Providing Quality Nursing Care in Pain Management Nursing Practice - Essay Example

Providing Quality Nursing Care in Pain Management Nursing Practice Introduction Quality nursing care has been defined differently, based on the nature of involvement of the nurses and the specific practice that the nurse is engaged in, considering that the activities that define quality in each practice are different. However, the concept of quality nursing care has been identified as the degree to which the nursing healthcare service offered to individuals and populations increases the likelihood of the desired healthcare outcomes, as well as remains consistent with the established professional healthcare knowledge (Hall, Moore & Barnsteiner, 2008: 417). While traditionally the concept of quality nursing care was defined by the policies, the facilities and the credentials associated with the nurses, this definition has been expanded in the modern times to incorporate the concepts of exploration, improvement of the processes and patient safety, as well as the evaluation of the whole outcome of all these components (Batalden & Davidoff, 2007: 2). In this regard, the concept of quality nursing care refers to the holistic evaluation of the nursing practice, starting from the time the nurse comes into contact with the patient, to the point where the individual is discharged from the health facility, and all the health practices that are involved therein (Institute of Medicine, 2001: 47). Therefore simply put, quality nursing care is the overarching umbrella under which the patient safety resides, and thus the concept of patient safety is indistinguishable from the concept of quality nursing care, since it is through quality nursing care that the safety of the patient is upheld (Russell et al. 2010: 49). Thus, this discussion seeks to analyse the concept of quality nursing care in pain management nursing practice, with a view to establishing how the quality agenda informs this practice. Discussion on How the Quality Agenda Informs Pain Management Nursing Practice Pain management is an area of nursing practice that has consistently proved to present multifaceted challenges to the nursing practitioners, considering that at some point in life, everyone experiences pain in its diverse forms. Pain has been classified as either acute or chronic, where the acute pain subsides as the process of healing continues, while the chronic pain is persistent (Jensen et al., 2003: 72). The multifaceted challenges faced by the nursing practitioners under the pain management practice emanate from the fact that pain must not always be physiological, but may also entail some components of psychological, spiritual or emotional dimensions (Jones, 2006: 42). Nevertheless, in all these dimensions, the goal of pain management remains the same: to provide the maximum pain relief possible while causing minimal side effects (Peter & Watson, 2002: 67). The difficulty in offering the high level of pain relief for patients by the nursing practitioners stems from a wide variety of factors, which may include pain rumours and myths, inaccuracy in information given by the patients and cultural issues (McCaffery et al., 2005: 227). However, the major risk factor in the nursing pain management practice is the difficulty in communication by the patients to the nurses, considering that a large percentage of pain is identified and reported fundamentally through the patients’ self-reporting (Dimond, 2002). In this respect, the inaccurate self-reporting given by the patients poses the risk of undertreatment, which then means that the pain that the patient is experiencing may not be relieved fully. Suitable Quality Framework for Pain assessment The process of pain assessment entails the actual appraisal of the factors that influence the patient’s experience and expression of pain (Hall-Lord & Larsson, 2006: 385). After the appraisal of all the factors that may contribute to the patient experiencing and expressing pain, the nursing practitioner then engages in a comprehensive process of describing the nature and level of pain that a patient is experiencing, and the description of the effect of this nature of pain on the nursing function. Further, the nursing practitioner should indicate any essential barriers that may influence or interfere with the effectiveness of the patient’s pain measurement (Wilson, 2007: 12). The Importance of Pain Assessment to the Quality Nursing Care Under the concept of quality nursing care, it is unacceptable for patients to experience unmanaged pain, considering that pain has been viewed as a contributory factor in the deteriorating state of physical and psychological health of a patient (British Pain Society, 2007: 33). In this respect, the practice of pain assessment is vital since it is a fundamental step towards providing an effective and high level of patient’s pain management. Therefore, through the suitable process of pain management, it becomes possible to achieve a reduced pain experience for patients while also contributing towards enhancing the comfort of the patients (British Geriatrics Society, 2007: 21). The patient’s comfort is one of the major necessities in quality healthcare provision since it contributes to the quick recovery of the patient through relieving the patient much of the psychological or physiological turmoil, thus creating