Different Kinds of Pain and How They Affect the Body - Assignment Example

?Lesson plan: PAIN MANAGEMENT Introduction: According to Marcia L. Meldrum (2003), “pain is the oldest medical problem and the universal affliction of mankind” (pp. 2470-2475). It is both a curse and a gift, since it also serves to alert us to changes in, or damages to, our body. Any “potential or actual tissue injury associated with an emotional and/or sensory experience” (Vanderwerf, 1998, pp. 264-265) is made known to us through pain. Without it, we would not know if we have cut or if we have suffered a fatal wound. Pain is suffering, but it is necessary. The American Pain Society labeled it as the “5th Vital Sign” (Campbell, 1995, as cited in Smeltzer & Bare, 2003, p. 217). As with all vital signs, doctors and allied health personnel continuously strive to keep it within acceptable parameters to maintain homeostasis. Pain management “encompasses all interventions used to understand and ease pain, and, if possible, to alleviate the cause of pain” (Krapp, 2002, p. 1804). It means that pain management is not just the intervention but also the assessment, evaluation, and continuous monitoring of pain. To better understand and treat pain, it is important to know how it is produced and transmitted to the brain. Elaine Marieb and Katja Hoehn (2006) talk about “noxious stimuli – a term for anything that damages the body” (A closer look section, "Pain: Sound the Alarm, But Pain Me Not!", Pain reception, para. 1), and how it can start a whole avalanche of chemical and neurological reactions which, reaching the brain, translate into pain. Different pain management techniques affect various body parts which may be involved in that reaction. Understanding specifically how an intervention works on pain is a key to choosing the best intervention for all kinds of pain. This lesson is geared to teaching students about different kinds of pain and how they affect the body; factors and barriers that may affect pain and pain management; proper and accurate pain assessment and the different tools used; different interventions, both pharmacologic and nonpharmacologic, and the formulation of nursing care plans used in the management of pain. We also tackle some specifics such as the World Health Organization's “three step ladder approach” to pain intervention. Objectives: - Given five minutes of the time, students will elaborate two of the four concepts of physiology of pain as discussed in class. -For fifteen minutes prior to the discussion proper, students will discuss common misconceptions about pain. - Given a situational example, students will describe three technological applications in pain management. - In an oral presentation, students will identify ten of the 12 discussed pharmacological and non-pharmacological interventions for pain. - Given a hospital scenario involving a child, students will discuss the role and responsibilities of the nurse in the pain management. - Given five minutes of the class time, students will identify and explain three out of the four components of pain assessment discussed in class. - Given a situation that involves a 65-year old woman with back pain and shortness of breath, students will develop a nursing care plan and evaluate the patient’s response to the pain management. -Without the aid of class notes, student will describe two out of the three identified barriers to effective pain management. Teaching/Learning theory: 1. Experiential Learning Theory – This is the learning theory developed by Carl Rogers, applied primarily to adult learners. This learning theory designates the teacher as a facilitator of learning since everyone has the potential to learn (Zimring, 1994, pp. 411-422). Rationale: According to Zimring (1994), experiential learning contains a principle that involves doing, living, and acting out what you have learned to make it more meaningful (pp. 411-422). Pain management is an applied skill. Through its application (i.e. by role play activity), learning can be made more meaningful. Another principle of experiential learning is that “learning is facilitated when the student participates responsibly in the learning process” (Rogers, as cited in Zimring, 1994, pp. 411-422). Participating responsibly may include genuinely involving themselves to the lesson to learn rather than just for appearances or recognition, volunteering to be part of the lesson rather than waiting to be called, making significant and appropriate responses to questions during the lesson, and others. Simulations and situational analyses can help the students learn more about the topic by increasing their participation in the lesson and making it more meaningful. 2. Cognitive Learning Theory – Cognition is the process of knowing. Cognitive learning key principles are derived from cognitive psychology. One of the most significant principles is that “learners acquire plans and strategies, and prior knowledge is important” (James Hartley, 1998, as cited in Smith, 1999). Rationale: Pain management is a skill derived from the students’ knowledge of human sensory perception, concepts of pain and medical and nursing interventions, including assessment. Relating new learning to previous learning can help students remember the lesson through its association to previous lessons and help them understand the significance of the lesson. 