Pain Limits Analysis Research Paper
Inadequately managed pain can lead to adverse physical and psychological patient outcomes for individual patients and their families. Continuous, unrelieved pain activates the pituitary-adrenal axis, which can suppress the immune system and result in postsurgical infection and poor wound healing. Sympathetic activation can have negative effects on the cardiovascular, gastrointestinal, and renal systems, predisposing patients to adverse events such as cardiac ischemia and ileus. Of particular importance to nursing care, unrelieved pain reduces patient mobility, resulting in complications such as deep vein thrombosis, pulmonary embolus, and pneumonia. Postsurgical complications related to inadequate pain management negatively affect the patient’s welfare and the hospital performance because of extended lengths of stay and readmissions, both of which increase the cost of care.Pain Limits Analysis Research Paper
Continuous, unrelieved pain also affects the psychological state of the patient and family members. Common psychological responses to pain include anxiety and depression. The inability to escape from pain may create a sense of helplessness and even hopelessness, which may predispose the patient to a more chronic depression. Patients who have experienced inadequate pain management may be reluctant to seek medical care for other health problems. (For more detail, go to the section, “Harmful Effects of Unrelieved Pain,” below.)Pain Limits Analysis Research Paper
Poorly managing pain may put clinicians at risk for legal action. Current standards for pain management, such as the national standards outlined by the Joint Commission (formerly known as the Joint Commission on Accreditation of Healthcare Organizations, JCAHO), require that pain is promptly addressed and managed. Having standards of care in place increases the risk of legal action against clinicians and institutions for poor pain management,and there are instances of law suits filed for poor pain management by physicians.7 Nurses, as part of the collaborative team responsible for managing pain during hospitalization, also may be liable for legal action.
Hospitals stand to lose reputation as well as profit if pain is poorly managed. Patient satisfaction with care is strongly tied to their experiences with pain during hospitalization. Evidence indicates that higher levels of pain and depression are linked to poor satisfaction with care in ambulatory settings. With the advent of transparent health care, report cards for hospitals are becoming more prevalent, and performance on pain management is likely to be one of the indicators reported.Pain Limits Analysis Research Paper
Under treatment of Pain
The under treatment of pain was first documented in a landmark study by Marks and Sachar in 1973.9 These researchers found that 73 percent of hospitalized medical patients had moderate to severe pain. The under treatment of pain continues. Thirty years later in 2003, Apfelbaum and others2 found that 80 percent of surgical patients experienced acute pain after surgery, and 86 percent of those had moderate to extreme pain. Of 1,308 outpatients with metastatic cancer from 54 cancer treatment centers, 67 percent reported pain.10 Of those who had pain, 62 percent had pain severe enough to impair their ability to function, and 42 percent were not given adequate analgesic therapy. It is estimated that 45 percent to 80 percent of elderly patients in nursing homes have substantial pain that is under treated.11 These studies and others suggested that when patients had moderate to severe pain, they had only about a 50 percent chance of obtaining adequate pain relief.
Harmful Effects of Unrelieved Pain
Patients suffer from pain in many ways. Pain robs patients of their lives. Patients may become depressed or anxious and want to end their lives. Patients are sometimes unable to do many of the things they did without pain, and this state of living in pain affects their relationships with others and sometimes their ability to maintain employment.
What is often overlooked is that pain has physically harmful effects. It is often actually physiologically unsafe to have pain.13 The effects of pain on the endocrine and metabolic system, cardiovascular system, gastrointestinal system, and immune system—and the potential for future pain—are but a few of examples of how unsafe unrelieved pain may be.13Pain Limits Analysis Research Paper
Pain causes stress. The endocrine system reacts by releasing an excessive amount of hormones, ultimately resulting in carbohydrate, protein, and fat catabolism (destruction); poor glucose use; and other harmful effects. This reaction combined with inflammatory processes can produce weight loss, tachycardia, increased respiratory rate, fever, shock, and death.14 Unrelieved pain prolongs the stress response, adversely affecting the patient’s recovery.