a suitable ground for the patient to recover. When pain is effectively assessed, there is the likelihood of increased physiological, psychological and physical functioning of the patient, which in turn means that they are easily manageable and treatable (Thrall, 2008: 24). Finally, through the process of effective pain management, there is a high level of patient satisfaction with the level of pain management that is offered, which eventually means that the state of wellbeing of the patient is higher when they leave the health facility rather than when they came in. This is an essential aspect of quality healthcare provision, where the final state of wellbeing of the patient should be improved by the healthcare services that the patient received in the course of their treatment, a state which is effectively measured through the level of the patient satisfaction with the healthcare services they have received (Nursing and Midwifery Council, 2008: 36). Nevertheless, the most important aspect of pain assessment as a fundamental step of pain management is the understanding of the diverse factors that contribute to pain, and their inclusion in the process of pain management (Melzack & Katz, 1994:54). Pain is not a simple sensation that can be measured or assessed, considering that it does not display in form of outward symptoms, as does other symptoms of illnesses. Therefore, despite the fact that the nursing practitioners highly depend on the self-reporting of patients to establish the nature, level and causes of pain, the nursing practitioner is supposed to possess the appropriate knowledge in relation to the diverse factors contributing to pain (Rowbotham & Macintyre, 2002: 81). Further, it is also essential that the nursing practitioner be well equipped with the relevant skills, attitudes and approaches towards effective pain management. Thus, the first step towards realising effective and maximum pain relief for patients is the appropriateness of the pain assessment procedures applied by the nursing practitioners, and this step serves as the fundamental of quality nursing care realisation (Bennett, 2001: 2). The essence of this step is that it reduces the future suffering of patients, which then serves as one of the fundamental benchmarks to the overall quality of healthcare offered by health facilities. How Pain Is Measured in Terms of Providing Quality Nursing Care Pain is measured using an appropriate pain assessment tool, which is suitable to assess the quantity or the quality of different dimensions of patients experiencing pain. The major dimensions that form an important pain measurement factor include pain intensity and subsequent intensity associated with anxiety and behaviour (Batalden & Davidoff, 2007: 3). Through assessing the intensity of pain and the intensity of the associated anxiety and behaviour, the nursing practitioner is able to determine the amount or level of pain that a patient is experiencing. Nevertheless, it is the patient’s self-reporting and expression of their pain that is applied as the gold standard providing the most valid information about pain (Jensen et al., 2003: 68). Thus the nursing practitioner should concentrate more on this dimension while ensuring to avail the most suitable environment that would enable the patient to communicate and express their level and intensity of pain amicably (Nursing and Midwifery Council, 2008: 51). The most influential factors that may impact the effectiveness of the patient’s self-reporting of the intensity and level of pain are mood, sleep disturbances, medication and stress. While the nursing practitioners may have their own pain measurement benchmarks, it is vital that the nursing practitioners do not apply pain myths and rumours, which often hold that patients normally overexpress or exaggerate their levels of pain (Dimond, 2002: 39). Pain Measurement Tools a. Uni-dimensional visual and verbal rating scale This is a pain measurement tool that measures one dimension of pain experience, for example pain intensity (Watson et al., 2001: 535). This tool involves concentrating more on the self-reporting analysis of the patient, where the nursing practitioner assesses both the verbal and visual bodily information that can clearly demonstrate the level and intensity of the pain being experienced by the patient. The advantage associated with this tool is that it is simple, more accurate and dependable, and is easily understood by the nurse (Rowbotham & Macintyre, 2002: 92). Nevertheless, this method is widely applied for the assessment of acute pain and is highly suitable for demonstrating the intensity of pain through rating the pain into levels of pain such as none, mild, moderate and severe pain levels (Thrall, 2008: 23). The suitability of this tool for assessing the level and intensity of patients’ pain is that it is fully dependent on the self-reporting information of the patients, thus having low levels of being influenced by the other negative factors such as myths or rumours. b. Multidimensional pain questionnaire This is a pain assessment tool that provides both qualitative and quantitative aspects of pain, and is highly useful where neuropathic pain is involved as a component of pain assessment (Russell et al., 2010: 56). However, this pain assessment tool is more demanding on the side of the patient and takes longer than the uni-dimensional