Pain Management Best Practice, Essay Example

Introduction and Problem Statement

Pain assessment and management represents a significant health concern in many areas throughout the world. Pain is a difficult challenge to address across many age groups and requires a high level understanding of the issues that impact health and wellbeing for this group, particularly when pain is difficult to overcome without clinical and/or pharmacological support (Grantham & Brown, 2012). These issues lay the groundwork for an increased risk of health problems in the adult years and reduced quality of life. Advanced practice nurses at the doctoral level may provide a level of education and guidance to adults to provide direction regarding pain management during this vulnerable period (Klassen, 2009). Pain management is a frightening process for many adults, given their level of pain tolerance; therefore, much of the emphasis should be on these areas and specifically, in areas where resources and knowledge are limited. Nurses at the advanced level are required to communication options regarding pain management during periods when this is a serious concern and how it may create challenges throughout the life span (Klassen, 2009). The following discussion will address the problem of pain management in greater detail and will emphasize the use of an educational intervention as led by advanced practice nurses in order to improve knowledge, expand resources, and promote behavioral change among those who experience pain in order to provide greater opportunities to improve health and wellbeing for many children and adults who experience this set of challenges. This discussion will include theoretical nursing perspectives from King and Swanson in order to demonstrate the importance of achieving goals and objectives, while also supporting a caring and nurturing environment for the designated population who require significant attention and focus during a vulnerable period.

Literature Review

Pain of the acute and chronic variations may have lasting complications; therefore, the scope of this problem must be addressed in the context of existing research and literature. To be specific, pain management requires a high level understanding of the different types of pain that exist and how this impacts patient health and wellbeing in different ways. The utilization of existing clinical practice guidelines represents an opportunity to convey new ideas and approaches to pain management and assessment that will aim to preserve patient health and wellbeing more effectively (Grantham & Brown, 2012). Clinical practice guidelines offer different types of resources that have a significant impact on patient care and treatment in order to minimize pain and suffering and support improved quality of life for patients (Grantham & Brown, 2012). Most importantly, education for patients with chronic pain must be established, using the following recommendations: “Institute educational and psycho-educational interventions as part of the overall plan of treatment for pain management; Implement educational and psychosocial interventions that facilitate coping of the patient and family early in the course of treatment” (Grantham & Brown, 2012, p. 19). In this context, cognitive-behavioral therapy must be considered as part of the treatment plan in situations where this might be a useful approach to manage patient outcomes more effectively than pharmacological treatments (Grantham & Brown, 2012).

Pain management is very difficult for many patients, particularly older adults, as it represents a challenge that is difficult to overcome with respect to their needs if they face cognitive or other behavioral deficits that impact their quality of life (Hadjistavropoulos et.al, 2009). These factors require a greater understanding of the different elements that are recognized as important to the pain management process, including those that impact patients in different ways and support long-term approaches to working with the older adult population (Hadjistavropoulos et.al, 2009). These factors require nurses and other healthcare providers to be cognizant of the challenges of working with older adults who possess deficits and to aim to improve outcomes through a variety of options that are designed to facilitate change and progress within this population (Hadjistavropoulos et.al, 2009).

Pain management in older adults requires an effective understanding of the different scenarios in which pain is experienced, including those involving the abdominal area, which may be very difficult to control (Samaree, 2010). Therefore, patients must be provided with an understanding of their pain and how to address it effectively so that they are provided with the best possible means of recovery and management of this pain if and when it persists (Samaree, 2010). These factors require the development of new ideas and directions that will facilitate effective pain management from the patient’s perspective, including understanding the nature of the abdominal pain and if other factors have exacerbated this condition (Samaree, 2010). For this population, it is often the case that patients do not receive the best possible treatments to address their condition; therefore, they must be provided with advanced practice tools and resources to improve their pain as best as possible (McLiesh et.al, 2009; Tracy, 2013). Education is critical to this process and provides a basis for exploring new ideas and directives to support patients in need of different pain management therapies, using prior research and knowledge to meet these needs (Michaels et.al, 2007; Reid et.al, 2011).

