Pain Management - Term Paper Example

 Pain Management Nurses are faced with the tough responsibility of ensuring patients remain comfortable while nursing their ailments despite facing extraordinary pain. The nature of contemporary diseases has made pain management a necessary component of treatment (Hall-Lord & Larsson, 2006). The American Pain Society classifies pain as one of the most common symptoms that lead to patients seeking medical care. Nurses encounter challenges in managing pain among patients because pain can either be ordinary pain resulting from minor injuries and headaches or extraordinary pain resulting from terminal diseases. Some nurses have specialized in their practice to deal with extraordinary pain. There is also the sub-specialty of pediatric pain control, which deals with children’s experience with pain. The topic of pain management in nursing has been at the center stage of research in nursing in the recent few years. Several books and articles in journals have been written with regards to pain management (Hall-Lord & Larsson, 2006). There have also been persistent ethical issues with regard to pain management especially in chronic diseases such as opioid therapy, which is characterized with instances of drug abuse among many patients (Hall-Lord & Larsson, 2006). Pain management affects the nursing practices in various ways as nurses encounter challenges with ethical dilemmas arising from pain management. Some of the issues raised in these studies about pain management in nursing include the following. Assessment and Diagnosis of Pain for a Successful Pain Management In order to give patients optimal care, it is necessary for nurses to have appropriate skills, knowledge and attitudes towards pain itself, pain assessment and pain management (Hall-Lord & Larsson, 2006). Pain assessment must be based on available evidence that will prevent patients from suffering more harm. It is not acceptable for patients to be left to experience pain without proper management from medical staff in a health facility (Hall-Lord & Larsson, 2006). It is also unacceptable for nurses to lack knowledge and skills to help patients manage their painful situations. It is a professional duty for nurses to be accountable to patients with regard to pain management. There have been calls in the nursing field to include pain management as a compulsory component of pre-nursing training programs so as to ensure all nurses are fully equipped with necessary skills that will enable them manage their patient’s painful situations. This, if implemented will result in patients receiving high standards of pain assessment and management. It will also help reduce instances of unnecessary suffering from patients (Hall-Lord & Larsson, 2006) Pain assessment is the first step in pain management and treatment. The main objectives of a successful pain assessment process should be aimed at reducing the pain that the patient is experiencing, increasing the patient’s comfort, improving the patient’s physical, physiological and psychological function as well as ensuring the patient is satisfied with the pain management process. It is not easy to measure and asses pain (Hall-Lord & Larsson, 2006). Nurses have to be aware of various factors that can influence how the patient feels and how he or she expresses pain. Pain assessment and measurement involves a lot of issues that have to be approached with a lot of attention. Pain assessment involves the following steps; Overall appraisal of all the factors that could influence the patient’s expression of pain Comprehensively describing pain and the effect it has on body functions of the patients Determining the barriers that may affect the nurse’s ability to asses and manage the patient’s pain, such factors include; The nurse’s lack of adequate knowledge, skills and attitudes that are needed in order to effectively manage pain Poor documentation of the patient’s pain, its assessment, management as well as pain re-evaluation The age of the patient, the type of pain and the stage of illness in which the patient is. Existing myths and misconceptions about pain and pain management. Pain measurement on the other hand requires using an assessment tool which helps identifying the quantity and/ or quality of dimensions of the patient’s pain experience (Lui & Fong, 2008). These dimensions include the intensity of pain and the anxiety and behavior associated with the pain. Measuring pain is very important as it enables the nurse to determine the amount of pain experienced by the patient (Lui & Fong, 2008). Pain assessment and measurement is also based on the patient’s self reporting, which most scholars believe provides the most valid way to measure pain. However, self reporting can be influenced by so many other factors such as the patient’s mood, sleep disturbances as well as the patient’s medication and may not give an accurate report on the patient’s pain assessment. Additional considerations are required in assessment and measurement of pain among patients with special needs such as children, the aged as well as patients with language barriers that may hinder proper communication with the nurse. It may be important for observational assessment of pain for patients in this category (Lui & Fong, 2008). A Pain Assessment Checklist may be used to assess pain among aged patients, or the Abbey Scale for cognitive impaired patients. Visually impaired patients can use a verbal rating scale which has been adapted to meet their need in pain assessment and measurement. Evidence-Based Pain Management: Analyzing the Practice Environment and Clinical Expertise Nurses charged with the responsibility of implementing Evidence Based Pain management (EBPM) need to have a lot of information at their disposal so as to help them meet the targets for their interventions. Evidence based practice (EBP) in medical practice promotes safe, appropriate and effective patient care. Implementing Evidence Based