Physiological and Emotional Distress - Essay Example

Assignment NRMW 1004 Introduction to Nursing Practice Pain Physiological and emotional distress is most often caused by one of the many forms of painthat patients and clients may experience. Not only does this make their experience unpleasant, it can result in lasting harm the individual if not relieved (Brooker and Wough 2009). In many different settings from communities to hospital wards, people that are experiencing pain are often those that seek out help or care. Pain also serves a practical purpose, as it is essentially nature’s diagnostic tool. It often gives practitioners and caretakers clues as to the site, intensity, and direction of the cause of the pain, allowing physicians and nurses to more adequately assess the disease process, and take the steps necessary to relieve the patient’s pain. Geriatric patients undergo pain, and which may pose particular challenges in nursing care. The physical, psychological, and social impact of geriatric pain will be highlighted in this study, and the particular issues of pain assessment and management will be explained as related to nursing care.  There is no single definition of pain, as pain can manifest itself in many ways to different patients. Pain may occur in varying levels of severity, and in various parts of the physical anatomy. Many times, pain may also have mental components that must be assessed. Pain often causes distress, and alleviation of patient distress is a primary goal. Measurement of pain and implementing interventions to relieve not only the pain, but also the source of the pain, is an integral part of the caretaker’s role (Glasper, McEwing and Richardson 2009). The aim of this discussion is to provide a definition of pain that is applicable to the care setting, in which consideration is given to the elements of pain that are subjective and complex. Pain is to be evaluated as a multidimensional experience with psychological, physical, emotional, cultural and spiritual ramifications that are each significant and must be considered in order to provide high quality nursing care to patient’s experiences diverse types and levels of pain. A balanced approach to nursing considers the entire scope of pain when assessing a patient or providing treatment.  Almost all nurses will need to interact with geriatric patients at some point in their career. In fact, according to the American Journal of Nursing, contemporary nurses will care for more patients in the age range 65 and older than any other type of patient (“Nursing Care of Older Adults”). In order to achieve an understanding of pain, and thus be able to treat it effectively, it is useful to examine how pain appears in the particular case of geriatric patients. These patients are unique because, unlike trauma and surgery patients, many of these patients are receiving long-term care, allowing the nurse to observe, assess, and treat many different manifestations of pain. Because a diverse number of chronic conditions may cause pain in geriatric patients, learning more about how pain affects these patients may contribute to improving a nurse’s performance with not just geriatric patients, but also with all patients requiring long-term care, who may express recurrent pain conditions. Intuitively, most pain is thought of as a physical occurrence that takes place after an injury. The most obvious definition of pain is a physical sensation of unpleasantness, generally caused by some form of tissue damage (Nerskey and Bogduk). This definition of pain is the most intuitive, as it relates fundamentally to our visible and tactile experiences with pain. To describe briefly the physiology of pain, one must understand the basics of the nervous system. A sensation of pain occurs when chemical sensors in the skin or organs release messages to the peripheral nerves, which connect into the spinal chord, and finally reach the brain. Once in the brain, signals reach the thalamus, which forwards the signal on to specialized regions of the brain known as the somatosensory cortex, the limbic system, and the frontal cortex. The somatosensory cortex lets you know where the pain is coming from. The limbic system generates an emotional response that causes the patient to want to pain to end. Finally, the frontal cortex analyzes the pain to see what it means and determine what action should be taken to lessen or avoid the unpleasant sensation. The brain may also send messages to the spinal chord that cause pain to be intensified or to be ignored ("How You Feel Pain"). In medical terms, this type of pain is referred to as nociceptive pain (Cavalieri 10), or pain caused by stimulation of bodily pain sensors. These principles work the same in all patients with fully functional nervous systems, regardless of age. Pain often serves as