Nursing Barriers to Effective Pain Management - Essay Example

?Nursing barriers to effective pain management     Introduction It is apparent that there has been an extensive history of recorded medical literature discussing and analyzing undertreatment of pain for general healthcare and especially terminally ill patients. There have been recommendations on reforming clinical education and clinical practice in the nursing profession. This was noted by Henke, Frogge and Goodman (2005, pp. 649-650) as they assessed ways through which cancer pain can be managed. This essay explores the issue of pain management with a focus on the barriers to effective pain management while highlighting some of the ethical and regulatory barriers undermining proper pain management. A brief overview of the barriers to effective pain management Failure of nurses to proiritise pain relief Some nurses are ignorant to the priority of pain relief as an ethical and moral requirement of the medical profession in relation to denying patients therapeutic support while citing the lack of remedies. Cassell argues that modern medicine has failed to adequately address patient suffering, which should be a core value in an efficient system of medicine (Pasero and McCaffery 2011, pp. 25). The curative model adopted in major healthcare institutions denies chronically and terminally ill patients a chance of good healthcare. This is in support of what Henke, Frogge and Goodman (2005, p. 649) termed as the fear of medical professionals including nurses to be subjected into regulatory scrutiny by governmental agencies. Another nursing barrier towards effective pain management entails the curative model. This model tends to prioritise scientific objectivity undermining the patient’s own experiences, which could sometimes be more relevant. The clinician is alienated from the patient’s experience of illness, pain, anxiety and emotional distress which are inherent to illness, and with such a chasm existing, the clinician cannot identify with patients suffering (Cox, 2009, pp. 46). This should forms better part of communication between the patient and the nurse. Surgeon Sherwin Nuland best exemplifies the curative model in his description of attempts to treat an elderly, terminally ill patient, Hazel Welch, acknowledging that in pursuit of the cause of illness the patient’s best interests may not be served. In this case, pain alleviation was the priority (Rich, 2006, pp. 56). In essence, the curative model vilifies death as a phenomenon that ought to be fought until all treatment proves futile. This is best exemplified by the negligible number of terminally ill patients under hospice care (Pasero and McCaffery, 2011 pp. 32). The patient is perceived as a vessel for the disease, and the clinician is mandated to administer the right diagnosis and an accurate prognosis; any need for palliative care is lost in the search for a cure. Curative method does not perceive a condition worse than death while pursuing a cure, for example, a prolonged existence in the vegetative state or extreme pain while pursuing therapeutic interventions. It fails to realise that care is equally important to curing (Moore, 2012, pp. 19). Lack of sufficient knowledge among practitioners The nursing fraternity has continually experienced the lack of adequate training, especially in pain management. Most medical institutions have not been able to offer pain management in their curriculum making it difficult for the nurses to handle patients when they start working at a hospital. However, it is apparent that some of the incidences of lack of sufficient knowledge in the pain management are attributed to ignorance by the nurses themselves. It is up to nurses to have full information on how they can manage patient’s pain (Thomas 2011, pp. 8). Nevertheless, there is a need for learning institutions to make it mandatory that all nurses undertake a course in pain management. In addition, practicing nurses should be subjected to performance scrutiny by a governmental agency in order to ascertain their competence on pain management. Every nurse should be accountable for their care in pain management area (Thomas, 2011, pp. 9). Fear of Regulatory Scrutiny for Opioid Analgesics prescriptions The medical licensing board is guilty of prioritising pain management regulation. Based on the number, frequency and nature of disciplinary cases, nurses who have the mandate of administering opioid drugs to patients with pain in comparison to the negligible number of cases against those who fail to provide adequate pain management. There is an emphasis on regulating against drug aversion and unnecessary prescription of opioid analgesics at the expense of pain management. This raises questions of integrity on the nurse’s part with the overriding concern being compliance to regulation instead of patient welfare (Hunt, 2009, pp. 16). Failure to Hold Nurses Accountable for Pain Management by Healthcare System Most academic medical institutions do not prioritise pain management through the nurses for critically ill patients as an essential part of medical support. However, this can be attributed to what Henke, Frogge and Goodman (2005, p. 649) figure out as fear of atrogenically induced addition by medical students. In this regard, although institutions may have such courses in their curriculum, such fears may undermine institutions’ efforts to adequately train their nursing students on pain management. In light of this, there is a need to have emphasis on how such fears can be overcome (Twycross, Dowden and Bruce, 2009, p. 172). Irrational Beliefs about Addiction, Dependence, Tolerance, and Adverse Side Effects Pain management has lacked efficiency in that there have been irrational beliefs about addition dependence, tolerance and adverse side effects. In essence, nurses have been reluctant in prescribing sufficient doses of narcotic and dependency on opioid analgesics by patients with severe pain or chronic (Srivastava, 2007, pp. 29). The associated side-effects are mild and can be effectively managed without compromising the pain relief process; this is contrary to the unfounded and overexaggerated reports on