Facilitators and Barriers to Effective Pain Assessment within a Clinical Setting - Essay Example

? FACILITATORS AND/OR BARRIERS TO EFFECTIVE PAIN ASSESSMENT WITHIN A CLINICAL SETTING Introduction Pain is anexperience a human being undergoes which is difficult to define and describe (Brennan 2007). According to Brennan (2007), pain is unique to every individual as individuals have different perceptions and tolerance on pain. In nursing, pain assessment and management plays an important role, as it is fundamental in daily nursing routine. Therefore, health care professionals must strive to overcome the barriers to effective pain management in practice. Past research findings show that, only an approximate half of all patients in the West receives adequate pain control. This highlights that the control of pain is a serious issue for a large number of patients that are hospitalized (Daniel & Carr 2001). This essay will explore lack of knowledge and attitude as nurse-related barriers to effective pain assessment and management with respect to elderly patients. Communication will also be discussed as patient-related barrier in assessing and managing pain. These barriers will be further explored and discussed throughout this essay and will be supported by the relevant literature. Furthermore, the discussion will also concentrate on how these barriers can be overcome using various educational texts, within the healthcare context.  There is a lot of evidence to demonstrate that nurses a have poor knowledge about pain and its management. For instance, Howell et al, (2000) in a study serves to confirm this postulation due to relatively poor educational curriculum for nurses in UK. A recent study carried out by Carr (2001) also suggests that modern-day nursing and medical education programs do not equip health care professionals with significant information on the nature of pain, the methods of pain assessments and the principles of pain management hence bringing about barriers to effective pain management. Moreover, Hamilton and Edgar in 1992 used McCaughey’s (1989) ‘knowledge and attitude report’ to examine the knowledge of nurses concerning pharmacological as well as physiological aspects of assessing pain and its management. The results concluded that nurses had lack of knowledge in basic concepts and principles in pain assessment and management (Hamilton and Edgar 1992). Concluded that lack of pain knowledge and general attitude are barriers in pain assessment and management which nursing professional should address to manage pain effectively. King (2004) identified how nurses confirm that they have a limited understanding of pharmacology and claim they are dissatisfied with the educational experience, leading to feelings of anxiety following qualification, which affects their attitude towards pain assessment and management. With a lack of knowledge and basic fundamental management skills, nurses may feel unprepared to care for patients suffering from pain, and consequently make incorrect decisions regarding the management of patient’s pain.  Communication The assessment as well as management of pain on elderly persons often presents a challenge to nurses. This is because elderly patients are more likely to experience both chronic and acute pain compared to younger patients. Prevalence of cognitive impairment, failing sight, hearing, confusion and dementia contribute to communication difficulties and as a result, this poses significant barriers to pain assessment particularly when using communication as a pain assessment tool. Dementia with ageing, are problems that may present serious barriers to the assessment of pain. A study of 60 Alzheimer's patients who were unable to communicate verbally showed that 26 had conditions commonly associated with pain but only three were given analgesics (Marzinski 1991). Parmelee et al. (1993) studied 758 patients in nursing homes, and concluded that although cognitively impaired patients’ slightly under-reported pain, their reports were as valid as for patients with no cognitive deficit. This suggests that cognitively impaired patients should be believed when they complain of pain. Where there is such impairment, frequent assessments of current pain may be required since pain recall may be unreliable. Discussion Effectiveness in assessment and record keeping by nurses is a fundamental necessity in eventual management of pain (Fielding and Irwin, 2006, p. 31; Wells, Pasero and McCaffery , nd, p. 3). There are however, basic challenges that nurses face in assessing pain in patients, which are related either to them (nurses) or to the patients themselves. In a study that was aimed at establishing the link between post registration education as well as the experience in clinical profession and knowledge of pain among practitioners, Wilson found the following. Among the nurses sample selected, nurses who were specialists scored higher in comprehensive knowledge though their knowledge failed to confirm any relation to years of professionalism. The explanation was proposed to be that education programs facilitate knowledge gain in matters regarding pain assessment and management. However, greater influence is noted from the environment of work as well as the professional studies undertaken in assessment and management of pain. Reduced efficacy feelings are often related to working environment in nursing practice and this would lead to a feeling of low personal control, which is likely to adversely affect the professional pain assessment and management practice by the nurse (Wilson, 2007, 1012). Optimality in offering patient care by nurses requires that they exhibit appropriate know how, attitudes as well as skills in management and assessment of pain as a prerequisite to preventing patients from suffering harm. It is unprofessional al and unacceptable to have nursing professionals who are insufficient in