Pain Management effectively relies heavily on administrative enforcement as well as adoption by individual practitioners. The nature of pain management has been evolving over the years and there is an urge for medical organizations to continually update their programs, integrate new equipment, and the latest standards in to relevant policies and procedures. This will improve the effectiveness of evidence based pain management programs. Using evidence based pain management strategies requires nurses to assess the readiness of their environment to deal with such interventions. A successful EBPM intervention is one in which the nurses alter their behaviors and attitudes towards pain management and assimilate the behavioral changes in to their practice. Huge differences between evidence of pain management and current practice especially in treatment of acute pain has been a major challenge to clinical nurses and administrators who are accountable for implementing pain management. The Theory of Planned Behavior can be very helpful in pain management. The theory integrates both individual and normative aspects that nurses can predict patient’s behavior and also provides a reliable framework that can be used to analyze eedifferent factors that are involved in implementing Evidence Based Pain Management. The theory states that human behavior is intentional and the intention comes as a direct result of many personal factors including clinical expertise, control factors for instance the degree of control for one to act independently and normative factors such as the expectations from the practice environment. Ethics and Pain Management The issue of optimal pain management for patients has posed many challenges to nurses and the medical field in general. Despite recent research showing improvement in understanding pain modalities as well as the innovation of new methods of treatment, patients still report dismal increase in satisfaction with the way their pain is managed by nurses. Ethical challenges also exist in management of pain in patients with chronic ailments especially opioid addicted patients. In order to successfully manage chronic pain with opioid medications, it is important to balance the dependence on opioid and addiction with pain relief and the restoration of function. It is always very difficult to evaluate the benefits and risks among patients suffering from chronic pain. This ambiguity is increased further for patients who are on methadone therapy for depending on opioid. Patients with opioid addiction are not only at a high risk of diversion and overdose, but also reduce the chances of them improving function while they are still on opioid, most especially if the opioid is their primary form of treatment (Bernhofer, 2011). The ethical dilemma stems from the potential risks that are involved with long term treatment of chronic pain. Such risks include patients developing drug resistance, which creates the need for escalating doses for the patient, hyperalgesia and addiction (Bernhofer, 2011). Hyperalgesia refers to the increased sensitivity to pain. In some cases, the patients may be reluctant to take medication prescribed for them. This may be because they fear developing an addiction for the drug. Nurses and other medical officers are therefore faced with the dilemma of whether to continue opioid medication, stop it or even whether to begin it as a whole (Bernhofer, 2011). The challenge of stopping the medication or not using it all together is that the patients are likely to continue languishing in pain. This goes against the professional code of conduct for nurses, which requires nurses to do everything possible to stop the pain and make the patient comfortable. This ethical dilemma has greatly affected the nurses’ ability to effectively manage pain during their practice (Bernhofer, 2011). There are studies being conducted within the medical field to come up with other reliable methods of pain management, especially chronic pain. Despite, significant progress being made, there is still a long way to go in solving this ethical dilemma. Conclusion The three issues raised in the articles above have profound influence on the practice of a nurse. In the first article about pain assessment and measurement, we discover that it is necessary for nurses to determine the type of pain the patients is suffering from. This requires the nurse to take various factors in to consideration when assessing and measuring pain. Pain assessment and measurement is the initial stage in pain management and it can go a long way to help the patient if it is done properly by the nurse. Evidence based pain management calls for attention to available evidence on pain management as well as requiring nurses to use new approaches in pain management. The theory of planned behavior is also relevant in pain management as it provides nurses with great insights in assessing and managing pain. When dealing with patients who have an opioid addiction, it is important to structure your practice such that it minimizes risks for patients in this condition. In your evaluation of the patient, be sure you determine the medical history of the patient, including any history of addiction. It is also important to determine the patient’s past history with opioid in the past, if any. This will help you to determine if the patient has had problems with opioid before, and it may be important in therapy especially in cases of relapses. References Bernhofer, E., (2011) "Ethics and Pain Management in Hospitalized Patients. OJIN The Online Journal of Issues in Nursing Vol. 17 No. 1. Hall-Lord, M.L., Larsson B. W. (2006) Registered nurses’ and student nurses’ assessment of pain and distress related to specific patient and nurse characteristics. Nurse Education Today; 26: 5, 377-387. Lui LY, So W, KW, Fong DY. (2008). Knowledge and attitudes regarding pain management among nurses in Hong Kong medical units. J Clin Nurs. 17(15):2014-2021. Read More