Pain in patients in the intensive care unit requires a high level understanding of the different elements that contribute to the improvement of the practice environment, as well as other factors that support the treatment of pain within this patient population (Barr et.al, 2013). In particular, pain management within the older adult population requires an understanding of the different elements that enable patients to understand their own situations and to work with nurses and other healthcare providers to manage their pain as effectively as possible (Klassen, 2009; Gropelli & Sharer, 2013). Pain management must be addressed with the older adult in mind and must reflect opportunities to examine the treatments that are available, and this must include an examination of behaviors associated with pain assessments and their impact on the treatment decisions that are made (Topolovec-Vranic et.al, 2010).

One of the most relevant nursing theories for pain management is the Goal Attainment Theory of Nursing, created by Imogene King in 1981 (Raingruber, 2013). This theory supports the belief that human beings react to different events that impact their health using their rationale, their ability to act, and their ability to perceive different events and experiences (Raingruber, 2013). For adults, it is necessary to consider a variety of factors that impact patients, such as non-pharmacological treatments, as these may have a significant impact on patient outcomes over time (Raingruber, 2013). Patients who require pain management must be apprised of their condition and the methods that are available to address it effectively so that the appropriate treatment choices are made (Raingruber, 2013).Concepts associated with this theory include transaction, communication, and goal setting, all of which contribute to goal attainment and an opportunity to improve health through these efforts (Raingruber, 2013).

Description of the Case

For older adults, generally considered to be a vulnerable population, there is a potentially greater risk of pain associated with chronic disease, cancer, and other conditions. Therefore, it is believed that older adults will largely benefit from an educational program that supports an understanding of pain and the treatments that are available to address this pain effectively (Tracy 2013).  The proposed case involves a group of older adults who require pain management therapy due to different forms of cancer. This group of adults ranges in age from 65-76 and is comprised of 15 members. For the proposed intervention, King’s Theory of Goal Attainment and Swanson’s Theory of Caring will be addressed in order to determine how they influence an education program taught by an advanced practice nurse in the clinic setting where these patients are treated. The proposed program would provide an environment in which adults would receive targeted information and guidance regarding pain management therapies, such as social and cognitive therapy, in order to address their pain management needs. It is important to address this adult population because with the appropriate knowledge and education, they will be able to make a valid contribution in enhancing their decision-making potential regarding pain and what is involved in addressing this condition to alleviate pain and facilitate greater quality of life, in spite of the cancer diagnosis (Tracy, 2013).

In this case, there are two advanced practice nurses who will provide instruction for the program. The educational program will enable an advanced practice nurse to provide valuable information and guidance to this group of adults so that they are able to make positive decisions regarding their pain management and their overall condition that will benefit their health and wellbeing. This group of individuals requires a high level understanding of the challenges and opportunities that are available through advanced practice nursing in order to make a difference in their own lives, particularly since they face a difficult diagnosis of cancer to begin with. Since pain management is a challenging condition in some communities, it requires an understanding of the issues and challenges that many communities face, including their lack of understanding of the issues that have a significant impact on managing pain under the direction of an experienced set of individuals to treat the pain in different ways (Hadjistavropoulos et.al, 2009). It is anticipated that there will be significant potential to develop new strategies to encourage members of the older adult community to be receptive to education and knowledge regarding their social and cognitive needs and expectations that will have a significant impact on their wellbeing, using established theoretical frameworks as a guide in this learning curve.

Discussion

The development of the proposed educational framework for older adults requires significant backing from existing theoretical perspectives in order to accomplish the desired objectives. For example, Swanson’s Caring Theory is comprised of a number of key components, including the following: 1) believing and having faith that change will occur; 2) knowing how to address specific experiences and how they demonstrate a high level of meaning and support with the chosen objectives; 3) recognizing the importance of an emotional connection to the issue; 4) treating others the same as one would like to be treated; and 5) supporting others and enabling them to be able to recognize how to provide self-care (Swanson, 2011). This theory represents an opportunity to examine the different constructs of caring and to be cognizant of the issues that impact older adults who face the risk of pain. For older adults, recognizing that those around them care about their wellbeing is an important step towards the discovery of self-awareness and the ability to care for oneself effectively towards the primary goal of improved health and wellbeing (Swanson, 2011).  Therefore, Swanson’s Caring Theory is applicable to the case in question because it engages adults in an environment that enables older adults to be receptive to learning about behaviors that will have positive results in their lives, even if they do not fully understand their significance.