pain measurement tool, considering that it demands for a high level of concentration on the questionnaire and the assessment, while the patients are also required to have good verbal communication skills (Hall, Moore & Barnsteiner, 2008: 419). The pain questionnaire is, however, advantageous in that it allows for the assessment of both the patient’s pain intensity and the patient’s perception of pain while allowing for the observational aspect of the tool to be applied when the patients are unconscious, cognitively impaired or sedated (Nursing and Midwifery Council, 2008: 13). However, even where the two tools of pain measurement differ in their mode of assessing the level and intensity of pain experienced and expressed by the patient, the fundamental aspect in the pain measurement process is the evaluation of the patient’s general medical and pain history, which informs the nature of pain management interventions that are suitably applicable to address every patient (Bennett, 2001: 147). The assessment of the patient’s history forms an important aspect of differentiation in the pain measurement tools, considering the fact that while the pain management tool might be effective in assessing the intensity of pain for different patients, the history of patients in relation to their health, clinical diagnosis and pain may affect the nature of the interventions that are suitable for each patient individually (British Pain Society, 2007: 14). In addition, the measurement of pain for different groups with special needs also requires further consideration for the overall measurement tool result to be effective. For example, children, the elderly and people with various forms of disabilities may not be able to express or communicate effectively the intensity and level of pain they are experiencing (Peter & Watson, 2002: 80). Therefore, while applying different pain measurement tools, it is essential to consider the effect of the tool on the comprehensiveness of the patient’s self-reporting so that the hindrances that may prevail in such tools are addressed through availing alternative channels that will collect complete, accurate and reliable pain information from the patients. Why the Pain Management Nursing Practice Is Performed in This Way The essence of undertaking pain management nursing practice in this manner is to ensure that the nursing practitioners do not measure the intensity and level of pain arbitrarily or based on their own-held myths and rumours, but purely on the basis of well informed benchmarks (McCaffery et al, 2005: 229). This then enables the nursing practitioners to address the pain management challenge of patients in a more effective way and thus be able to provide the maximum pain relief possible (British Geriatrics Society, 2007: 18). In this respect, the application of this framework to pain management nursing practice serves to enhance quality nursing care. References Batalden, P. B. & Davidoff, F. (2007) ‘What is quality improvement and how can it transform health care?’, Quality and Safety in Health Care, 16(1): 2–3. Bennett, M. (2001) ‘The LANSS pain scale: the Leeds assessment of neuropathic symptoms and signs’, Pain, 92(1–2): 147–157. British Pain Society (2007) The Assessment of Pain in Older People - National Guidelines. Dimond, B. (2002) Legal Aspects of Pain Management. Salisbury: Quay Books. 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. Institute of Medicine (2001) Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, D.C.: National Academies Press. Jensen, T. S. et al. (2003) Clinical Pain Management: Chronic Pain. London: Arnold. Jones K. (2006) ‘Effective pain management: lessons from a nursing home research study’, Journal of Healthcare Quality, 28(1): 41–47. McCaffery, M. & Pasero, C. (1999) Pain: A Clinical Manual. St Louis, MO: Mosby. McCaffery, M. R. et al. (2005) ‘Pain management: cognitive restructuring as a model for teaching nursing students’, Nurse Educator, 30(5): 226–230. Melzack, R. & Katz, J. (1994) ‘Pain measurement in persons in pain’ in P. D. Wall & R. Melzack (eds.), Textbook of Pain. London: Churchill Livingstone. Nursing and Midwifery Council (2008) The Code; Standards of Conduct, Performance and Ethics for Nurses and Midwives. London: NMC. Peter, E. & Watson, J. (2002) ‘Unrelieved pain: an ethical and epistemological analysis of distrust in patients’, Canadian Journal of Research, 34(2): 65–80. British Geriatrics Society (2007) The Assessment of Pain in Older People; National Guidelines. Concise guidance on good practice series, No 8. London: RCP. Rowbotham, D.J. & Macintyre, P.E. (2002) Clinical Pain Management: Acute Pain. London: Arnold. Thrall, T.H. (2008) ‘Nursing. Front-line nurses offer ways to improve care, increase staff morale’, Hospitals & Health Networks, 82(5): 22–24. Watson, J. B. et al. (2001) ‘Relationship between nurses’ knowledge and pain management outcomes for their postoperative cardiac patients’, Journal of Advanced Nursing, 36(4): 535–545. Wilson, B. (2007) ‘Nurses knowledge of pain’, Journal of Clinical Nursing, 16(6): 12–20. Hall, L., Moore, S. & Barnsteiner, H. (2008) ‘Quality and nursing: moving from a concept to a core competency’, Urologic Nursing, 28(6): 417–426. Russell, T. L. et al. (2010) ‘Pain management in nursing homes: what do quality measure scores tell us?’, Journal of Gerontol Nursing, 36(12): 49–56. Read More