3. Andragogy is a concept of learning developed by Malcolm S. Knowles based on the notion that adults learn differently compared to children. As a person grows older, his or her motivation and attitude to learning change. Rationale: Since the nursing student is an adult learning work skills to be applied in his or her chosen field of expertise, we can assume that “his time perspective would change from one of postponed application of knowledge to immediacy of application, and accordingly his orientation toward learning shifts from one of subject-centeredness to one of problem-centeredness” (Smith, 2002). Adjusting the teaching method to fit the developmental age of a student is a must to give significance to the lesson. For adult students, applying the lesson to real-life situations is much more meaningful than just presenting the lesson plainly. Student’s expectations and participation By the end of the lesson, students will be able to: - define pain and the types of pain - define pain management - demonstrate giving an accurate, complete, and comprehensive assessment of pain - enumerate various pharmacologic and nonpharmacologic interventions for pain - discern the proper intervention for pain depending on the characteristics of the pain and the patient’s situation. - identify barriers to pain management - formulate patient-oriented, comprehensive, and effective nursing care plans for patients experiencing pain. Learning Methods For this lesson, the learning style to be used will be the VARK model of Neil Fleming. VARK stands for (V)isual, (A)ural, (R)eading/Writing, (K)inesthetic. This learning method centers on the various ways we give and receive information. Visual learners learn more through pictures; aural learners learn through lecture and discussion; read/write learners prefer handouts; kinesthetic learning focuses on “doing things to understand them” (Fleming, 2001, as cited in Hawk, 2007, pp. 1-19). We will make use of slideshow presentations with diagrams and images; we will have discussions; we will make use of handouts; and we will have role playing activities to teach pain management in all four areas of the VARK Learning model. Here are some activities related to each of the VARK learning styles: Visual: Diagrams, Graphs, Colors, Charts, Written Text, Spatial Arrangements, Design Aural: Debates, Discussion, Conversation, Audio/Video, Music, and Drama Read/Write: Books, Handouts, Notes, Essays, Multiple choice, Written feedback Kinesthetic: Examples, Demonstrations, Physical activity, Construction, Role play, Interactive activities and models Teaching Strategy, Facilitative Aid, and Method of Delivery I.a. Teaching Strategy: Discussion b. Facilitative aid: Slideshow presentation c. Method of delivery: Lecture Define Pain: potential or actual tissue injury associated with an emotional and/or sensory experience (Vanderwerf, 1998, pp. 264-265) A. Physiology of pain 1. Nociceptive pain physiology: transduction, transmission, perception and modulation 2. Gate-Control Theory of Pain 3. Physiological Responses 4. Behavioral Responses B. Misconceptions about pain (Source: Potter, Perry, Stockert, & Hall, 2012) II. a. Teaching Strategy: Brainstorm/Discussion b. Facilitative aid: Slideshow presentation, Whiteboard c. Method of delivery: Questions and Discussion Let the students enumerate the types/classifications of pain By Duration: 1. Acute 2. Chronic 3. Chronic Episodic 4. Cancer 5. Pain inferred pathological process 6. Idiopathic pain By cause 1. Cancer 2. Neuropathic (Source: Potter, Perry, Stockert, & Hall, 2012) III. a. Teaching Strategy: Brainstorm/Discussion b. Facilitative aid: Slideshow presentation c. Method of delivery: Questions and Discussion Discuss and enumerate some factors affecting pain and its management 1. Physiological factors – age, fatigue, genes, and neurological function 2. Social factors – attention, previous experience, family and social support, and spiritual factors 3. Psychological factors – anxiety and coping style 4. Cultural factors (Source: Potter, Perry, Stockert & Hall, 2012) IV. a. Teaching Strategy: Discussion b. Facilitative aid: Slideshow presentation c. Method of delivery: Lecture Define pain management: “all interventions used to understand and ease pain, and, if possible, to alleviate the cause of pain” (Krapp, 2002, p. 1804). V. a Teaching Strategy: Discussion b. Facilitative aid: Slideshow presentation, handouts containing the different Pain Intensity or Rating Scales c. Method of delivery: Lecture Discuss pain assessment as the first step of pain management. Components of pain assessment 1.(COLDERR): 1.1. Character: sensation (sharp, aching, burning, piercing, etc.) 1.2. Onset: When started and how did it change? 