an indication that some physical damage is occurring, and it has often become known as the “fifth vital sign” because it can be used to indicate a number of conditions and to alert practitioners when a patient’s condition is changing or worsening (“Pain Management Nursing”). Pain also may alert the patient that a certain part of the body is injured, and it serves the purpose of preventing the patient from doing more damage to fragile tissues (Holden and Winlow 106). When the patient is aware of pain, he or she can alert physicians or nurses; but when a patient ages, certain physical changes may occur that affect the functioning of the nervous system, and so change the way in which patients recognize or respond to pain. One difficulty experienced by geriatric patients is poor responsiveness to certain types of pain, which may result in physical symptoms being overlooked by patients or caretakers. Because of this it is important in providing quality care that symptoms are not overlooked, and any indications—even those that are nonverbal—of pain are acknowledged by the nurse. This can cause common conditions such as bedsores, or edema in extremities or joints when pain fails to warn the patients that tissue damage is occurring. The American Pain Society states that it is “not the responsibility of clients to prove they are in pain; it is the nurses responsibility to accept the clients report of pain” (5). Also, geriatric patients are more likely to have bone and joint disorders, arthritis, cancer, and a variety of other chronic disorders that may be responsible for nervous damage, interfering with the way in which the patient perceives pain (Cavalieri 10). In order to maintain the patient’s activities of daily living with maximum independence, this requires the nurse care taker to pay particularly close attention to patients and their symptoms, even when the patient is not expressing verbal discomfort or pain. Chronic pain occurs when pain is ongoing, or recurring. Generally, pain that lasts longer than six months is medically classified as chronic pain (“How You Feel Pain”). Twenty-five to fifty percent of all geriatric patients experience chronic pain, and many other age groups also suffer with chronic pain (Cavalieri 10). Chronic pain can be caused by a variety of events, such as surgery, infection, or ongoing conditions like arthritis or joint disorders (“How You Feel Pain”). In other cases, chronic pain can be caused by damage that has been done to the spinal or peripheral nerves in the body, essentially causing the brain to think there is pain even when pain receptors are not being stimulated. This type of pain is referred to as neuropathic pain, because its source is damaged nerve fibers, not an injury (“How You Feel Pain”). Pain can also sometimes occur when there is no evidence of injury, disease, or tissue damage. This, however, does not mean that the patient’s suffering is not real or that the patient is simply malingering. This type of pain is referred to as psychogenic pain (“Pain: Assessing…”). In geriatric patients, neurological disorders, such as Alzheimer’s disease among others may cause psychogenic pain. It may cause very real symptoms and major discomfort to the patient, and must be taken seriously by nurses and care takers. Pain can be a social challenge for geriatric patients because it may further distance them from loved ones and make it difficult to complete essential daily activities. Pain may prevent patients from engaging in work or hobbies, communicating, or even simple actions such as grooming, feeding, and dressing themselves. It may also interfere with social relationships they have with friends and family members. When in pain, patients may find themselves sleeping more and requiring additional rest from emotional and social demands in order to manage their pain (“Pain: Assessing…”). Pain can affect the bodies of patients, making them less healthy in an overall sense. Pain may also affect the patient’s appearance, particularly when the pain is chronic (Lynn and Harrold). When a patient’s appearance is altered, the patient is more likely to exhibit poor self-confidence and withdrawn from many social situations. Patients are less likely to enjoy social activities and they may additionally be inhibited or prevented from enjoying sexual activities. This can result in feelings of isolation or loneliness that may become more extreme in geriatric patients that are already separated from family, friends, or loved ones. In order to provide high quality nursing care, the nurse must not just treat the pain, but also the social symptoms. Helping a patient to appear more healthy can often help them to have a higher quality of living and be more motivated to participate in daily activities. Pain may also be a psychological stressor for patients, as it