Patients in Pain - Research Paper Example

?Running Head: PATIENTS IN PAIN Patients in pain Evidence based practice paper regarding the single study research "The challenge of caring for patients in pain: from the nurse's perspective. Appraisal Questions for a Single Study Research Report Introduction This research study is aimed at investigating why the nursing process for hospitalized patients in pain remains poor in spite of a wider knowledge base, advancements in technological as well as a wealth of research on such patients. The study population size will be made up of 249 nurses with at least two years of nursing experience working with adult medical and surgical inpatients ward. The study findings are however applicable to any nurse working in a hospital setting dealing with patients in pain. The study is a qualitative research conducted in natural settings, and uses data that are words or text rather than numerical in order to describe the experiences that are being studied as recommended (LoBiondo-Wood, 2010). Ten (10) participants were selected from a sample size of twenty (20) nurses from three (3) hospitals. They were given in-depth, unstructured interviews in form of dialogues focusing on their care of patients in pain. The study was conducted to appraise the problem: hospitalized patients still suffer from pain due to poorly managed nursing processes. The study question is: “what are the nurses’ experiences when caring for patients in pain?” The research study is phenomenological; that is aimed at obtaining a description of an experience as it is lived in order to understand the meaning of that experience for those who have it. It is also non-experimental; that is the investigator observes a phenomenon without manipulating the independent variable and finally it is qualitative; that is research about human experiences whose data types are words or text rather than numerical in order to describe the experiences that are being studied (Auerbach, et al 1990) Overview of the Study In virtually all hospitals world over hospitalized patients report the same thing: pain. This is in spite of a wider knowledge-base, the advancements in technological as well as a wealth of research (Auerbach, et al 1990). The professionals who are charged with pain assessment and the administration of analgesia or other relief are the Nurses. On the face of it, it might appear automatic to point an accusing finger on them as failing in their duties. However a closer look on these complaints exposes several situations; that is one, nurses usually do not make decisions independently as to the prescription of drugs meaning that what they may consider as a prescription ideal to a paining situation may differ from issued guidelines, inter alia. Nurses therefore do not have a free hand to operate mainly due to their relationship with the ‘gate-keepers’; that is the physicians (Walker, J2002), in spite of the problems and costs associated with and inherent in unrelieved postoperative pain (Walker, J2002). This therefore makes it essential for researchers, physicians as well as nurses and patients to deeply understand the strengths and weaknesses of the nursing profession in the process of achieving pain relief for hospitalized patients. Other barriers include:- Anxiety: Most nurses are anxious about the possible consequences of using opioid drugs, such as respiratory depression and addiction. Assessment Inadequacies: owing to the huge workload on most nurses on the one hand, and the organizational ineffectiveness (Shealy, 2006) on the other, pain assessment by nurses is usually inadequate as well. However, it has been observed that most of researches conducted have tended to conclude negatively with regard to nurses and their pain management. Conclusion about the Strength of Evidence/Findings The study exposed that the challenges encountered by nurses while caring for hospitalized patients in pain can more easily be understood if the role of a nurse is viewed from a goal-directed mission standpoint; that is an aim towards relieving pain. This mission involves three aspects; the first one is factors motivating nurses as patient advocates such as moral obligation, knowledge, as well as personal experience, and self-confidence and conviction; and the second one being, challenges nurses face regarding pain management such as reading the patient; dealing with inner conflict and moral dilemmas; as well as dealing with the ‘gatekeepers’, and dealing with organizational hindrances in pain management. Finally, there are the positive and negative patient outcomes of pain management and their effects on nurse and patient. Application to Practice Case Study Clinical Sequence A woman, who is 48 years old and is morbidly obese, is brought to the hospital requiring surgery for a detached retina. The woman is known to be suffering from diabetes in addition to sleep apnea (treated using nightly nasal CPAP). She underwent a two-day preoperative assessment with the use of locum tenens physician before surgery. In this exercise, she reported a 3–4 day history of phlegm-producing cough and intermittent shortness of breath. It is after examination that the general practitioner diagnosed the case of bronchitis. He thus advised the use of antibiotics in addition to a bronchodilator further sending the pre-operative report of patient to the surgeon. He also discussed all pertinent result with her surgeon. Owing to the fact that the patient was scheduled for day surgery, the physician never ordered post-op CPAP. It is worth mentioning that it was during the patient’s pre-operative interview that the anesthesiologist noted the patient’s acute bronchitis and sleep apnea. However, there lacked documentation for respiratory assessment. 6:30 p.m. The patient was stable, alert, and oriented when she was moved to the ward of inpatients. The ward nurse received the patient not only without any documented report but also without any mention of the patient’s sleep apnea condition. 7:00 p.m. There occurred change in shift 8:00 p.m. The patient was among the eight of whom the incoming nurse took full responsibility. She complained of eye pain thus given Demerol (PO) by the nurse. 8:30 p.m. The patient vomited which furthermore led the nurse into assuming that the pain medication had been expelled. She had clear orders to contact the physician if the patient complained of uncontrolled eye pain. However, she overlooked the order and administered an antiemetic and another dose of Demerol (IM) without notifying the physician. 9:30 p.m. The patient again complained of unrelieved pain. This time however the nurse contacted the physician, who ordered a different antiemetic and pain medication. It was after receiving medications along with being persuaded to lie down that the patient appeared comfortable and began to fall asleep. 11:45 p.m. The nurse, on her routine check-ups found the patient to be lethargic with cool, moist skin. This time round the nurse called the lab assistant to draw her blood sugar. While waiting for the blood sugar report, she deemed it fit to give the patient a glass of orange juice. Her blood sugar had shot up to 278 and she appeared more alert. 