Skills Necessary for Pain Management - Essay Example

? Clinical Judgment: Postoperative Pain Introduction Pain management is a very important nursing process especially for surgery patients because postoperative pain can impact negatively on the patient. This is because patients need a holistic care (Selimen & Isikandsoy, 2010). In this regard, there is a need to understand how to manage postoperative pain in surgery patients in order to help them have a quick recovery with as little pain as possible. Patients have a right to have pain management in hospitals and managing pain should be regarded as part of the medical health (D’Arcy, 2012). Yet, regardless of this, many patients still have to deal with excruciating pain after surgical processes operated on them. Nurses still don’t have the necessary skills for pain management and this continues to affect patients in a very negative way. This document looks at this issue from a case study point of view with a regard to understanding this issue and looking at how the individual nurses can use the Tunner’s Model which is a four step model for nurses to apply clinical Judgement. Part I There are a number of advantages associated with treating post-operative pain. The main advantage is related to the fact that nursing is about returning the patient to his or her normal state before the health problem at hand. Surgical operation on a patient treats one health issue but can leave the patient with other health issues such as excessive pain. In such a case, a surgical process cannot be considered as complete in terms of healing the person until the pain associated with it is overcome. Treating the patient in order to manage this pain and eliminate it is therefore a vital part of treatment and the sooner the pain is dealt with the sooner the patient can get back his or her health (D’Arcy, 2012). Failing to manage this pain would mean that the patient will not be able to get their health back. Pain varies in intensity and postoperative pain can be so excruciating to the amount of death if not well managed. Different people respond differently to pain and this difference can lead to different health implications for different individuals. In this regard, it is the role of the nurse to be able to look at the patient and understand how the postoperative pain is affecting their health and be able to deal with this as soon as possible and in the most efficient way possible (Bell & Duffy, 2009). Failing to manage postoperative pain can lead to two main issues. To being with, it can lead to over-delayed discharge of the patient which will definitely affect the efficiency of the hospital as well as the cost of healthcare to the patient or whoever is footing the bill for the patient. At the same time, it can lead to complications on the patient’s recovery process and sometimes lead to more issues which were not existent before the surgery. However, the bottom line of postoperative pain treatment should be based on the fact that the patient has a right to minimised pain in post-operative situations (Layzell, 2008). Part II Noticing Noticing is a very important part of the clinical judgement process as it provides for the basis of treatment before any other implicit knowledge is gained with regard to the customer (Tanner, 2006). With regard to Josie, there are a number of issues which the nurse could be able to look at in this regard. As seen in the case study, Josie has a history of other medical issues which may contribute to her response to the post-operative pain not being very well. As a diabetic, there may be other issues which the nurse may want to consider as Josie goes through the process of surgery. These include such explicit information such as her glucose levels, her body temperature levels, her heartbeat rates etc. These details are important in order to identify any issues which might arise during and or after the survival process. After the surgery, tracking information about her heartbeat, the glucose levels (especially due to her diabetic condition), her temperatures etc are important. At the same time, looking at how her body is responding in terms of returning to its normal conditions such as bowel movements etc can be very important in order to guarantee that Josie is recovering her health gracefully as effectively as possible without any form of delay. Failing to log this progress can be a detriment to her recovery. Interpreting the patients data After the first process of noticing, it then becomes very important for the nurse to be able to interpret what they have just noticed (Tanner, 2006). Since noticing is the process of gathering heath-related information about the patient, reflecting is the process of making sense of this data in order to guarantee that the nurse will be able to deal with the patient in the most appropriate way (Lubin, Dodson & Winawer, 2012). With regard to Josie, there are a number of interpretation issues which may arise. To being with, with regard to her medical history, it is necessary for the nurse to be able to know what the best options for pain management are after the surgery. Responding Interpretation goes hand in hand with responding (Tanner, 2006). Once the nurse has been able to interpret the patient’s information which was acquired through nursing, the nurse