Another theory to consider in evaluating pain management and related education for adults is Imogene King’s Theory of Goal Attainment, whereby there is a significant opportunity to examine the different challenges related to the issue and to establish goals and objectives that are reasonable and appropriate in order to achieve the desired outcomes (Current Nursing, 2012). It is believed that “Transaction represents a life situation in which perceiver & thing perceived are encountered and in which person enters the situation as an active participant and each is changed in the process of these experiences” (Current Nursing, 2012). These factors represent an opportunity to examine the different constructs of goals and how to achieve them, using active and practical experiences a guide in this process (Current Nursing, 2012). These factors will enable older adults to understand the challenges of pain management and how to improve outcomes. From this perspective, older adults require an active and appropriate support system that is designed to encourage them to learn how to make positive decisions for themselves and to recognize the importance of developing strategies that are likely to improve their lives over the long term. Nonetheless, this requires support and knowledge to ensure that pain management is handled as best as possible.

Summary of the Case

The proposed case example provides a framework for advancing a critical health issue that impacts many adults in their most vulnerable years. This issue reflects the importance of having a strong and close-knit support system that will enable adults to obtain social and cognitive support in order to effectively manage their pain condition as best as possible. However, this is not achieved without a greater understanding of the issues that are likely to be most influential in improving the quality of life of adults so that they are able to address their health and pain management needs in a comprehensive manner. These circumstances require a high level of support and guidance in order to effectively demonstrate a new perspective that will positively impact adults who experience pain and support their own decision-making capabilities. The education and knowledge that would be provided by the advanced practice nurse supports adult learning and their ability to impart new lessons learned to others. There are considerable advantages in adopting nursing-based theories and in supporting the development of new ideas to encourage adults to make an effort to have a positive impact on the lives of children who require support, guidance, and an understanding of why specific behaviors are more appropriate than others. This process is instrumental in expanding knowledge and resources in order to effectively support adults who are lacking knowledge regarding how to effectively manage pain in other ways beyond pharmacological means. It is believed that these factors will encourage the development of new ideas to educate adults to make positive decisions regarding their pain as best as possible.

Proposed Solutions

Most importantly, the proposed intervention will be used to spread awareness of effective pain management solutions through education and example. This will support adults, understanding of pain and its many different patterns and how they must pay attention to these issues on a regular basis. Adults must also learn that pain management is a constant battle for many patients that requires ongoing attention and focus, yet it also requires a level of support and guidance that will have a positive impact on patient outcomes. This process requires advanced practice nurses with extensive knowledge of health issues, including pain management, in order to educate other adults in order to provide them with opportunities to make positive decisions of their own in this regard. In particular, the use of non-pharmacologic therapies is essential to this population and provides a greater sense of discovery and support in enabling adults to experience recovery from pain on a consistent basis.

It is also believed that the proposed education program will enable adults to recognize the importance of understanding pain and how to manage it through a variety of interventions. The intent is to enable adults to make positive decisions regarding pain management that will have a positive impact on their lives and their overall health. This process requires adults who will provide examples of social support and cognitive therapies who will be supportive of their needs during this vulnerable period. This process will engage adults regarding their own welfare and will encourage them to take the steps that are required to achieve effective outcomes and engage other factors in order to support pain management in a way that is consistent with established guidelines and that does not promote a dependency on pharmacological pain therapies that may impact patients over time.

Identification of Research Instrument

In order to evaluate the effectiveness of the proposed education program for adults with pain management needs, it is important to develop a survey instrument after the education program has taken place in order to determine if it has been effective in meeting its desired goals and objectives (Hadjistavropoulos, et.al, 2009). This process requires advanced practice nurses to develop an instrument that will determine whether or not the program provided any new forms of knowledge to the targeted adults. This process will also provide a basis for exploring other ideas to ensure that adults are able to use the education that they receive and transform it into a valuable approach and to pass the information on to others in a successful manner (Grantham & Brown, 2012). The questionnaire instrument provides a basis for exploring the dimensions of pain management and how this will impact patients across a variety of population groups who require different forms of therapy to meet their needs, including cognitive therapies. These options must be available to patients in order to improve their quality of life, while also considering other factors that will have a significant impact on patient outcomes and relationships between older adult patients and healthcare providers (Grantham & Brown, 2012).