The cardiovascular system responds to stress of pain by activating the sympathetic nervous system, which produces a variety of unwanted effects. In the postoperative period, these include hyper coagulation and increased heart rate, blood pressure, cardiac work load, and oxygen demand. Aggressive pain control is required to reduce these effects and prevent thromboembolic complications. Cardiac morbidity is the primary cause of death after anesthesia and surgery.13, 15Pain Limits Analysis Research Paper
Since the stress response causes an increase in sympathetic nervous system activity, intestinal secretions and smooth muscle sphincter tone increase, and gastric emptying and intestinal motility decrease. This response can cause temporary impairment of gastrointestinal function and increase the risk of ileus.13, 15
Unrelieved pain may be especially harmful for patients with metastatic cancers. Stress and pain can suppress immune functions, including the natural killer (NK) cells that play a role in preventing tumor growth and controlling metastasis.13, 16 Further, management of preoperative pain is probably a critical factor in preventing surgery-induced decrease in resistance against metastasis.
Unrelieved acute pain can result in chronic pain at a later date. Thus, pain now can cause pain later. If acute shingles pain is not treated aggressively, it is believed to increase the risk of prosthetic neuralgia.18, 19 A survey of patients having undergone surgery found a high prevalence of chronic post surgical pain in patients whose acute post surgical pain was inadequately managed.20
Challenges experienced in managing pain essay
The major challenge of such methods of managing pain as psychotherapy and hypnosis is the fact that in order to use such therapy, the healthcare professional should possess special knowledge and skills. This challenge can be addressed by integrating evidence-based approaches and psycho therapeutic practices into nursing training programs (Parsons & Preece, 2010).Pain Limits Analysis Research Paper
With regard to such methods as relaxation and distraction, the major challenge is the fact that the patients should be well-informed about the process of pain treatment, and should be able to use these pain management approaches themselves. This challenge can be addressed by explaining the mechanisms of pain control, the essence of the methods and key techniques to the patients.
There also exist challenges which relate to all pain management approaches. The sensitivity to pain is individual, and different patients might respond differently to common methods of managing pain. In order to address this challenge, nurses should apply multi-component pain management programs. Another challenge is the possible extinction of positive behaviors due to the lack of reinforcement (Laccetti & Kazanowski, 2008); this challenge can be addressed by providing a follow-up after the set of therapeutic sessions aimed at managing pain. Chronic pain might fluctuate and the responses to treatment might differ because of different pain cycles (Laccetti & Kazanowski, 2008); in such cases, nurses should carefully trace the patient’s dynamics and choose the appropriate methods of pain management in accordance with the changes in chronic pain intensity and character.Pain Limits Analysis Research Paper
Conclusion
Management of pain is one of the important nursing skills. Pain changes the quality of patient’s life and leads to various negative consequences, so nurses should be able to manage pain timely and adequately. Earlier pain management in nursing was viewed from a predominantly medical perspective, but recent evidence shows that there are numerous psychological factors influencing the process of pain perception. There are core psychological approaches for managing pain such as hypnosis, cognitive-behavioral therapy, relaxation, distraction, meditation, music etc. These approaches are often combined and nurses use multi-component programs for pain management. It is crucial for nurses to be aware of psychological approaches of managing pain and to incorporate them into the integral process of nursing care.
Pain is a word that most of us hate even to experience in life. It is a fundamental element that we feel,
When we get hurt physically or mentally. In a very small age, it is common to fall down and cry because of a slightly pain. The more we experience it the more we grow stronger in future. Physical pain is what we feel outside, It is temporary and we learn from it, The one in the inside called Mental pain can last for even a whole year and even keep us thinking. In a young age, We experience it in life such as relationship with your girlfriend, Friends, Family or even local people.Pain Limits Analysis Research Paper
Whenever someone hurts you, you become vicious even if the person tries to help you. Lots of people try to neglect this feeling by simply being apathy. It sounds odd to do it but there are few human beings that actually do it, Whoever knows a person like that calls him crazy without knowing his past. Pain leads certain people to reach their goals because of the hard life they went through. While youngsters complain about how their relationship is conducted pretty bad, Adults take their time thinking on how to invest their money on their children. For adults it’s a huge pain, when their kids fail it shows them no hope to continue spending and it makes them get disappointed all caused by pain.