12:45 a.m. After another round of check-ups the patient again appeared lethargic but arousable. The nurse, with her moral and ethical concerns all over her patient, asked the charge nurse to assess her. On assessment, the charge nurse felt the pain medications had taken effect and thus the patient was sleeping comfortably hence assessed the situation to be in control. Therefore he found no need to contact the physician. 1:15 a.m. The nurse however conducted further examination and found the patient without a pulse or respirations. He called a code. The patient was resuscitated and transferred to a neighboring hospital. However on being transferred to the ICU, she was declared dead. Allegation The staff members of the hospital that undertook surgery were sued by the deceased daughter. This included three anesthesiologists, ophthalmology fellow, nurse anesthetist and the nurse caring for her the evening after her eye surgery. The daughter alleged negligence. She argued that the team performed a non-emergent surgical procedure to the deceased while quite aware of the presence of her acute respiratory infection. Furthermore, they also failed to diagnose the patient’s sleep apnea condition, resulting in her death. Disposition The case was in favour of the daughter and a fine in excess of $1 million was allocated evenly among two physicians and one nurse. Risk Management Perspective The result exposes the lack of awareness by the nurses in relation to critical aspects of this patient’s medical condition. For instance the nurses on night duty were unaware of the history of sleep apnea, use of CPAP, and recent acute bronchitis. This ultimately impeded the care she would otherwise have received. It is imperative therefore that while transferring patients to new locations they should be accompanied by key information about their medical history which should be handed to the receiving caregiver. Such information is vital in guiding decisions such as the regulation of medications provided to the patient, rooming the patient closer to the nurses’ station to allow for more frequent observation as well as or flagging the need for special care. This setting, sample and population is typical of many hospitals and relevant to the study as to the nurse-physician relationships. The staff was casual in admitting the patient for the night of post-op observation. It is consequently unsurprising that it was subject to numerous and errant assumptions. The nurse overlooked the order to promptly call the physician and relied on her cognitive abilities. She administered narcotics exceeding initially ordered This led to the patient’s uncontrolled pain to be reported too late to be managed. This implies that there is no casual case in hospitals. A case taken casually is usually aggravated by the absence of absence of specific notes/ orders regarding any pre-existing health conditions. It also means that the nursing staff can minimize the risk of an adverse event by monitoring each patient through continual clinical assessment and reporting any deterioration in his or her condition. This is typical of such cases in many hospitals. If the correct and timely intervention was administered the patient would not would not have been at risk. In the overall the study shows that a wider knowledge on the part of the nurses can ward off many dangers, such as unnecessary deaths and lawsuits. Also an improved relationship between the ‘gate-keepers’ and nurses would improve communication between them. This would significantly trim down risk in patients. In general the strengths outweigh the weaknesses in this study. Each patient should always be accompanied by the requisite notes and orders on transfer. Also whereas nurses should be given a much freer hand to operate they should not overlook the orders of the physicians. The more knowledgeable the nurse is the higher will be the safety standards and quality of care to patients. Nurses with a wide-knowledge base tend to make more informed accurate decisions. Relevance to clinical practice One of the most conspicuous outcomes of this study is its ability to ‘open the eyes’ of physicians, the administration as well as the nurses themselves. It can act as a stimulus to nurses thereby enabling them to not only reflect critically upon their current pain management strategies but also enable them identify their strengths as well as their limitations to their achievements. This in turn provokes the desire to improve their knowledge and performance on their own, or else request more education, training and support. In a nutshell, the findings seem to point towards improving the knowledge base of nursing and to a need for change in education curriculum of the nurses as well as a need for support at work regarding pain management. Professional and student nurses need to be taught communication skills as well as negotiation and assertiveness in order to learn how to convey their ideas in a forceful and even confrontational manner in order to invoke successful collaboration (Rossner, 2004). Of noteworthy is that nurses should be adequately consulted by physicians. Otherwise, the inadequately consulted ones should be the ones to initiate the consultation process (Hendler, 2009). It should also be pointed out that nursing education should encompass fields of moral responsibility and ethical dilemmas of pain management. In particular, the Carper’s patterns of knowledge should be incorporated in nursing. Conclusions From the foregoing it can be appreciated that hospitalized patients in pain management is a challenging task to nurses. The nurses must therefore be adequately prepared by way of acquiring multidimensional knowledge about pain management. The study recommends that the nurses be in a position to improve their knowledge and performance on their own or be sponsored by the employer to acquire more education, training and support. It is also recommended that nursing as a professional course become more broadened and more interdisciplinary. Also of concern is the organizational environment. This environment need to be enhanced and be made more favorable to the nursing process which in turn will enhance the growth of nurses through their experiences, thereby providing opportunities to enhance quality of care. Perhaps of much importance are improvements in pain management. This process should be improved with a view to taking an advanced holistic approach. It is noteworthy that the results demonstrate that theoretical as well as personal and ethical knowledge are fundamental and thus form the basis for effective pain management. The limited nature of previous studies in this field could not have been able to isolate the unique aspects of pain management and its importance. In the contrary, they have been negative towards nurses and have not been able to embrace the complexity of the nursing process of caring for patients in pain. References Auerbach, et al (1990): “Helping patients cope with post-concussion,” Patient care, Vol. 24 53- 80.  Hendler, N (2009). Diagnosis & non-surgical management in chronic pain. N Y: Raven Press. Shealy, C. (2006). The pain game. California: Celestial arts. Rossner, H. (2004). “Chronic care: managing pain in midlife,” transition   Vol. 26, 57-62. Walker, J., (2002). “The chronic pain patient,” RES STAFF PHYS Vol. 3, 13-19. Read More