Pain Management: A Fundamental Human Right, Research Paper Example

Nurse face the challenge on a quotidian basis to ascertain and utilize credible and reliable data in order to justify clinical decision-making and meet certain expectations and objects for evidence-based nursing. Web-based health information services have recently emerged as the most practical venues for the implementation of nursing interventions for patients (Miller et al., 2010). Extant studies and reviews of traditional nursing educational interventions for surgical patients  have yielded nebulous objectives and mixed effects on acute pain levels. As such, researchers have opted to turn to web-based interventions in order to spawn changes in health behaviors amongst diverse communities and populations (Krebs et al., 2010). Interactive health technologies that are easily accessible to the patients have emerged as the most impactful and promising media for nursing health education. Indeed, information technologies and computers have become a ubiquitous feature in people’s daily lives and retain the capacity to facilitate nursing interventions in order to effectively influence patient behaviors. Web-based interventions have yet to be utilized in the management of acute pain, yet they represent a feasible alternative to any further surgical procedures. Pain education lacks true innovation because of the inertia of interventions and the conclusions drawn in them for the past two decades (Oshodi, 2007). Thus, an innovative, web-based approach to pain management education is necessary in order to catalyze a paradigm-shift in post-operative pain management that promotes self-management in a cutting edge manner. The efficacy of both short-term and long-term approaches to pain intervention can be achieved through health information technologies such as the web-based intervention proposed below.

The majority of adults who undergo brain surgery suffer from acute pain ranging from moderate to  for up to a week following their surgery. Indeed, acute pain is the most common type of pain patients feel, which has profound psychosocial, financial, and physiological ramifications (International Association for the Study of Pain, 2010). If the pain is not controlled and is untreated, delayed mobilization of and complications in patients following surgery can be experienced in addition to vulnerability to chronic pain and longer hospital stays post-operation (Brennan et al., 2007, p. 205). Physicians most commonly prescribe and administer analgesic medication in low doses for pain relief after brain  surgery (Watt-Watson et al., 2004). Patients who are discharged early are charged with the responsibility of managing their own pain levels and intensity. The most common analgesic administered to patients for pain relief following brain surgery is Hydrocodone, although Percocet is often doled out to patients on an idiosyncratic basis depending on the type of surgery and the level of invasiveness. In addition, opioids such as morphine are commonly administered, especially during the first two days after surgery. Idiosyncratic attitudes and barriers regarding pain and pain relief often render patients averse to report their pain. As such, they do not request any analgesic medication, which results in deficient pain management and levels of analgesia, especially of the administration of the analgesics is patient-controlled. Patients expect to feel pain following brain surgery, so pain cognitions and perceptions of pain dictate movements or lack thereof. Avoiding movement can cause further pain following an operation, resulting in chronic, persistent pain and other potential complications (Forsythe et al., 2008). This endemic problem calls for more cutting-edge educational interventions for pain relief following brain surgery operations. Developing a web-based nursing intervention to influence patients to become actively involved in their postoperative pain management is necessary in order to increase patients’ accessibility to health education while also actively promoting pain relief at minimal costs.

Proposed Intervention and Justification

A virtual nursing education and assistance for patient-managed pain relief  needs to be developed using an evidence-based, pragmatic approach. The web application would be created using a blueprint found through extensive and meticulous research conducted by nursing researchers at a top-scale research center. Technology tailored to use on the computer in order to provide brain surgery patients with personalized mechanisms to empower patients and relieving clinicians and nurses of any burdens wrought by acute pain management and care in the busy, hospital environments. Moreover, it aims at providing gender-specific information to the patient prior to discharge, especially if he or she is being discharged earlier than six days following surgery. This web-based intervention screens the pain barriers and pain cognitions of the patient using persuasive and tailored communication strategies for behavioral modifications. Following the screens, the tool then creates a thirty minute session tailored to the results for the patient’s viewing prior to brain surgery guided by a virtual nurse. The virtual nurse discusses the arduous process of pain management and also provides two booster sessions ranging between five and ten minutes long that are face-to-face. Prior to implementation, clinicians would thoroughly analyze and assess the content, credibility, and usability of the web-based intervention. This intervention germinated out of the desire of nursing researchers to understand the impact of health education on the pain barriers of patients, the interference of pain on the patient’s quotidian activities following brain surgery, pain intensity, pain cognitions and the tendency to “catastrophize pain,” and patient consumption of analgesics for pain relief following surgery (Forsythe et al., 2008). It addresses a diverse population of patients who undergo brain surgery, as patients of all races, ages, and gender suffering from brain issues would benefit from such an innovative intervention.