will now have to responding to the patients needs based on this information. This will involve carrying out the necessary steps related to Josie’s case such as making sure that her hand is treated in the right way by placing it in the right way. Offering her extra blankets if the temperatures are lower than normal will also be part of helping her to recover as soon as possible etc. Reflection The other important issue with regard to the process of clinical judgement is the reflection. Reflection is quite useful in the process because it is an analysis of how effective the process of treating the patient is. The reflection is a way to monitor how the patient is responding to the process of medication. It is therefore an important aspect of the patient care as it provides evidence of whether or not the patient is responding well to the process he or she is being subjected to. If the patient is not responding well to the process, the nurse can repeat the interpretation and response processes in order to look for alternatives for treating the patient. In the case of Josie, this process is important in a number of ways. To begin with, it is necessary in order to guarantee that her surgery did not affect her other health issue in a negative way. Josie must be monitored in order to identify how well she is responding to medication and whether this is helping her to overcome her postoperative pain in a positive way. At the same time, it will be important to identify how well her body is recovering after the surgery in order to help her have the best painless recovery she can get. Part III: patient progress clinical judgement notes Patient: Josie Preconditions Josie is a 26 year old lady admitted to hospital for a surgery to a bone fracture sustained from a football game. Josie is a diabetic and has been a diabetic since she was about the age of four. There are no known allergies known about Josie on any of the medication which she may receive for pain treatment. Day 1 30/7/2013 1430 hrs - early afternoon handover Josie woke up well after the surgery but was sleepy. Medication before theatre; IV gentamicin 80 mg Medication after theatre: 5 mg IV morphine’ Body temp: T35.9°C One Litre of 5% glucose with 5 units of Novorapid and 20 mmol/s KCl administered, to be taken in eight hours to manage her diabetic condition Day 1 30/7/2013 1630 hrs - late afternoon handover OBS at 1600 hrs were T 36.5°C P 70 BP 110/66 RR 14 SpO2 99% Patient complains of pain and is given IV morphine 5 mg She still has Litre of 5% glucose and 5 units Novorapid and 20 mmols KCl running over 8 hours due at 2200 hrs Her glucose levels need to be checked, Her pain needs to be assessed and managed Access her IV therapy to know when she is through with IV fluid intake Encourage and help her to continue with fluid intake Encourage and help her with physical activity Day 1 30/7/2013 1800 hrs - early evening handover: Her OBS at 1800 hrs are T 36.8°C P 74 BP 112/64 RR 14 SpO2 99%. Her fingers are pink and warm Josie complains of pain in her wrist, a pain of 6/10 on a pain scale Analgesics to be given are IV morphine 2-5 mg 4-6 hourly PRN, oral tramadol 100 mg 8 hourly PRN and paracetamol 1g 6 hourly PRN. Her IV therapy is still ongoing and is of one litre Day 2 31/7/2013 0700 hrs - morning handover Still taking her IV therapy The patient has voided three times last night Her vital signs are stable at 0600 hrs T 36.5°C P 70 BP 108/60 RR 12 SpO2% 99% RA Conclusion Clinical judgments can help in making the patient’s conditions much better. The nurse must however be vigilant and be able to know how to get the information he or she is looking for in order to help the patient using the Tunner Model. This is especially so with regard to managing postoperative pain for surgery patients. Postoperative pain management is something that has been ignored for a long time and many nurses do not give this area of the nursing profession the seriousness it needs. Yet, this is a very serious issue because the patients have the right to be helped in minimizing their pain. Pain management is something which must start well before the surgery begins so as the patient is given the opportunity to discuss the postoperative pain and how it can be managed (Oshodi, 2007). Discussing this with the patient can be useful in helping to avoid complications such as those caused by allergies from certain analgesics. Reference list: Bell, L. & Duffy, A. (2009). Pain assessment and management in surgical nursing: a literature review. British Journal of Nursing, 18, 3 : 153-159. D’Arcy, Y. (2012). Treating Acute Pain: in the Hospitalized Patient. The Nurse Practitioner 37, 8: 22-30. Layzell, M. (2008). Current interventions and approaches. British Journal of Nursing, , Vol 17, 7: 414-419. Lubin,M.F., Dodson, T.F., Winawer,T.F. (2012). Medical Management of the Surgical Patient. Cambridge: Cambridge University Press. Oshodi, O. (2007). The impact of preoperative education on postoperative pain. Part 1. 706 British Journal of Nursing, 16, 12 , 706-711. Selimen, D. & Isikandsoy, L. (2010). The ImportanceofaHolistic Approach Duringthe Perioperative Period, AORN Journal , 93, 4. 482-492. Tanner, T. (2006). Thinking Like a Nurse: A Research-Based Model of Clinical Judgment in Nursing. Journal of Nursing Education, 45, 6 : 204-222. Read More