Pain is an everlasting feeling we won’t be able to change even if we feel like, it will haunt us for the good or for the bad.
In my opinion, I recommend you learn from it anytime in all sorts of ways in relationship, work, outside anywhere. The only way you defeat it is by getting stronger every day, a lot of people feel pain and give up easily without trying to get over it except talking. It seems to be inhuman to accomplish it but it is the truth if you become stronger you will gain more advantages in the future so do not take everything to heart just learn from it.Pain Limits Analysis Research Paper
Types of pain essay
Pain is the signal of distress sent by the body; it is hard to define pain in a precise way though. One of the definitions of pain is the following: “the feeling of suffering or agony, caused by stimulation of specialized nerve endings” (Rosdahl & Kowalski, 2008, p.704). According to the classification of the International Association of the Study of Pain, it is possible to identify three different types of pain: acute pain, chronic pain and cancer pain (Parsons & Preece, 2010).
Acute pain, also referred to as nociceptive pain, is described by patients as sharp, throbbing or abrupt pain. This pain mostly occurs as a response to tissue damage or trauma as a result of normal processes in the nervous system (Acello, 2010). This type of pain usually lasts for a short period of time (up to 6 months, but most frequently less than that), and disappears when the damage is treated.
Chronic pain, also referred to as neuropathic pain, lasts for a long time (more than 6 months) and is the result of the damage to the nervous system and/or incorrect processing of the input signals by the nervous system (Laccetti & Kazanowski, 2008). The causes and mechanisms of chronic pain are often unknown or complex. Chronic pain dramatically changes the patient’s quality of life and causes negative psychological consequences, such as anger, anxiety and depression (Rosdahl & Kowalski, 2008). Cancer pain is a specific type of chronic pain which is caused by a certain malignancy in the organism and is very severe.
This is a reflective essay that will be focusing on my experience and feeling on how I related with a patient who was complaining of severe pain in the surgical ward during my posting there. I will be using the Gibbs (1998) reflective cycle as a guide on this essay. The Gibbs (1998) Reflective Cycle which is one of the most popular models of reflections consists of six steps: Description which describes as a matter of fact the situation and what happened during the incident. For my case the management of this patient who was admitted and was being managed pre-operatively for intestinal obstruction; secondly, feelings which is the description or the analysis of what my thoughts and feeling were at the time of this incident. Thirdly, the evaluation of my experience: this is about what was good and bad about my experience. Fourthly the analysis of my experience about what I can make out of the situation. Conclusion is the sixth step and it is about what else I could have done and what could I not have done. The final step is the action plan. The action plan will be about what I will do if this situation arose again or what I will do differently bearing in mind my experience from the steps above (Jasper 2003).
