Barriers and Enablers to Pain Management - Essay Example

Running head: Name: University: Course: Tutor: Date of Submission: Introduction Definition of pain As per the definition established by The International Association for the Study of Pain (IASP), it defines pain as a sensory as well as an emotional experience normally associated with real or potential tissue damage. Furthermore, the definition takes into consideration both acute pain, cancer pain and chronic as well as noncancer pain (Ann, 2007). Pain therefore is not a product of tissue damage alone since as there exists no predictable relationship between identifiable tissue damage and the pain sensation (Gehdoo, pp.375-390, 2006).In precise pain is considered to be very much repulsive as it is always treated as an emotional experience which demands explanation from the sufferer for it to be accorded the meaning (Ann 2007). Importance of pain assessment and management One would have to understand the fact that pain assessment is an essential prerequisite to safe and efficacious management. Pain is very much common in patients with cancer hence to ensure optimal pain management efficacy as well as effectiveness of new drugs, it requires that treatments be investigated before being administered to the patient (Briggs, 2007). Assessment of pain in patients’ is always done with an aim of attempting to identify the mechanisms which produce the pain as well as other factors which does influence that pain to occur (Argoff &Selvershein,2009). Pain can be caused by such factors such as physical capacity, emotions, behavior, lifestyle and relationships (Liebert, 2006).Though, pain is invisible its cause cannot be readily determined especially in those patients’ who are suffering from noncancer pain. In such cases it’s always necessary to believe in the patient’s account though not always as the assessment should always stick within a particular objective and goal. Pain assessment and management plays vital role in indicationg heart rate, blood. For almost years, the Medicare Hospice tends to provide a full medical care to terminally ill older patients and mostly an average of 80% cover the health plans (Liebert, 2006).Though, these services are available more than a third of patients’ die without using them(Liebert, 2006). Given the fact that pain differs between various individuals, involving a patient in the initial as well as continuing assessment of their pain is very much important as its helps in monitoring patient’s level of pain, monitoring their response to medication, it helps in assessing the need for the patient’s frequency of monitoring and lastly it helps in determining the patient’s pain intensity (Briggs, 2007). Assessment, documentation and management of pain plays a vital role as it helps the nurse’s to develop effective pain management strategies when administering medication to the patients (Liebert, 2006). Thesis statement: This essay will critically discuss the enablers and barriers to effective pain assessment and management of pain in a client with an eventually fatal condition. Pain assessment in patients There are various types of pain assessment put down by various researchers. To begin with, the first type is referred immediate post operative assessment in which the patent’s vital signs are assessed as well as other signs such as Conscious level, Temperature, Pulse, Blood pressure and Respiratory status (Ann, 2007). In cases of critical pain situations, then the nurse can carry out an emergency action that could include immediate life saving measures or just an immediate referral to other high levels of care. The other type of patient assessment is Post operative pain assessment in which the patient’s pain is assessed on an hourly basis for the first twenty four hours after a particular major surgery (Ann, 2007). In situation’s where the patient is sleeping then the nurse’ post operative observation assessment alone is enough for that particular patient. For the nurse’s to achieve effective pain control it’s necessary that a patient’s pain be assessed on a particular given regular schedule or through other methods of pain intervention (Liebert, 2006). When pain assessment is being done on patient’s its always necessary that a nurse should be in a position to differentiate between acute and chronic pain since Acute pain is a pain that occurs for a short period of time hence easy to manage and treat(Liebert,2006).Palliative care is an effective method of pain management in patients with a fatal conditions such as chronic obstructive pulmonary as this kind of care tends to maintain the optimistic view of the patient’s prognosis and death delay (Briggs, 2007).Curative care in such condition is usually not preferred since the this kind of pain management tends to bring the patient close to death making the whole care more discomforting and awkward (Enguidanos, Housen,Goldstein,Vesper, Allen & Braun, 2009).There are various factors identified by researchers which usually encourage hospice referrals thus enablers to effective pain management as well as other factors that discourage hospice referrals known as barriers (Bruera, 2007). Both the enablers as well as barriers are divided into three categories thus physicians and other health care professionals, patients’ and their families and lastly the hospice system that includes both the regulations, financing as well as rules that applies to palliative care (Anand, Stevens, McGrath, 2007). Enablers Enablers that relate to physicians and other health care professionals Hospice experts value so much the need for the professionals and other physicians to help the patient’s in pain management in terms of having collaborative as well as interdisciplinary approach to patient’s palliative care. The second type of pain management enabler under this category is the Physicians better understanding of the patient pain management palliative care through training as well as continuous medical education through end-of- life issues (Bruera ,2007).When Physicians have a clear overview of the hospice pain management program then it’s easier for them to educate terminally ill patients’ on how end life care should be care or administered to them as way of prolonging the patients’ life span (Liebert,2006).The other enabler is the provision of information to the physicians which in the end encourages referrals (Anand, Stevens, McGrath, 2007). Through this way the physicians become more