Pain Management in Long-term Care Patients - Research Paper Example

? [CRITICAL REVIEW OF LITERATURE] (2000 words 55 PLEASE DO NOT RE-FORMAT THIS TEMPLATE Introduction [400] Include background and importance of the topic; and research question with brief description of PICO; and overview of the implementation, appraisal and discussion of the 5 papers. One’s race or ethnicity; age and gender can influence people’s response or perception to others’ pain. Therefore, a person’s pain expectation or experience of another person is influenced by stereotypes that they have about different genders, races and ages (Wandner 2012, p, 220). There seems to be a misconception the elderly do not feel as much pain as other people. According to Taverner (2005), nurses have a misconception that older patients have their perception of pain lessen, as they grow older. Therefore, they treat older patients who complain of pain differently because they believe that the pain may not be as intense as reported by the patient. This study seeks to find out the role of nurses’ perceptions of patient age as a barrier to effective pain management among the elderly. Pain management is vital in any setting of health care provision identification and treatment of pain adds to the patient’s well-being (Beaton, 2008, p, 73). Furthermore, pain is among the basic human rights that a patient is entitled to, according to Vadivelu, Urman, & Hines (2011, p, 3) and Janmohamed (2009, p, 16). Therefore, the research question of this study is, “To what extent are nurses’ attitudes and beliefs a barrier to effective pain management for the elderly?” PICO in this case, includes a population of nurses who routinely provide pain relief or manage older patients, and the issue of nurses’ perceptions or beliefs of older patients’ pain tolerance or threshold. There is no comparison done in this case, while the expected outcome is to identify the attitudes, beliefs or perceptions of nurses, pertaining to pain management in older patients. To carry out a critical literature review, a search strategy will be devised to gather information from five, past and published relevant research papers from databases. These databases are Dove Medical Press, Elsevier and PubMed. The search will be narrowed to those articles that are five years old or less to gather the most recent and relevant information. However, articles written by Walker and Blomqvist, which were published ten years ago, have been included because they have relevant information that is extremely significant in carrying out this study. The abstracts, findings and discussion provision of these articles will be reviewed and analyzed. The abstract provides about an overview of a study, and will be crucial in determining the objectives of the study, as well as, establishing whether the study achieved its objectives. Findings and discussions will provide insights about the current status of the issue under investigation. This information is extremely significant in ensuring that the study is carried following the right course. Implementation and Appraisal [300] Report how you implemented the search strategy from your Assignment for NURS 3044, including other criteria that you used and/or any refinements made to your original appraisal criteria. The search strategy should be attached as Appendix 1. The search strategy that was implemented from my assignment for NURS 3044 comprised of various steps. First, the key terms in for this study were identified, and these were pain management, age and nurse perceptions. These key terms were used to search for articles with relevant literature, with these major themes, pertaining to the topic. After reading the literature that was available, the findings of the authors or researchers were analyzed. The analysis was based on relevance of the article’s literature and findings. The literature part of these articles provided a baseline for analysis, while findings and discussion were helpful in drawing up inferences about the current situation as regards to the topic. Since most of the articles that were used in the search strategy included past research on the topic, methodology that was used was appraised. The participants involved in the various studies were also included in the analysis and appraisal of literature. The analysis of participants was crucial because it could be established whether the research question was related only to one group of participants or the study was a comparative one for easy analysis of data (Munhall, 2012, p, 559). Refinements were made to the original appraisal criteria to come up with a refined search strategy. First, this search strategy was done using nursing databases. Therefore, the research study’s PICO had to be defined. It was then used to search for the most recent articles dealing with the topic under study. Once the home page of the nursing database was opened, key words were entered in appropriate places on the search engine. Then the search queries were narrowed by key terms and inclusion of the period to get peer reviewed articles, which were five years old or less. The abstracts of all the articles displayed on the search results were read to select the most suitable articles for analysis (See Appendix 1). Abstracts, methodology, participants, findings and discussions and conclusions were analyzed for the critical review of literature. Table of Findings [500] Summarize each of the selected research papers – type into this table Harvard –Referencing citation Study design/Level of evidence (if applicable) Population/ participants Sample size Intervention or Exposure or Issue Results/findings Conclusion: Author’s and yours (Alm & Norbergh, 2013) A questionnaire with three questions regarding pain assessment and management, involving two scenarios of sick, elderly people was used. The first scenario involved a smiling patient while the second scenario involved a grimacing patient. The participants of this study was registered nurses who work daytime in