the side effects of these drugs (Hunt, 2009, pp. 22). The use of opioids in the management of cancer pain has been dogged by excessive regulation. In situations where nurses are supposed to administer opioids to their patients, they have to be conscious of the regulatory policies and the regulators. In 1997, the Institute of Medicine’s Com­mittee on Care at the End of Life recommended reforms on drug prescription laws, cumbersome regulations and medical board practices on the use of opioids for relief of pain and suffering (Twycross, Dowden and Bruce, 2009, pp. 176). Nurses are also attached to regulatory barriers that have been cited by palliative care providers as a disincentive to their practice with calls for cooperation between palliative care practitioners and policy-makers, law enforcers and regulatory authorities for a balanced and positive environment for pain management. For example, in her research, Lawton (2000, p. 24) noted that a day care, a package introduced in the U.K for critically ill persons, limited the care to an eight-week package of therapy. This means that if the patient could in a way not have recovered, he/she would continue to suffer after the package is over. However, the system is still plagued by cases of abuse and diversion of opioids with some nurses charged with over prescription and some contradicting statements from the Drug Enforcement Administration (DEA), which is likely to jeopardise the envisioned balance of patients accessing drugs for pain relief and prevent practitioners from abusing the prescription pain drugs system. It is critical that regulation does not infringe on the rights of cancer patients whose condition is in remission through under treatment even as stakeholders discuss the case for the use of opioids to manage chronic non-cancer pain (Portenoy and Bruera, 2003, p. 20). Nurses have unfounded fears in relation to authorities that target oncology experts or other related professionals, who are at risk of losing their licenses yearly due to opioid prescription irregularities. This fear and misconceptions jeopardise the effective use of opioids in pain management making the whole process difficult to handle for the nurses (McClain and Suresh, 2011, pp. 14). Patients seeking opioid medication for the treatment of chronic pain can sometimes be mistaken to be substance addicts leading to stigmatisation and denial of the drugs due to their desperate search for pain relief. To avoid this unfortunate anomaly, patients should be properly screened for iatrogenic opioid addiction and concurrent addictive disorders, and chronic pain patients with such disorders should be prescribed with proper monitoring. This is in relation to what Verster et al. (2012, p. 243) argued in their article.  Patient management Since prescription and medication using opioids is a delicate and sensitive part of pain management, patient handling and observation is critical. The nurse should explain to the patient the purpose of opioid therapy and the side effects and how to manage them. The nurse should discuss with the patient on issues revolving addiction. Discussion should include withdrawal symptoms in case of abrupt discontinuation, dose titration, contingent dosing and breakthrough medication (Bullock, Clark and Rycroft-Malone 2012, pp. 225). This is critical to patients with opioid refractoriness. Nurse’s responsibility The nurse has a duty to ensure that any opioid therapy he/she prescribes is above board. This section highlights some of the best practices; a thorough history and physical examination of the patient needs to be incorporated in the process. The treatment plan should be outlined and documented with clear reasons for the particular treatment plan. For patients with a high risk of medication abuse or diversion, it is emphasised that the nurses should insist on a written agreement with the patient (Quinlan-Colwell, 2011, pp. 78). Conclusion Indifference to pain relief and management in the clinical setting is inherently prevalent. While the prevailing ignorance, fear, misinformation and lack of education is understandable, it is hard to defend a system that does not prioritise a patient’s comfort, treating the patient as a mere vessel carrying an illness which as such should be subjected to all sorts of diagnosis and tests in pursuit of a cure till any further effort proves futile. References Bullock, I., Clark, M. and Rycroft-Malone, J. (2012) Adult nursing practice: using evidence in care. Oxford; New York: Oxford University Press Cox, F. (2009) Perioperative Pain Management. Chichester: John Wiley & Sons. Henke, C., Frogge, M. and Goodman, M. (2005) Cancer nursing: principles and practice. Sudbury, Mass.; Toronto: Jones and Bartlett Publishers. Hunt, R. (2009) Introduction to community-based nursing. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. Lawton, J. (2000) The Dying Process: Patients' Experiences of Palliative Care. London: Routledge. McClain, B. and Suresh, S. (2011) Handbook of pediatric chronic pain: current science and integrative practice. New York; London: Springer. Moore, R. (2012) Handbook of pain and palliative care: biobehavioral approaches for the life course. New York: Springer Pasero, C. and McCaffery, M. (2011) Pain assessment and pharmacologic management. St. Louis, Mo.: Elsevier/Mosby. Portenoy, R. and Bruera, E. (2003) Cancer pain: assessment and management. Cambridge: Cambridge University Press. Quinlan-Colwell, A. (2011) Compact clinical guide to geriatric pain management: an evidence-based approach. New York: Springer Pub. Rich, B. (2000) “An Ethical Analysis of the Barriers to Effective Pain Management”. Cambridge Quarterly of Healthcare Ethics, 9, pp. 54-70. Srivastava, R., (2007) The healthcare professional's guide to clinical cultural competence. Toronto: Mosby Elsevier. Thomas, R. (2011) Pain Management Task Force: Final Report. Oxford; New York: DIANE Publishing. Twycross, A., Dowden, S. and Bruce L. (2009) Managing Pain in Children: a Clinical Guide. Chichester: John Wiley & Sons. Verster, J. et al. (2012) Drug abuse and addiction in medical illness: causes, consequences and treatment. New York, NY: Springer.       Read More