supportative of their patient’s through proper communication of other Physicians on patient’s pain palliative care (Liebert, 2006). Enablers that relate to patients and their families This is an effective way of pain management since it involves the participation of both the patient alongside their families. Since the patient’s family is very much crucial to the patient’s cure its acts as strong enabler in the process of pain management as it gives the patient an ease as well as willingness to heal much more faster (Ann, 2007).Patient’s families are considered a major frontline to effective patient pain management by the nurses through the provision of psychological, physical as well as emotional support to the patient especially when the patient is at the point of death(Anand, Stevens, McGrath, 2007). At this point they act as major enablers to patient pain management as they help the patient to strictly adhere to the nurse instructions through proper a drug administration and emotional support. Moreover, as way of assisting the nurse in monitoring the progress of the patient in terms of pain management patient’s family tends to ensure that it does every day assessment of the patient health. By doing this assessment it gives a good report to the nurse so that the nurse can determine the state of the patient and whether she or he needs to change the nature of the treatment (Anand, Stevens, McGrath, 2007). Patient Coaching intervention This is considered as one the pain management related to both the nurse and the patient. This kind of enabler involves coaching the patient on various methods and guides of managing the pain by the nurse through active participation of the patient towards behavioral change (Michael, Fisch, Allen, pp.319, 2007).The main purpose of patient coaching is for the nurse to achieve positive outcomes in changing barriers that may negatively hinder positive pain management by a patient. Enablers related to patient’s beliefs and cultures Though, nurses ought to respect the beliefs of the patients its necessary that they provide necessary information which can allow them to choose whether or not to accept treatment for their pain. In cases where a patient expresses or reacts negatively to particular pain management technique being administered by the nurses due to their cultural beliefs in a manner that does not conform to the nurse’s beliefs and expectations, then there is need for nurses to reexamine their own cultural beliefs first about pain (Michael, Fisch, Allen, pp.319, 2007).When nurses do this they tend to improve their attitudes and cultures towards patient pain management hence end up influencing the patient to change his or cultural belief towards pain management (Michael, Fisch, Allen, pp.319, 2007). Other kinds of Enablers Enablers to pain management would be inclusive of the prerequisites of healthcares institution management, most of which tend to set goals of fighting pain effectively (Briggs, 2007).There are also key factors of feedback, leadership and human resources management. The research carried out by Ann (2007), on other enablers it proved that enablers also could include structures and government policy that aids research on the issue of pain management (Ann, 2007). Barriers to successful pain assessment Barriers related to the patient Pain management is a complex process due various barriers that make this process more unsuccessful in certain given situations. Since ineffective pain assessment acts as a barrier to good pain management process then it implies that pain itself is considered as the first barrier to successful pain assessment process (Anand, Stevens, McGrath, 2007). A patient suffering from certain particular pain has a shortened memory span this my make it more difficult for him or her to communicate more clearly (Ann, 2007). This usually stemmed from the mere fact that when a patient is experiencing some level of pain, it automatically inhibits the patient’s memory from comprehending other stimuli hence the pain becomes an obstacle to health care professional efforts for relief. Secondly, the patient’s mental status is considered as another important barrier which may be caused by either pain or not (Ann, 2007). When a patient experiences some form of pain, he or she develops anxiety that eventually combines with pain reducing the levels of comprehension, memory as well as ability to communicate effectively. A patient usually experiences significant levels of anxiety which come a byproduct of patient’s hospitalization, treatment, diagnostic procedures, role difficulties as well as other factors related to his or her health (Liebert, 2006). Health professionals, addressing the state of patient anxiety is more important as it can effectively help them to address the patient pain more effectively. In cases where this is not important then its always important that steps be taken to accommodate the patient anxious state of mind. To achieve this, it’s necessary that the health care profession make an effort of talking to the patient more slowly, clearly, frequently when it comes to validating the patient’s way of understanding as well as response (Liebert, 2006). A quiet environment should be put in place and the activities surrounding the patient should be varied as away of accommodating the patient’s shortened attention span (Anand, Stevens, McGrath, 2007).The third barrier is Confusion which may severely interfere with the assessment of pain and this could be a result of physiological condition resulting from the disease that patient is suffering from and they include; hypoxia, blood loss, low blood pressure, hypoglycernia and among others (Anand, Stevens, McGrath, 2007). The fourth barrier is patient’s physical condition that acts as a barrier when conducting a thorough pain assessment process (Anand, Stevens, McGrath, 2007).The patient may find it hard to hear, comatose or even communicate more effectively making it hard for the health care professionals to carry out pain assessment process (Liebert, 2006). This implies that nurse’s should carry out careful assessment of any signs of discomfort such as grimacing at rest or even if the patient has problems with his or her movement. The other barrier which is more important is time since the patient health care provider in some cases may not be always physical present on prolonged long period of assessment as a result of multiple demands placed on his time Sorkin,2005). To deal with this