elderly care, in both in municipal home care and municipal nursing homes in the mid-Sweden region. The sample size was 128 nurses. To investigate the opinions of registered nurses regarding pain and the assessed need for pain medication for elderly patients using patient scenarios. Registered nurses with more experience did not show the same opinion about pain of the smiling patient and gave inadequate medication, contrary to the recommendations from the county hospital and WHO. Nurses have different opinions about pain depending on the characteristics of the person reporting pain. Nurses ‘opinions and beliefs about a patient determine the level and quality of pain medication that they offer to a patient. (Takai, Yamamoto-Mitani, Chiba, Nishikawa, Sugai, & Hayashi, 2013) A descriptive study that employed the Abbey Pain Scale-Japanese version (APS-J) to explore factors related to pain. The participants of this study were long term residents of two Special Nursing Homes for the Elderly in Tokyo, Japan. These residents divided into two groups, one group which could report their pain (self-report group) and the other group of residents who were unable to report their pain. A sample size of 171 residents was used. To examine the prevalence of pain in older adults living in nursing homes in Japan. The prevalence of pain in the self-report group was 41.7% while a pain prevalence of 52.0% was recorded for the residents who were unable to report their pain. The overall pain prevalence of all residents was 46.2%. Age was among the factors that were significantly associated with resident’s pain in the group that could not report their pain. About fifty percent of the residents had paid pain when they moved or were moved. The elderly require proper assessment and management of pain, just as the younger patients. (Motov & Khan, 2009) A descriptive study of some of the common problems with, and barriers to pain management in the Emergency Department, age being among them. Elderly and young patients in an emergency department. There were 231 patients involved in this study. To establish the problems with pain, and barriers to pain management in the Emergency Department. Only 66% of the elderly patients received analgesia, compared to 80% of their younger counterparts. Elderly patients had delays in the administration of analgesia, in comparison to their respective counterparts. There is a need for an increased appreciation of pharmacokinetic and pharmacodynamic changes associated with aging. There should be proper assessment, documentation and treatment of pain, as an emergency in the Emergency department, regardless of the patient’s age. (Walker, 2007) A qualitative study that employed the use of a questionnaire and structured interviews to gather information from district nurses and sick, elderly people. Participants of this study were district nurses and 190 sick, elderly people who received visits from a district nurse and who reported pain of more than six weeks. The study sought to find out the nursing needs of elderly people in the community who experience continual pain. Most of the elderly people need people who understand how they feel, listen to them, and provide information and encouragement. Nurses felt helpless when medication failed as they could not rely on social support to the elderly. There should be a strong focus on psychosocial assessment and management during professional training for health care givers. Nurses should not rely on medication alone when managing pain among the old, but rather integrate psychosocial aspects in the provision of care. (Blomqvist, 2003) A descriptive study that used interviews and employed a typology of staff perceptions of pain in older people. A population sample of 150, Swedish 52 nursing auxiliaries, Registered Nurses, physiotherapists and occupational therapists was used, but 52 responses were obtained. To explore the nursing and paramedical staff perceptions of older people in persistent pain and their day to day management of pain. Older people were perceived as exaggerating the pain. Those with care related self caused pains exhibited frustrations with the staff. Staff should provide care and treatment of pain, based on older people's needs, rather than on staff attitudes and preferences. . Discussion [500] Summarize the main interventions/ issues discussed, the overall main findings, and identify any existing gaps in knowledge or practice. Ensure you make clear the associated implications for nursing and nurses. Ensure your discussion focuses on your research question and research findings and whether or not you would/would not change your practice as a consequence of what you have found. Discussion should be supported by relevant additional literature/references. The main issues discussed in these five articles involve the opinions of registered nurses regarding pain and the assessed need for pain medication for elderly patients, the prevalence of pain in older patients and the problems with pain, and barriers to pain management. Also, the nursing needs of elderly people in the community who experience continual pain and the nursing and paramedical staff perceptions of older people in persistent pain and their day to day management of pain have been explored. Findings in these studies show that nurses perceive the pain of a smiling patient as insignificant and give inadequate medication. Also, the prevalence of pain in those who cannot report their pain is higher than that of patients who can report their pain. Younger patients are given priority when it comes to the provision of analgesia, compared to the elderly. There is rationing of health care to the elderly, based on the notion that they are likely to die sooner and thus benefit less from expensive diagnostic tests and treatment (Lange, 2011, p, 6). Nurses have a perception that older people exaggerate pain, and most importantly, most of the elderly people need people who understand how they feel, listen to them, and provide information