Pain Assessment and Management within the Elderly Population - Essay Example

Running head: PAIN ASSESSMENT Pain Assessment and Management within the Elderly Population You’re Table of Contents Introduction………………………………………………………………………….4 Chapter 1 Approaches to the Management of Pain in the Elderly………...……………………5 Chapter 2 Pain Assessment Tools………………………………………………………………9 Conclusion…………………………………………………………………………..12 Bibliography………………………………………………………………………...15 Abstract Within the realm of healthcare and with particular focus on the elderly and their needs within a medical environment, there is particular concern on how to facilitate ways in which to properly manage their pain levels. Many ideas have developed in this area with music therapy, therapeutic touch, and holistic therapies being among the nursing theorizations utilized in deciphering ways in which to correctly alleviate and manage the level of pain of the elderly patient. This research focuses on this area and discusses various ways in which pain is managed most effectively over the elderly. Also, a brief idea of how the cost of elderly career affects the realm of healthcare is mentioned to give credence to the fact that incurred costs often play a role in the type of treatment that the elderly patients receive and in what they receive in the assessment and management of their pain. Also, there are concerns about the social psychological and environmental needs of the elderly as well. All of these pertinent issues are discussed so that a better enlightenment can be illustrated in what exactly caring for the elderly patient entails in a nursing practice, specifically within a medically facilitated environment. The conclusion demonstrates that despite the fact that care of the elderly can be more complex and costly they are entitled to the same rights as any other patient and deserve to have effective and appropriate pain management given to them to provide them with the best quality care and comfort level possible. This is the goal of any nurse in the medical field in regards to any and all patients which the finality of this literature defines. Pain Assessment and Management within the Elderly Population Introduction Pain is something that is experienced by every human being regardless of their age, gender, or economic status. The theory in behind pain is more than one; in fact there are three theorizations to provide a medical definition of pain. However, pain is normally described as an unfavorable experience that creates an extensive emotional and disabling influence on an individual, especially within the elderly population. The three theories of pain are the Specificity theory, Pattern theory, and Gate theory (Adams & Bromley 1998). It is the Gate Theory that is commonly used in medical terminology to discuss the pain levels of the elderly. This is because this theory focuses on many past experiences that older people have had while receiving medical care and of which dictates how they will perceive their ability to tolerate pain during their treatment. For instance, it is the only theory that takes into account psychological factors of pain experiences and therefore is relevant to the older population group (Adams & Bromley 1998). Research has shown that experiences of pain are directly influenced by the many physical and psychological factors that correlate with this identity. These include individual beliefs, prior experiences, motivation, emotional aspects, and anxiety and depression levels. All of these factors including the biological ones plus the psychological ones all affect the interpretation that an elderly patient has on what level of pain that they experience, therefore the nurse needs to be sensitive to this area and work with the elderly patient in calming their fears and providing ways in which their pain is properly managed. To properly ascertain the needs of an elderly patient it is becoming more and more obvious that efficient medical screening needs to be carried out in order to correctly assess the pain levels and the other health concerns that the elderly patient might have (Lippincott 1999). Of course nurses have an obligation to all patients and the type of care that they give, especially with emphases to the techniques that are used to keep pain in check and to ensure the patient is adequately medicated to provide comfort from pain. In this regard nurses have had a long standing role in providing care, such as management of pain to those in a hospital or medical environment for many years, with their services being some of the most detrimental to the outcome of the elderly patient in particular. Nursing, which has been recognized as a dedicated and noble profession is highly difficult to define due to the extensiveness that is related to the field and the constantly changing scope of its functions, in direct relation to the care and management of elderly patients. For the initial phase of nursing, the profession has transformed since the period of 1859 when Florence Nightingale defined nursing in these terms: “The goal of nursing is to put the patient in the best condition for nature to act upon him or her, primarily by altering the environment” (Nightingale 1969). Within elderly care, Nightingale’s philosophy seems to be one of the most favorable in caring for the elderly because the degree of care is more complex and requires extensive management, especially in the management of pain. When Nightingale discusses how the environment can be changed to assist in patient care, nursing today has assumed that to be an essential part of keeping pain levels and comfort levels in check among the patients. Therefore many new ideas have developed such as those of, music therapy, therapeutic touch, and holistic nursing as well (Henderson 1978). Even with the inclusion of techniques such as these the nurse is obviously still the essential person responsible for providing immediate care to the sick (elderly), but as is being evidenced the role has greatly transcended to something more pertinent to the care of the patient than what it once was. Nurses are expected to be more dedicated in alleviating pain and