1.3. Location: where? 1.4. Duration: constant, intermittent 1.5. Exacerbation: what makes it worse? 1.6. Relief: what makes it better? 1.7. Radiation: pattern of shooting/spreading/radiating/location of pain away from its origin 2. Pain history 3. Pain severity 3.1. Verbal numerical rating scales grade the pain from 0-10 with zero having no pain and ten being the most painful 3.2. Verbal rating scale None Mild Moderate Severe 3.3. Visual analogue scale Patient’s pain is measured in millimeters 3.4. Wong-Baker Faces Pain Rating Scale Patient chooses the face that best describes how much pain they have. 3.5 Oucher scale - a poster used to help children express the amount of pain they feel. 4. Effects of pain on the patient 4.1 Behavioral effects 4.2 Influence on ADLs (Source: Berman, Snyder, Kozier, & Erb, 2008; Potter, Perry, Stockert, & Hall, 2012) VI. a. Teaching Strategy: Brainstorming/Discussion b. Facilitative aid: Whiteboard c. Method of delivery: Questions and Discussion Enumerate interventions for pain Nonpharmacologic: Biofeedback, relaxation, guided imagery, distraction, music, cutaneous stimulation, herbals, reducing pain perception Pharmacologic: Analgesics, opioids, adjuvants, anesthesia Technology used in pain management Transcutaneous Electronic Nerve Stimulation PCA Infusion pump Perineural Local Anesthetic Infusion VII. a. Teaching Strategy: Discussion b. Facilitative aid: Slideshow c. Method of delivery: Lecture Discuss the WHO three step ladder approach to managing pain (Berman et al., 2008; Potter, Perry, Stockert, & Hall, 2012) VIII. a. Teaching Strategy: Discussion b. Facilitative aid: Slideshow c. Method of delivery: Lecture Discuss barriers to effective pain management: 1. Patient barriers 2. Health care provider barriers 3. Health care system barriers (Source: Potter, Perry, Stockert, & Hall, 2012) IX. a. Teaching Strategy: Role Play, Discussion b. Facilitative aid: Handouts c. Method of delivery: Small Group Permutations (pairing) 1. Discuss the entirety of Pain Management 2. Divide students in pairs. One student will have the role of the nurse and the other student will be experiencing pain. Each pair will pick a situation randomly from a box of prepared situations and will act out the assessment and management of the pain. They will make use-of-pain scales and will be graded by their performance, the proper classification of pain, and the proper selection of pain intervention. Sample Scenario: 10-year old child goes to the school nurse due to stomach pain in the right lower quadrant of the abdomen possibly due to appendicitis. The students will supply the other characteristics of the pain according to the signs and symptoms of appendicitis; the nurse will make a thorough pain assessment and choose appropriate interventions according to the signs and symptoms presented. X. a. Teaching Strategy: Discussion b. Facilitative aids: Slideshow, handouts, whiteboard c. Method of delivery: Lecture 1. Review main points of the lecture 2. Ask students for questions or clarifications Faith Integration Concept and Rationalization Pain is defined as “a potential/actual tissue injury associated with an emotional and/or sensory experience” (Vanderwerf, 1998, p. 264). According to the International Standard Bible Encyclopedia, 28 out of the 34 passages wherein pain is used in the bible pertain to “conditions of mental disquiet or dismay due to the punishment of personal or national sin”. This can be seen clearly in Jeremiah 30:15, “Why do you cry out over your wound, your pain that has no cure? Because of your great guilt and many sins I have done these things to you”. Other times, pain referred to toil, grieving, sickness or trouble. A verse from Matthew 4:24 gives hope to people by saying, “News about him spread all over Syria, and people brought to him all who were ill with various diseases, those suffering severe pain, the demon-possessed, those having seizures, and the paralyzed, and he healed them." This shows that pain can be overcome through the grace of God. In a commentary by Matthew Henry, he says that “by thus curing bodily diseases, [Christ] showed that His great errand into the world was to cure spiritual maladies. Sin is the sickness, disease, and torment of the soul: Christ came to take away sin, and so to heal the soul.” Rationale: Prayer and believing that there is a higher power taking care of you can be a form of imagery and takes away some emotional uncertainty and anxiety, which can lead to a decrease in pain. Meditation involves controlled breathing, which also diminishes pain by properly regulating oxygenation to the body tissues. Faith and prayers have a real if unclear effect on people’s pain, thus should not be overlooked as part of pain management. Evaluation A. 5-point, multiple choice quiz at the end of the lecture This test was given in an objective, situational way to see if the students are able to apply the lesson to situations that may arise in the clinical field. 