and encouragement. Finally, most nurses are unable to offer social support tote elderly. From these findings it can be noted that pain assessment and treatment is carried out inadequately for older patients. The fact that many older adult patients do not complain much about pain has created misconceptions, such as believing that pain is a normal consequence of aging (Stacy & Lough, 2013, p, 155). Nurses’ perceptions, attitudes and beliefs are a barrier to effective pain management for the elderly. This is because most nurses have shifted from the requirements of the professional code of health care provision, which requires that health care provide to patients should be equitable, regardless of race, gender or age. Therefore, there is a gap between practice and theory. Pain is a personal experience, which should be assessed and treated adequately (Carr, Christensen, & Layzell, 2010, p, 14). As much as self-reporting is considered the best way to approach pain assessment, exceptional cases should also be taken into account. Differences in reporting pain, and the disparity between patients and caregivers should not lead to a gap between theory and practice. From these findings, my practice will not change, but will remain rooted to the provisions of professional health care and management. I will seek to maximize function and quality of life of the old, by minimizing or eliminating their pain by reviewing and applying current medications. A major barrier to treatment is inadequate assessment (Buttaro & Barba, 2012, p, 490). It should be noted that both patients and health care providers have beliefs, which must be acknowledged, but should not be allowed to affect the process negatively, during the process of pain management. Pain assessment must be regular, systematic and documented in order to enhance effective treatment (Miller, 2009, p, 580). It should not be presumed that older adults always complain about pain. Conclusion [300] This should not be a summary/repetition of the findings. Clarify the contribution of your findings to existing knowledge, outline future research, report implications/recommendations for practice/research/education/management as appropriate, and consistent with the limitations. The study has established that nurses’ perceptions, attitudes and beliefs are barrier to effective pain management for the elderly. Therefore, the study has reaffirmed that perceptions, attitudes, and belief among nurses and other health care providers is a significant barrier to effective pain assessment and management among elderly patients. Most of the beliefs and perceptions are rooted in past experiences of nurses and health care providers. It should be noted that there is a gap between health care provision literature and guidelines and what is practiced in real life situations. Most nurses apply their perceived cost benefit analysis in assessing and treating or managing pain among the old. This study has found that this trend is wrong because the old are also significant in society and that there are ways of assessing and managing pain among the old even if they may be unable to report pain. The study recommends that nurses should observe the provisions of professional health care and management in providing pain management for the old. This will eliminate or minimize pain, which will improve the quality of life, in turn. Current medical applications are recommended for effective pain management among the old. There should be also appropriate acknowledgement of beliefs and perceptions about age. Nurses should ensure that pain assessment is regular, systematic and documented. Further research should be carried out to find out the ways in which pain assessment among the old can be improved among the old who are unable to report their pain. However, it should be noted that interview and questionnaire based research is subject to limitations. For instance, the responses may not be absolutely genuine because nurses may seek to safeguard their profile, therefore, they may provide incorrect responses that may affect the validity of data, findings and inferences. References Alm, A. K., & Norbergh, K.-G. 2013, June. Nurses’ Opinions of Pain and the Assessed Need for Pain Medication for the Elderly. Retrieved from http://www.journals.elsevier.com/pain-management-nursing/recent-articles/ Beaton, C. A. 2008. Understanding the Process of Pain Management Among Male Veterans with. Ann Arbor: ProQuest Publishers. pp. 72-75. Blomqvist, K. 2003. Older People in Persistent Pain: Nursing and Paramedical Staff Perceptions and Pain Management. Journal of Advanced Nursing, pp. 575-584. Buttaro, T. M., & Barba, K. A. 2012. Nursing Care of the Hospitalized Older Patient. Ames: Wiley-Blackwell Press. pp. 488-492. Carr, E. C., Christensen, M., & Layzell, M. 2010. Advancing Nursing Practice in Pain Management. Chichester: Blackwell Publishers. pp. 12-16. Janmohamed, S. S. 2009. Pain Management in Long-term Care Patients. Ann Arbor: ProQuest Publishers. pp. 14-17. Lange, J. W. 2011. The Nurse's Role in Promoting Optimal Health of Older Adults: Thriving in. Philadelphia: Davis Company Press. pp. 4-8. Miller, C. A. 2009. Nursing for Wellness in Older Adults. Philadelphia: Lippincott Williams & Wilkin Press. pp. 578-581. Motov, S. M., & Khan, A. N. 2009. Problems and Barriers of Pain Management in the Emergency Department: Are We Ever going to get Better? Journal of Pain Research, pp. 5-11. Munhall, P. 2012. Nursing Research. Sudbury: Jones & Bartlett Learning Press. pp. 558-562. Stacy, K. M., & Lough, M. 2013 Critical Care Nursing: Diagnosis and Management. New York: Elsevier Mosby Press. pp. 153-158. Takai, Y., Yamamoto-Mitani, N., Chiba, Y., Nishikawa, Y., Sugai, Y., & Hayashi, K. 2013, June. Prevalence of Pain Among Residents in Japanese Nursing Homes: A Descriptive Study. Retrieved from http://www.journals.elsevier.com/pain-management-nursing/recent-articles/ Taverner, T. 2005.The Evidence on Perceptions of Pain in Older People. Retrieved from Read More