Conclusion

Managing pain in older adults with cancer is a serious concern that requires further evaluation in order to better understand the scope of this practice and its impact on health and wellbeing. It is important to identify the tools and resources that are required to ensure patients receive successful treatments that will positively influence outcomes that will alleviate pain through specific recommended therapies. Social cognitive theory-based approaches must be considered as part of the pain management process, and patients must be receptive to these recommendations. These issues are critical to the success of the endeavor and demonstrate an opportunity to examine the different constructs of pain management and their impact on health and wellbeing. It is believed that pain management techniques must reflect an opportunity to promote healing and to improve quality of life, particularly for patients who experience chronic pain on a continuous basis. Therefore, education must be provided to older adults as a means of addressing specific circumstances that will support and guide patients through difficult periods when their pain is difficult to bear. With cognitive and social support, however, it is believed that these practices will improve and patients will receive the type of care and treatment that is necessary to improve their health and wellbeing as best as possible. Cancer patients must receive social support and guidance in managing their disease and the pain that accompanies it, as these practices will ensure that they are able to stimulate some degree of recovery and improvement of their lives in different ways that will have a positive impact on their overall health status and level of mood.

References

Al Samaraee, A. (2010). Factors contributing to poor post-operative abdominal pain management in adult patients: a review. Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland, 8(3), 151-158.

Barr, J., Fraser, G. L., Puntillo, K., Ely, W., Gelinas, C., Dasta, J. F., Jaeschke, R., et al (2013).

Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit: Executive summary. 70, 53-8.

Current Nursing (2012). Imogene King’s Theory of Goal Attainment. Retrieved from currentnursing.com/nursing_theory/goal_attainment_theory.html

Grantham, D., & Brown, S. (2012). Pain Assessment and Management: Clinical Practice

Guidelines. Winnipeg Regional Health Authority. Retrieved from http://www.whra.mb.ca

Gropelli, T., & Sharer, J. (2013). Nurses’ perceptions of pain management in older adults. Medsurg Nursing, 22(6), 375-382.

Hadjistavropoulos, T., Hunter, P., & Fitzgerald, T. (2009). Pain assessment and management in older adults: Conceptual issues and clinical challenges. Canadian Psychology, 50(4), 241-254.

Klassen, B. L. (2009). Pain management best practice with older adults: Effects of training on staff knowledge, attitudes, and patient outcomes. Physical and Occupational Therapy in Geriatrics, 27(3), 173-197

McLiesh, P., Mungall, D., & Wiechula, R. (2009). Are we providing the best possible pain management for our elderly patients in the acute- care setting? International Journal of Evidence Based Healthcare, 7, 173-180

Michaels, T. K., Hubbart, E., Carroll, S. A., & Hudson-Barr, D. (2007). Evaluating an Educational Approach to Improve Pain Assessment in Hospitalized Patients. Journal of Nursing Care Quality, 22, 260-265

Raingruber, B. (2013). Contemporary Health Promotion in Nursing Practice. Jones & Bartlett Learning.

Reid, M., Bennett, D., Chen, W., Eldadah, B., Farrar, J. T., & Gallagher, R. M. (2011). Improving the pharmacologic management of pain in older adults: Identifying the research gaps and methods to address them. Pain Medicine, 12(9), 1336-1358.

Topolovec-Vranic, J., Canzian, S., Innis, J., Pollman-Mudryj, M. A., McFarlan, A. W., & Baker, J., et al., (2010). Patient satisfaction and documentation of pain assessments and management after implementing the adult nonverbal pain scale. American Journal of Critical Care, 19(4), 345-355

Tracy, B. (2013). Pain management in older adults. Clinical Therapeutics, 35(11), 1659-1668