1. A 7-year old male child was admitted to the school clinic at 10 am, crying because of pain in his “tummy”. He pointed to the right lower quadrant when asked about the location of the pain. How will you assess the severity of pain? a. VNRS b. VRS c. VAS d. Oucher pain scale - used for children 2. Which of these drugs is different from the rest? a. Acetylsalicylic Acid b. Acetaminophen c. codeine - only opioid d. aspirin 3. Which of these people have a higher pain tolerance? a. A 14 year old student b. a 25 year old nurse c. a 50 year old war veteran - age and culture(due to his occupation) make him feel less pain. d. a 60 year old retired banker 4. What are the first drugs that you would give to a cancer patient who is experiencing mild pain? a. codeine b. acetaminophen - first step in the 3-step ladder. Non-opioid with adjuvant not indicated. c. acetylsalicylic acid with baclofen d. morphine with acetaminophen and cyclobenzaprine 5. How often should pain medication be given to cancer patients? a. every 3-6 hours - as stated by the WHO b. every 2-3 hours c. every 8 hours d. as needed B. True or false This test is to show if the student was able to grasp the objective facts presented in the lesson. 1. Pain is a potential or actual tissue injury associated with an emotional and/or sensory experience. (True) 2. Pain management encompasses interventions used to understand and ease pain, and to alleviate the cause of pain. (True) 3. Pain is felt more by older people. (False) 4. Pain is the same for all people. (False) 5. Exacerbation means worsening pain. (True) 6. Pain beginning in the morning until the afternoon without disappearing is called intermittent pain. (False) 7. Opioids are the best drugs for mild pain. (False) 8. Codeine is a non-opioid. (False) 9. Aspirin is a drug used in the first step of the WHO 3-step ladder. (True) 10. For cancer patients, pain medications should be given as needed. (False) C. Short essay: This test is a subjective evaluation of how the student understands and relates to important topics of the discussion. It also gives them freedom to express their own opinions which would show how involved they were with the lesson. 1.Why is proper assessment important to pain management? (5 points) 2. What is the relation of faith to pain intervention? (5 points) Between the role-play activity and the written test, the teacher will be able to assess whether the students have achieved the expectations and objectives of the lesson. The main focus of the lesson is on the pain management process as seen here in the table with the majority of questions (10 items). All the Knowledge based questions can be found within the discussion to ascertain if the students were paying attention. Comprehension and analysis questions were added to test the student’s critical thinking skills, and one essay question on faith integration was added to see if the students understood the application of faith to pain management. Competencies Knowledge Comprehension/application Analysis Total number of items The student understands the concept of pain and factors affecting it 3 3 6 The student knows and understands the proper procedures for pain management from assessment to intervention 5 2 3 10 The student understands the role of faith in the management of pain 1 1 17 References Berman, A., Snyder, S., Kozier, B., & Erb, G. (2008). Kozier & Erb’s fundamentals of nursing: Concepts, process and practice (8th ed.). Upper Saddle River, NJ: Pearson Education, Inc. Hawk, T. F., & Shah, A. J. (2007). Using learning style instruments to enhance student learning. Decision Sciences Journal of Innovative Education 5, 1-19. Doi: 10.1111/j.1540-4609.2007.00125. Henry, M. (1706). Matthew Henry commentary on the whole Bible. Retrieved from http://www.biblestudytools.com/commentaries/matthew-henry-concise/matthew/4.html?p=2. Krapp, K. (Ed.). (2002). The Gale encyclopedia of nursing and allied health (Vol. 4). Farmington Hills, MI: Gale Group. Marieb, E. N., & Hoehn, K. (2006). Human anatomy and physiology (7th ed.). San Francisco, CA: Benjamin Cummings. Meldrum, M. L. (2003). A capsule history of pain management. JAMA 290(18), 2470-2475. Pain. (n.d.). In International Standard Bible Encyclopedia. Retrieved from http://www.bible-history.com/isbe/P/PAIN/. Potter, P., Perry, A., Stockert, P., & Hall A. (2012). Fundamentals of nursing (8th ed.). St. Luis, MO: Elsevier. Smeltzer, S., & Bare, B. (2003). Brunner and Suddarth’s textbook of medical-surgical nursing (10th ed.). Philadelphia, PA: Lippincott Williams & Wilkins. Smith, M. K. (1999). The cognitive orientation to learning. In The Encyclopedia of Informal Education. Retrieved from http://www.infed.org/biblio/learning-cognitive.htm Smith, M. K. (2002). Malcolm Knowles, informal adult education, self-direction and andragogy. In The Encyclopedia of Informal Education. Retrieved from http://www.infed.org/thinkers/et-knowl.htm Vanderwerf, S. F. (1998). Elsevier’s medical terminology for the practicing nurse. Temple, TX: Elsevier. Zimring, F. (1994). Carl Rogers. Prospects: The Quarterly Review of Comparative Education 24(3/4), 411-22. Read More