was lack of specialized nursing care in the chronic pain department. The situation was further made worse by inadequate funding. (Pain Society, 2001) Health professionals currently are found to have deficits in knowledge and skills for proper pain management. Nursing care is often found to be influenced by attitude of patients, their culture and value systems. (Redorbit.com, 2006) . The Services for Patients with Pain, in their study in 1999 found that 50% of trusts did not provide pain care services for children and awareness of guidelines were poor (Susan M, 2003) An analysis by Ferrell et al (2000) on the text books used in nursing found that only 0.5% of a total of 50 books was devoted to pain care. In fact nurses have been found to be deficient even in basic mathematical skills that account for the maximum errors in drug dosage calculation. Some patients remain passive and dependant many take active measures to remedy or live with to lead productive lives. In either case the relationship between patients and health professionals are of prime importance to improve outcomes. Eccleston et al (2003), addressing pain management in young people, stresses the importance of a multidisciplinary approach to pain management. Ideally the team should share clinical experiences and work on perceived/observed deficits. The role of family support to patients is pivotal to recovery says the study. To meet the challenges of Pain management, the Royal College of General Practitioners and the Pain Society under the banner "Control pain, live life," have made the following pledges to help patients in persistent pain. These patient centric pledges are: Active involvement in management of their pain Timely assessment of their pain Access to appropriate management and support Relevant information Access to adequate resources and facilities. Coleman and Booker-Milburn, say that a dedicated pain care nurse can address, "deficiencies in knowledge of pain management among ward staff and patients. " (Coleman and Booker-Milburn, 1996). Nursing professionals hence form an integral part in a management team, as they are often responsible for assessment, administering interventions and assessing effectiveness of care. Their observation and inferences can be valuable in altering the type, extent and the need to individualize of care given for patients with chronic pain/acute pain. The paper provides insights into various aspects of pain management to a nursing professional. Some examples of practices successfully followed by professional organizations have also been sited. The Royal College of Anaesthetics and the Pain Management Services have together drafted some recommendations for good practices in pain management. In general the committee advocates the need for acute pain management services in all hospitals and chronic pain management services in district general hospitals and most specialized hospitals and special pain services in specialized hospitals. They also emphasise the need for an interdisciplinary approach and the importance of good liaison between activities of different professionals and healthcare groups assisting in the pain management services. Hospitals are to allocate adequate and appropriate resources in the form of manpower, facilities, infrastructure and equipment. The services should offer quality care to all sections of the people without bias to economic, social or ethnic differences. Special attention should be given to understand people with language barriers, those unable to vocalize pain and patients with special needs. The mandate also stresses the need for framing a programme that will educate the patient and also prevent abuse of the system by the patient. Assessments and audits are also included as an integral part of pain management services. Acute pain may develop post-surgically or non-surgically as in the case of back pain, burns, trauma and so on. Between 1994-2000 after pain care services have been introduced, the number of children alone in acute pain services has gone from 60 -120 patients per month (Susan M, 2003). Unrelieved acute pain is a pre-disposition for chronic pain. Managing acute pain leads to lessened hospital days, lowering GP visits, better recovery and avoiding the development of chronic pain. As a wide range of drugs and interventions are available for managing acute pain, adequate well-trained professionals must be available to administer the complex interventions. The committee's recommendations for Acute Pain Management include (quoted from the report): "a. Establishment of a system for regular assessment and individual treatment of acute pain. b. Provision of specialist care and advice for difficult acute pain problems such as occur in patients already taking strong analgesics for cancer pain or chronic non-cancer pain, and for patients who are problem drug users. c. Seamless liaison with other healthcare teams responsible for the shared care of patients with acute pain. d. Provision of back-up arrangements, education programmes and appropriate guidelines or protocols to ensure that there is continuous cover for acute pain management round the clock, seven days a week. e. Information, education and reassurance for patients presented in a way that they understand. f. Education for nursing, medical staff and other allied healthcare professionals leading to increased awareness of the consequences of unrelieved acute pain and of the techniques available to relieve pain. g. Continuing audit and evaluation of the service and the needs of patients." (RCA & Pain Soc., 2003) The committee describes the role of nursing personnel in paragraph 2.8c of the guideline, "There should be clinical nurse specialists to advise on pain management and to undertake a programme of regular review of acute pain problems have defined the role of the nursing personnel in acute pain. The nurse specialists should undertake education of nursing colleagues informally in clinical areas and as part of a formal educational programme for all disciplines in conjunction with medical colleagues. The nurse specialists should also be responsible for the day-to-day organisation of the acute pain service." Paragraph 2.18 defines good acute pain management when recovery is quick, complications few and hospital stay minimal Pain has an influence on physical, psychological and emotional parts of patient. Pain management therefore needs a multi-disciplinary team for success. All reports highlight the need for better understanding of guidelines, clinical practices, patient perspective, deficits of the system and also identifies the areas for change by nurses involved in caring for patients with pain. The working part recommends the honing of nurses to become the principle caretakers of patients in pain in order to cut costs. This makes nurses the principle caregiver and shifts the onus of pain care from doctors to nurses. It is therefore pertinent for nurses to implement strategies as recommended by guidelines and involve themselves in continuing education that will enable them to serve better. Nursing will address issues on change management in pain care and enable the shaping of better pain management in the UK. Bibliography: Anaesthesia UK (2006). Assessment of acute and chronic pain.[URL] http://www.villapissouri.com/article.aspxarticleid=100549 Audit Commission (1998) Managing Pain after surgery. A Booklet for nurses. 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