sickness, providing a form of total care with one of the best definitions of this field being formed by Virginia Henderson (1978) who stated: “I say that the nurse does for others what they would do for themselves if they had the strength, the will, and the knowledge. But I go on to say that the nurse makes the patient independent of him or her as soon as possible” (Henderson 1978). It is within the care of the elderly patient that the nurses’ role becomes more fundamental than basically anywhere else in the medical environment as these patients are more fragile and demand more care and pain management than in other areas, which has been stated. Therefore pain management assessments, pain management tools, and the skills of the nurses in particular have to be consisting of accurate and appropriate skill levels in order to achieve the quality of care that is needed for the health facilitation of the elderly patient population in a medically facilitated environment. Chapter 1 Approaches to the Management of Pain in the Elderly Population 1.1 Music Therapy The utilization of music therapy to try and manage pain among the elderly has grown in the last five years. The reason for this is there have been increasing positive affects of its usage among elderly patients who are under surgical care, who are suffering with a terminal illness, or who are battling a disease that promotes chronic pain such as osteoarthritis (Seers & Tutton 2003). In the article by McCraffrey & Freeman (2003) there is clear and concise evidence that music therapy as a pain management tool proves to be highly effective in minimizing pain associative with osteoarthritis in a medical population of the elderly. Not only does the article define music therapy as being beneficial to those who have osteoarthritis but it is highly beneficial for patients who suffer with diseases that bring on chronic pain within a day by day basis as well. Music therapy can clearly motivate individuals more effectively, elevate their moods, and increase their feelings of control in regards to attempting to have some form of say so over their own pain management (McCraffrey & Freeman 2003). For instance with the utilization of a Visual Analogue Scale, observations were made among a group of elderly people within a retirement facility. The results showed that those who sat quietly and listened to their own preferences of music seemed to be unaware at points of any prevalence of pain caused by their diseases progression while those who were left with no such intervention complained more regularly and were requesting narcotics to try and minimize their pain levels. In this regard it seems that music can be something of a comforting experience and holds an aesthetic quality which minimizes a patient’s attention to their pain and helps them to remain calm and relaxed (McCraffrey & Freeman 2003). Of course music therapy is not the only type of alternative form of a pain management tool that could be incorporated to manage and assess pain in patients with more reliable accuracy either. Therapeutic touch following perioperative surgery has been defined as a highly influential way of managing pain as well. Therefore both of these could do well in an acute care setting to properly evaluate, assess, and control pain levels among acute care patients. 1.2 Therapeutic Touch In a literary study by Polit & Hungler (1993) therapeutic touch is defined as an alternative means of pain management which allows the patient to be viewed by more than a sum of parts but as a whole person. This has been found to be imperative in the proper management and assessment of pain control among patients in an acute environment. However, there is often not a strategic implementation such as therapeutic touch among the elderly in this medical area but the research finds that incorporating it would prove to bring an improved outcome for these particular patients. Polit & Hungler (1993) also describe therapeutic touch as a form of pain management that is best utilized following the perioperative period and works by focusing on the energy fields between the patient and the healer, in this case this would be the attending nurse in charge of the patient care. This concept also shows that therapeutic touch is effective in promoting relaxation of the patient and reduces their anxiety levels as well (Polit & Hungler 1993). This changes the elderly patients’ perception of pain which allows for room for the nurse to effectively manage it more proficiently and of which works to restore the body’s natural processes. Basically, the importance of therapeutic touch to nursing is tremendous due to the fact that it provides numerous positive patient experiences. Therefore Polit & Hungler (1993) state that the implementation of this treatment of pain is crucial to try and incorporate into the acute care environment because as studies have shown it is very effective in easing the pain associative with surgical incisions, and also alleviates anxiety prior to surgery of patients as well. A more relaxed patient obviously equals an improved operating experience in the long run. Thereby this technique has been being taught and supported by many nursing schools randomized throughout the UK and specifically in Canada. Although it has extended into a wide range of nursing practices in today’s time it still is non-existent in the acute care environment and again the recommendation would be for it to be phased in to offer nurses a more improved way of monitoring and assessing their patients pain and controlling it to provide improved comfort in the patient care routine. Chapter 2 Pain Assessment Tools Though there exists a lack of pain assessment tools in the acute care environment among hospitalized patients, this section is meant to discuss the possibilities that could incur with the inclusion of the proper pain assessment tools for nurses who work in acute care. One type of medical procedure where patients are often monitored following the surgical procedure is Coronary Artery Bypass Grafting. Often patients suffer severe pain following this procedure and therefore there could exist ways to improve