Reflective practice writing is a way of expressing and explaining one’s own and others stories crafting and shaping to and understanding and development and it enables practice development because the outcomes of reflection are taken back into practice, improving and developing (Bolton 2005). Reflection “is a way of learning from your direct experiences, rather than from the second-hand experiences of others” (Cottrel 2003, p6). There are several other models of reflective practice. In addition to the Gibbs (1998) models, there are the Johns’ model of reflection (1995); Kolb’s Learning Cycle (1984) and the Atkins and Murphy’s model of reflection (1994).Pain Limits Analysis Research Paper
Description
During my placement at the acute surgical ward, I came across a patient who I will name Mr Jones (not real name). This is due to confidentiality. According to the NMC (2008) The Code: Standards of conduct, performance and ethics for nurses and midwives article 5, 6 and 7, it states that ” You must respect people’s right to confidentiality; You must ensure people are informed about how and why information is shared by those who will be providing their care; You must disclose information if you believe someone may be at risk of harm, in line with the law of the country in which you are practising” (NMC 2008, p2). When I arrived at the ward on the 8th of October, the senior nurse briefed us about the cases on the ward. I learnt that Mr Jones was admitted into the surgical ward with severe abdominal pain and he has been diagnosed with small intestinal obstruction and is being managed per-operative for surgical intervention. While attending to the patients in the ward under the supervision of my mentor (NMC 2008), Mr Jones called out to me that he is in severe pain. Walking up to him, I noticed the agony and pain he was in. Once he had my attention he was screaming and berating me that he is in terrible pain and that he need more pain killers. I approached Mr Jones and introduced myself with the aim of building an initial and good rapport with him and to establish a nurse-patient relationship (Holland et al 2008). I was so petrified with the signs and the way he communicated with me in such a way that really expressed he was in severe pain. I assured Mr Jones that I will have a word with a qualified nurse and will be back. I walked up to my mentor and ask that Mr Jones would need some pain killers as he is in severe pain.
I was very surprise when my mentor said to me “okay, where is Mr Jones drug chart”? And to my utmost surprise, instead of getting a cocktail of pain killers for Mr Jones, she was asking several questions. How do you know that he is in such severe pain as you have just described to me? Have you asked him with the trust policy of pain scale? What type of pain killers has been given to Mr Jones and for how long ago were these given to him? She went on and on and I felt embarrassed and at same time very eager to correct my mistakes. I was unable to answer any of the questions she has asked. I guess I must have been overwhelmed with sympathy rather than empathy for the patient. I went to bring Mr Jones’ drug chart and my mentor explained to me that from his drug chart recordings, he is on oral morphine 10mg 4 hourly and the last dosage was given in just an hour ago. He would need a doctor to review to see whether he might need another route and dosage of the analgesic she explain to me.Pain Limits Analysis Research Paper
Feeling
My first feeling was that this patient could be in severe pain and there is need to administer some form of strong analgesics. Pain according to the International Association for the Study of Pain is, “An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage” (IASP 1979). Pain may not be totally objective but subjective according to Braun et al (2003), they went on to further point out that included in pain are emotional as well as personal experiences. Pain could be divided simply into acute and chronic pain based on its duration (Shipton 1999). Acute pain is of short or limited duration usually associated with traumatic tissue injuries, whereas chronic pain is a pain or discomfort persisting for about 3 to 6 months and may persist beyond the healing period (Sinatra et al 2009; Ready and Edwards, 1992) and pain could progress from acute to chronic (Blyth et al, 2003). There is a psychological aspect to pain. According to Eccleston (2001), pain can be influenced among other things by culture, previous pain experience, mood, ability to cope or even belief. He concluded that pain is multifactorial and as such individuals should be treated differently. One of the underpinning principles of the Roper-Logan-Tierney model of nursing is the individualisation of nursing care and nursing practice (Roper et al 2000). My mentor showed me that Mr Jones is on 10mg oral morphine four hourly and that he may need a new review by the doctor so as to reassess his pain. I went to inform Mr Jones of this. On getting to him, I introduced myself with the aim of continuing our initial good rapport and also to obtain consent. According to the RCN “Informed consent is an ongoing agreement by a person to receive treatment, undergo procedures or participate in research, after risks, benefits and alternatives have been adequately explained to them” (RCN 2005, p5). Also, it has long been documented that information reduces anxiety (Byshee 1988 cited in Hughes 2005). I informed him that he will need a reassessment by the doctor in order to change his pain killer or if there is need to increase the dose and that the doctor has been notified of this. To my surprise, this seemed to calm him down a little as I explained and listened empathically to him. In a study carried out by Matthew son at the elderly care unit at New Cross Hospital in Wolverhampton, she concluded that nursing is the art of caring and as such we must listen empathically to what patients and service users want so we can give them the care that they deserve (Matthew son 2002).Pain Limits Analysis Research Paper