problem it’s necessary that the health care provider develop some organizational skills the can help in resolving the time constraint problem (Gehdoo, pp.375-390, 2006). Health Care System Barriers The health care system itself can pose barriers to effective pain relief in the form of practical constraints (Michael, Fisch, Allen, pp.319, 2007).The lack of a neighborhood pharmacy, the lack of transportation to the physician or pharmacy, an absence of high doses of opioids at the pharmacy, and the lack of a home caregiver to assist with administering drugs pose major obstacles to pain treatment (Michael, Fisch, Allen, pp.319, 2007).Changes in reimbursement policies impose barriers, especially for older patients whose Medicare benefits do not pay the costs of outpatient prescription drugs (Argoff & Selvershein,2009). In addition, patients and care-givers might confront increasing co-payments, out of-pocket expenses, limits on the number of prescriptions filled per month, and limits on refills. Such fears can result in the selection of less effective analgesics and, ultimately, under treatment of the patient's pain. Moreover, patient’s with cancer are more reluctant to report their pain feelings and sometimes more rebellious to take opioid analgesics (Argoff & Selvershein, 2009).  Attitudinal Barriers According to a study established by (Brunskill, 2008), it shows that attitudinal barriers to pain management especially issues concerning personal beliefs may hinder the adoption of good behaviors that may help the patient and the nurse in achieving adequate pain relief (Brunskill, 2008).His study further indicate that complex experience of cancer pain may make a patient to develop negative attitudes towards pain management behaviors. The research proved that in the event of cancer pain the patient’s may develop a belief that they healthy and strong to tolerate the pain as well as handle it without the use of strong medicines or the help of a nurse. In the event this may hinder so much the nurse efforts in helping the patient in terms of pain management. Moreover, as result of attitudinal barrier patients may become more reluctant in reporting their pain to the nurse as well as they may even fail to take their medicines as prescribed by the nurse hence making it more difficult for the nurse to carry out the process of pain management more effectively (Briggs, 2007). Barriers related to the patient culture and beliefs Sometimes, beliefs and culture about pain may interfere thoroughly with pain management as patients may develop an attitudinal barrier that may hinder proper pain management. This is one of the major barriers hindering effective pain management especially in situations where the patient’s language is different from that of the nurse or health care provider (Bruera, 2006).This is because in such situations it becomes more difficult for the nurse to assess and manage the patient’s pain’s more effectively as a result of communication barrier. Culture tends to have a great impact on beliefs when it comes to the way patient’s ways of preventing as well as treating pain (Bruera, 2006). This is a major barrier to the nurses since most of the time they are forced to adhere to a particular patient’s culture in the process of pain management rather than attempting to catalog the pain beliefs and the cultures. People from various cultures tend to react to pain in various ways example, some individuals from certain culture may avoid vocalizing with moans or screams when in pain while others may keep their faces masked trying not to show how they are feeling (Brunskill, 2008). This may be steered with the some individual beliefs that when an individual show that he or she is in pain they may deem him as weak hence to avoid this they may deny having pain when asked by the nurses as way of maintaining their ego(Gehdoo,pp.375-390, 2006).This act as a barrier since such patient’s may prefer to be left alone to endure their pain hence end up not seeking proper medication (Brunskill, 2008). Conclusion In conclusion this essay critically analyzed the concept of pain assessment in patients’ with fatal condition by discussing in depth the enablers and barriers to effective pain assessment as well as management. Research suggests that most of the health professionals tend to focus on pharmacological pain management with heavy emphasis on the physical problem with clearly carrying out an examination to determine real type of pain. Furthermore, less emphasis is usually given to the concept of pain management in relation to spiritual, emotional and psychological aspects. In some cases, pain management may prove difficult in cases where the patient is not willing to discuss his or her medical history regarding the pain. Patient’s individual beliefs and concerns about pain can negatively influence pain management as they may hinder effective communication between the health providers and the patient. When patient’s beliefs about pain interfere with pain management then .This clearly implies that nurses should be very much careful when administrating medication to a patient with a fatal condition as this gives the patient the desire to live longer and not perceiving death as the only option to his or her condition. References Anand, Stevens, B. J., and McGrath, P. J., (2007). Pain in neonates and infants, Volume 18. Elsevier Health Sciences. p67 Argoff, C. E., & Silvershein, D. I. (2009). A comparison of long- and short-acting opioids for the treatment of chronic noncancer pain: Tailoring therapy to meed patient needs. Mayo Clinical Proceedings, 84(7), 602. Retrieved August 30, 2009, from ProQuest Nursing & Allied Health Source. Ann, M (2007). Principles and Practice of Palliative Care and Supportive Oncology, 3rd edition. Philadelphia: Lippincott, Williams & Wilkins Bruera, I (2006).Palliative Medicine.New York: Hodder Arnold (distributed in the United States by Oxford University Brunskill, D. (2008). Pain as the fifth vital signs? SERNA Newsbulletin, 9(5), 2. Retrieved August 18, 2009, from ProQuest Nursing & Allied Health Source. Briggs , E (2007). Cultural perspectives on pain management. New York: Wily and Sons Enguidanos, S., Housen, P., Goldstein, R., Vesper, E., Allen, J., Braun, W., (2009). ‘Physician and Nurse Perceptions of a New Inpatient Palliative Care Consultation Project: Implications for Education and Training’. Journal of Pallative Medicine. 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