knowledge concerning assessing patient pain. Nursing professional curricula has been pointed out to be among pivotal structures in instituting knowledge and skills in the professional nurses concerning assessing pain of patients. This would improve on managing excessive suffering by patients at the hands of the professionals (Wood, 2008, para 1-4). According to IASP (International Association for the Study of Pain), patients’ pain relief is a universal right and standards of managing pain universally requires that health providers receive training on assessing and managing pain. It should however be noted that pain as a feeling is subjective and thus management and assessment is dependent on the feelings of the individual patient. Patients’ ability to communicate is thus deemed critical in assessment of pain. The capacity to communicate by patients is however, variant and this presents the major challenge that health professional’s experience. For instance, children who are not at the age of communication would pose a great challenge to the medics to assess pain because of breakdown in communication. Pain in children “has sensory, emotional, cognitive, and behavioral components that are interrelated with environmental, developmental, socio -cultural, and contextual factors,” (Stanley and Pollard, 2013, p. 165) and this renders it often untreated and under assessed. Nevertheless, it is the responsibility of a nurse to plan of effective mechanisms through which pain is to be assessed, adopt favorable tools to manage it together with the other professionals as well as carry out follow-up in order to assess effectiveness of the management practices adopted. Stanley and Pollard therefore found out that nurses’ knowledge as well as their attitude directly influences their capacity to assess and manage pain effectively. Effectiveness in assessment of pain for a patient is dependent on both the patient and the nurse where communication is a fundamental attribute. In the analysis of patient related barriers to pain assessment, communication therefore stands out. The collaboration required between a nurse as well as the patient is wholly dependent on the capacity of the two to communicate. Communication by a patient therefore becomes a prerequisite to the successful assessment procedure. The inability of a patient to communicate through either the written or the spoken mode therefore presents the major challenge in communication (Wells, Pasero and McCaffery, nd, para 1-6). The lack of predefined tools for testing of pain on patients, the nature of pain as being subjective leaves only communication as the most effective tool for assessing pain in patients. Nevertheless, it is to be acknowledged that in some instances, patients are unable to present to nurses self-reports on pain in verbal means, writing as well as such other means as gestures which therefore presents the major hurdle in assessment as emanating from the patient (Herr, 2011, p. 3-4; Hooten et al, 2013, p. 34). Among other benefits of carrying a successful pain assessment procedure on patients is establishing good rapport as necessary for subsequent management of pain as would be required (‘National Pharmaceutical Council’, nd, p. 21). This report therefore recommends that nurses and patients should always endeavor to develop productive environment for the purpose of effective assessment of pain in patients. This is because, as have been shown in the discussion, both nurses as well as the patients have an active role to play in the assessment procedure. Knowledge and appropriate attitudes are prerequisite to effective assessment from the nurses while the ability to communicate by patients is very essential to the process. Best practice therefore would involve proper training for the nurses while designing of improved tools of assessment for patients should be embraced to make the process of assessment easy and effective (Glajchen , 2001, para 1-2). Bibliography Fielding R. and Irwin M. G., 2006. The knowledge and perceptions of nurses and interns regarding acute pain and postoperative pain control. Hong Kong Med J,12 (1): 31-4 Glajchen , 2001. Chronic pain: treatment barriers and strategies for clinical practice. J Am Board Fam Pract, 14(3):211-8. Herr K, 2011. Pain Assessment in the Patient Unable to Self- Report. Available at: < http://www.aspmn.org/organization/documents/UPDATED_NonverbalRevisionFinalWEB.pdf>[Accessed 23 December, 2013]. Hooten et al, 2013. Assessment and Management of Chronic Pain. Institute for Clinical Systems Improvement. Available at: < https://www.icsi.org/_asset/bw798b/ChronicPain.pdf>[Accessed 23 December, 2013]. ‘National Pharmaceutical Council’, nd. Section II: Assessment of Pain. Pain: Current Understanding of Assessment, Management and Treatments. Available at: < http://www.americanpainsociety.org/uploads/pdfs/npc/section_2.pdf>[Accessed 23 December, 2013]. Stanley M. and Pollard D., 2013. Relationship Between Knowledge, Attitudes, and Self-Efficacy of Nurses In the Management of Pediatric Pain. Pediatric nursing, 39(4):165-171 Wells N, Pasero C. and McCaffery M., nd. Chapter 17. Improving the Quality of Care Through Pain Assessment and Management. Available at: < http://www.ahrq.gov/professionals/clinicians-providers/resources/nursing/resources/nurseshdbk/WellsN_SMTEP.pdf>[Accessed 23 December, 2013]. Wells N, Pasero C. and McCaffery M., nd. Chapter 17. Improving the Quality of Care Through Pain Assessment and Management. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Available at: < http://www.ncbi.nlm.nih.gov/books/NBK2658/>[Accessed 23 December, 2013]. Wilson B., 2007. Nurses’ knowledge of pain. Journal of Clinical Nursing, 16, 1012–1020 Wood S., 2008. Assessment of pain. Available at: < http://www.nursingtimes.net/nursing-practice/clinical-zones/pain-management/assessment-of-pain/1861174.article>[Accessed 23 December, 2013]. Read More