Two to three days prior to surgery, patients have baseline measurements collected in addition to socio-demographic variables, which would later be imputed in the web-based tool.  Clinicians also would note whether or not chronic pain is present prior to the operation. In addition, baseline psychological measurements would be collected and assessed according to the Hospital Anxiety and Depression Scale, which includes fourteen different questions related to anxiety or depression (Zigmund & Saith, 1983). Extant literature and studies have attested to the validity and reliability of HADS (Bjelland et al., 2002, p. 69). The results would be imputed into the web-based intervention, which articulated messages to the patient via tailored communication. Profiles would be generated accordant to various behavioral determinants detected and gender idiosyncrasies as well as the normative, evaluative, and descriptive feedback garnered (Hawkins et al., 2008). Health information technologies attest to the currency of tailored communication and how it can modify patient perceptions and behaviors. Dynamic tailoring, or real-time answers given by the patients would also play a role in the messages delivered to the patient prior to brain surgery. One real-time question the virtual nurse could ask is what level of pain the patient expects to feel one or two days following brain surgery.

Both dynamic tailoring and static tailoring vis-a-vis a predetermined algorithm would shape the contours of the messages delivered prior to and following surgery.  The algorithm is determined by averaging the scores on the seven rankings on a pain scale questionnaire devised about the patient’s perceptions of pain–seven questions in which the patient chooses between on and five on–and the seven categories on a questionnaire developed regarding pain barriers. Averaging the scores rather than using the total for each enables more personalized and refined messages to be formulated and articulated to the patient. As a result, two separate profiles based on each is generated, which spawns different types of messages delivered to the patient. If a score between zero and two is noted, then the virtual nurse would deliver a reinforcement message to the user, which suggests that he or she possesses a mild profile. If a score between two and five is recorded on the Barriers Questionnaire, or a score between two and four on the PCS, then the application would create a reflection activity. The use of a virtual nurse delivering these messages grafts persuasive communication into this intervention because the figure of the nurse is a reliable, credible figure from the perspective of the patient.

Following this initial screening, the patient then goes through three web sequences as part and parcel of the educative component. The first sequence discusses the definition of pain; the second sequence delves into how patients react to pain on an idiosyncratic basis; and the final sequence meticulously discusses pain management. Fifty web videos in total would be shot with the virtual nurse and put on forty pages that contained various kinds of content. Seven screening pages, eight question-and-answer pages for the generation of more feedback, fifteen data pages, and seven animated pages that consolidate and evaluate the data collected. The first sequence is preceded by an introduction and outline of the general content therein, and a variety of activities are provided based on the patient’s scores. Such activities are reflective in nature and require patients to answer a series of questions. At the conclusion of each sequence, the virtual nurse would present to the user an action plan that integrates various facets for the management of pain after brain surgery. The nurse avatar would also remind the patient that a nurse would follow-up on the pain management post-operatively. The pre-operation web session would transpire one or two days prior to surgery on a laptop because of the lack of internet service available in hospital surgical units. Following surgery, the intervention calls for the dictation of which analgesic–usually Hydrocodone–the patient is administered and the dosage. After day three following the surgery,  the patient is asked a variety of questions in order to implement any modifications to the post-operative management of pain relief. Measurements of pain barriers, the intensity of pain, and to what extent does post-operative pain interfere with various activities would be collected and analyzed in the web program everyday. Modifications would germinate as the levels oscillate over a six-day period. Although an arduous process, this web-based intervention provides the patient all available education on pain management and provides ample support so that the patient mitigates any post-operative complications or fears of seeking any and all strategies for pain relief. Alternatives include post-operative education rather than pre-operative interventions. This intervention takes place over the course of one day, but its ramifications occur over a protracted period of time following brain surgery and during the recovery process.