in this with the right form of pain assessment tools, which has been stated (Finklemeier 1995). Within this type of medical situation the communication between the surgical nurse and attending nurse is the main factor in guaranteeing the patient is monitored closely, as well as keeping vigilance for physical signs of severe pain. Of course, the patients’ pain level is one of the primary concerns and it is definitely a controlling factor in the patients recovering health. Normally one of the assessments of pain surrounding patients that undergo this type of medical procedure is through a verbal questionnaire or sometimes written. The patient judges his or her pain according to a number line with 0-4 being minimal pain levels and 5-10 leading to the more severe associations of pain (Mayer et al 2001). Another way in which pain assessments are carried out is by using tools such as preverbal and nonverbal pain assessments for those patients who lack the ability to communicate properly. Self-report techniques are not always available or reliable and in cases such as these a physiological or behavioral measure is used to assess the pain levels of a patient (Adrian 1982). The Pain scale of Pre-verbal and Non-Verbal patients is in a column format which makes it easier for the nurses to tally up the scores in each category that gives the end result of the patients pain level (Adrian 1982). This pain assessment scoring is carried out by observing the behavioral characteristics of the patients or by the nurses own judgment of what they perceive the pain level to be of the patient themselves. If the pain score depicts one that requires an intervention to minimize the pain then this will either be done intravenously by a form of narcotic or an alternative form of therapy might be given such as therapeutic touch and various other possible holistic approaches depending upon what the patients’ preference is in their records. One other pain assessment tool that is commonly utilized is the Wong Baker face scale. This scale is more commonly used among patients who are 3 years of age or younger. The pain is normally assessed by facial characteristics which nurses then use to judge the possible level of pain. It can also be used to acknowledge degrees of pain within patients who can not speak English or those who are cognitively impaired and therefore can not communicate appropriately (Krohn 2002). The scale consists of faces with features from smiles to tears lined with a number or letter indicating pain intensity. Not all medical facilities use this pain assessment tool but it is recommended that it would help assist nurses better determine levels of pain in patients that they are otherwise uncertain as to what degree of pain they might be in (Krohn 2002). All of these mentioned pain assessment tools are felt to be necessary in accurately determining what level of pain any aged patient might be in so therefore it is highly perceptible to assume that even an acute care unit should have pain assessment tools such as these or ones that are similar to their geographic area. Furthermore, the tools that have been discussed are used daily in hospitals throughout the world and they seem to provide highly accurate information for nurses and other medical professionals to work with. It appears that they give nurses in particular highly useful information that makes them excellent tools for measuring not only the elderly patients’ level of pain but children’s level of pain as well. This provides ways for the best management of pain possible, as the research has been attempting to point out. Also, it has been realized that when a young child is in an acute area and they are being assessed on their pain level they often try to mimic the faces that are on the Wong tool which helps nurses decipher their actual level of pain and then manage it appropriately. The same holds true for the elderly who can not communicate or for those who again can not speak English so it is a multi-faceted tool that is worthwhile to implement in all areas of the nursing environment (Krohn 2002). In conclusion, pain assessment and the management of pin is quickly becoming a major part of patient care in the nursing profession. Pain is definitely a significant sign that something is simply not right and if not corrected can adversely affect the patients recovery and possibly their quality of life for the future. Therefore, pain has become the fifth vital sign in the nurse/patient relationship (Krohn 2002). Addressing pain as a vital sign recognizes the importance of pain management as a standard of care for patients which is crucial to the quality of care being given. The tools explained are simple, flexible, and very easy to implement in the nursing routine. Utilization of these tools should assist the nurse in formulating a plan of care that is effective for managing the individual patients’ pain and documenting the results of the care given proficiently and with a compassionate means. References Adams, B. & Brumley, B. (1998). Psychology for Health Care: Key Terms and Concepts. New York: MacMillian Press Publications. Finklemeyer, Betsy. (1995). Cardiothoracic Surgical Nursing. Journal of Advanced Nursing, 101. Henderson, V. (1978). Principles and Practices of Nursing. New York: McMillian Publications. Krohn, B. (2002). Using Pain Assessment Tools. Nurse Practitioner 27, Issue 10. Lippincott, Vincent. (1999, July). Role of the Male Nurse. Journal of Advanced Nursing, 63, 70. Mayer, D. & Torma, L. & Bycock, I. & Norris, K. Speaking the Language of Pain. American Journal of Nursing, 101, 44. McCraffrey, Ruth & Freeman, Edward. (2003). Effect of Music on Chronic Osteoarthritis Pain in Older People. Journal of Advanced Nursing 44, 517-524. Nightingale, F. (1969). Notes on Nursing: What it is and What it is Not. New York: Dover Publications. Polit, D. F. & Hungler, B. P. (1993). Essentials of Nursing: Research Methods, Appraisal, and Utilization. (3rd Edition) Philidelphia: J. B. Lippincott Publications. Seers, Kate & Tutton, Elizabeth (2003). An Exploration on the Concept of Comfort. Journal of Clinical Nursing 12, 689-696. Read More