increases stress levels and fatigue while interfering with the body’s ability to heal itself and fend off disease. When a patient is in pain, he or she may be more easily fatigued, and coping abilities may be decreased. At this point the perception of pain is often heightened, and the patient experienced increased stress and anxiety levels. The patient may also be afraid, or feel helpless or out of control, which generates additional anxiety (“Pain: Assessing…”). In order for a nurse to deliver efficient care, sensitivity must be exhibited to the psychological effects of pain, and the care giver must always respect and encourage independence in his or her patients. Many patients like to think of themselves as self-sufficient, and particularly in the case of geriatric patients independence may be limited by pain, generating anxiety. Some patients may deny their pain because they are resistant to relying on a nurse or care giver for assistance, while others may require emotional or psychological support of others in order to cope with their pain (“Pain: Assessing…”). In order to provide high quality care, some patients may react better psychologically being allowed to administer their own analgesia, whereas others may benefit from being dependent on nurses, doctors, or other authority figures for analgesia administration. The personality of the individual patient must be considered when determining how analgesia will be administered. It is ultimately the responsibility of the nurse to be responsive to the patient’s needs and expectations in order to increase the comfort level of the patient. The quality of life of a patient is affected more by pain than any other health problem seen in the nursing environment, because pain influences every area of the patient’s activities of living without exception. According to the Roper-Logan-Tierney model of nursing, these activities include maintaining a safe environment, communicating, breathing, eating and drinking, eliminating, personal cleaning and dressing, sleeping, sexual expression, work and play, mobilizing, control of body temperature, and dying (Roper et al. 15). Simple actions, such as dressing oneself may become difficult or impossible when pain levels, particularly in joints and shoulders are too high, as often occurs in geriatric patients. This can detract from the independence level of a patient, and cause discomfort. Many times pain is unduly discounted by nurses and practitioners. This has prompted the American Pain Society to declare that relief from pain is a fundamental right, or “basic human right” of patients (American Pain Society 88). Ensuring high quality care means ensuring that each patient has the maximum level of comfort possible given their condition. Pain is not merely a physical symptom. It has many physiological causes, and may be created by a physical stimulus or by problems in the nervous system that essentially trick the body into feeling pain. In the specific case of geriatric patients, many causes of pain exist, and it is very likely that caregivers will come into contact with situations in which pain is chronic instead of acute, or short term. Pain can affect manner in which patients carry out their daily living activities, or even their ability to do so. Because of this pain impacts a patient not only physically, but also socially and psychologically. Each nurse or caregiver is responsible for assessing pain and being responsive to the needs of individual patients in order to assure maximum comfort levels, and minimize loss of quality of life due to pain. Works Cited American Pain Society. Principles of analgesic use in the treatment of acute and cancer pain (5th ed.). Glenview, IL: American Pain Society, 2005. Cavalieri, Thomas. "Managing Pain in Geriatric Patients." Journal of the American Osteopathic Society 107.6: 10-16. Print. Holden, Arun and Winlow, William. The Neurobiology of Pain. Manchester, UK: Manchester University Press, 1984. "How You Feel Pain." The Mayo Clinic. Web. 27 August 2010. Retrieved from Lynn, Joanne; and Harrold, Joan. Handbook for Mortals: Controlling Pain - The effects of pain. Excerpt from text. Web Retrieved from Nerskey, H. and Bogduk, N. "IASP Pain Terminology." International Association for the Study of Pain, 1994. Web. Retrieved from "Nursing Care of Older Adults." Lippincotts Nursing Center. Web. 27 August 2010. Retrieved from "Pain: Assessing and Treating Pain." Nursing CEU. Web. 27 August 2010. Retrieved from "Pain Management Nursing." Johnson and Johnson, Inc. Web. 27 August 2010. Retrieved from http://www.discovernursing.com/jnj-specialtyID_256-dsc-specialty_detail.aspx Roper, Nancy; Logan, Winifred; and Tierney, Allison. The Roper-Logan-Tierney Model of Nursing: Based on activities of living. Philadelphia, PA: Elsevier Health Sciences, 2000.   Read More