Desired outcomes of this web-based intervention include the alleviation of acute pain intensity; minimizing pain so that it does not interfere with the patient’s activities following the surgery; modify perceptions of analgesics such as Percocet or opioids like morphine as being pernicious to patient health after brain surgery; and increasing the consumption of analgesics to alleviate pain on an idiosyncratic basis. Pain with movement and pain while resting are both considered in the measurement of pain intensity following surgery. Brain surgery patients often complain of pain after surgery when they simply breath or cough, so minimizing this complaint through an intervention aimed at normalizing the consumption of analgesics is necessary. Catastrophizing the consumption of analgesics for post-operative pain undergirds the hesitancy of many patients to adequately manage their pain following surgery. Debunking certain myths regarding this issue prior to surgery has the potential to deconstruct educative barriers regarding the consumption of analgesics, especially as the pain begins to wane. By day six following the operation, it is the hope of this intervention that pain levels subside in patients.

A web-based nursing intervention geared towards alleviating pain following brain surgery retains potential to have a profound, short-term impact on both intensity of pain patients experience as well as the interference of pain in activities such as coughing or breathing. In the past, patients were given an educational pamphlet prior to surgery as the educative component of preoperative activities. However, studies and trials have shown that the pamphlets have time and again proven inadequate in the promotion of patient’s self-management of their post-operative pain because of the salient stigma attached to analgesics and myths regarding their impact on patient health following brain surgery (Watt-Watson et al., 2004). This proposed web intervention unequivocally promotes self-management and encourages pain medication consumption by surgical patients. Extant studies have attested to the fact that there remains a lack of analgesic consumption in surgical patients, which is why an intervention that targets barriers related to pain is necessary for analgesic and opioid intake to increase (Watt-Watson et al., 2004). Such an intervention has to potential to have promising biological consequences for the patient both short-term and long-term. Pain barriers have time and again caused low analgesic intake, which is why deconstructing antiquated ideas circulating in medical discourses about the harmful effects of pain medications must be addressed through a modulated web intervention such as the one proposed.

Conclusion

With the germination of innovative technologies that can be applied to nursing, it is definitely plausible that pain management behaviors for brain surgery patients can be influenced vis-a-vis a brief intervention. This intervention calls for educative messages that are custom-created and pertinent to patients on an individual basis. One educational approach to a nursing intervention on pain management for patients following brain surgery is a web-based one in which specific strategies and mechanisms are provided that proffer sound feedback and personalization. Nursing retains a privileged position and forum to intervene in pain prevention, especially in its nascent, acute stages immediately following brain surgery. Amplifying the efficacy of health information prior to and following surgery retains the potential to decrease any and all barriers to pain management simply by empowering the patient and guiding him or her through self-management of post-operative pain. Web-based interventions provide an accessible format through which health information can be disseminated without generating high costs. Developing innovative, cost-efficient means to treat patients experiencing acute, post-operative pain is critical in efforts to decrease the chasm between evidence and practice results of undertreated, post-operative pain. If implemented, this intervention provides a far more in-depth and informative education to the patient regarding analgesics, which fully promotes self-management, especially for patients who are discharged less then a week after brain surgery. The inefficacy of pamphlets as the educative component for the surgical population calls for this intervention to be implemented in order for short-term and long-term benefits to be achieved.

References

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