Poor Post-Operative Abdominal Pain Management, Essay Example

The article chosen for this review was one published in the British Medical Journal in 2011 entitled, “Efficacy of Treating Pain to Reduce Behavioral Disturbances in Residents of Nursing Homes with Dementia: a Cluster, Randomized Clinical Trial”.  This paper will review the study itself, as well as discussing its theoretical framework, new insights gained by the review and its application in clinical practice.

The Study and its Theoretical Framework

In this study on the relationship which exists between pain and one particular behavioral manifestation, agitation, 352 residents in 18 nursing homes across the United Kingdom were involved in a study to determine if “a systematic approach to the treatment of pain can reduce agitation with people with dementia” (Ballard, 2011, p. 406).  In this study, the intervention group was given individualized pain treatment in a stepwise protocol; at the end of the 8 week trial it was found that the intervention group (compared to the control group who received regular care) has an average decrease in agitation of 17%.  The study concluded that “Effective management of pain can play an important role in the treatment of agitation and could reduce the need for the number of unnecessary psychotropic drugs in this population” (Ballard, 2011, p. 413).

The theoretic framework which drives this research and others like it is one that pain that is uncontrolled or poorly controlled will manifest itself in other ways (in this instance, behavioral disturbances), particularly in a patient population that is difficult to assess because it is largely nonverbal (Voepel-Lewis, 2010, p. 55). This framework was entirely appropriate: the findings in this study validated the theoretical framework and its conclusions have also been validated by other similar studies, such as a recent one published in The Surgeon on poorly controlled pain in post-operative patients which concluded that “pain management needs the implementation of an active approach in practice…nursing staff should continually use appropriate pain assessment tools to evaluate pain” (Samaraee, 2010, p. 157).

Insights

This study provided a good insight into the real and concrete consequences for patients in regards to whether or not pain in adequately controlled.  Pain management can be challenging at the best of times, but when other complications are factored in, such as in this study when the population in question had dementia and was largely nonverbal. To give another example of this, in a 2010 paper published in OncologyNursingForum found factors of race, class and age to be barriers in development of a plan of care for adequate pain control in cancer patients. The study found that “disparity results in inadequate management of cancer pain in vulnerable populations (poor patients, ethnic and racial group members, older adults) and is unacceptable in cancer care” (McNeill, 2010, p. 128).

Application to Clinical Practice

The practice problem of inadequate or inappropriate pain control has infinite possibilities for research and is going to be one of the ongoing fields of study in nursing for some time to come, partly because of the real consequences it has for patient outcomes.  On one hand, inadequate pain, as is shown in the studies previously discussed, has real consequences for vulnerable groups like ethnic minorities, recuperating post-operative patients, low economic status patients and those with dementia, all of whom need support. On the other hand, there are the social ramifications of the overuse of opioids for pain control: the use of these analgesics has increased tenfold since the 1990’s and since that time there has been a sharp rise in accidental overdoses and ER visits. Robert Rolfs, Utah’s state epidemiologist notes, “This is, in some ways, an unintended consequence of an intent to treat pain better.” (Okie, 2011, p. 983).

Conclusion

In conclusion, the study under review (as well as the other studies cited in this text), is part of a growing body of research dedicated to one of the most challenging aspects of nursing care: safe and adequate pain management. Whether this is being looked at from the point of view of floor nurses who give direct patient care or researchers trying to gain new insight into this issue, it remains a topic which requires ongoing study to formulate best practice and to improve patient outcomes.

References

Ballard. C. (2010). “Efficacy of Treating Pain to Reduce Behavioral Disturbances Disturbances in Residents of Nursing Homes with Dementia: a Cluster, Randomized Trial”.  British Medical Journal.  34 (3) 406-416. Print

McNeill, J. (2010).  “Unequal Quality of Cancer Pain Management: Disparity in Perceived Control and Proposed Solutions”.  Oncology Nursing Forum.  34(6) 112-128. Print.

Okie, S. (2011). “A Flood of Opioids and a Rising Tide of Deaths”. New England Medical Journal.  36(3) 981-985. Print.

Samaraee, A. (2010). “Factors Contributing to Poor Post-Operative Abdominal Pain Management in Adult Patients: a Review”.  The Surgeon, a Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland. 34(3) 151-158

Voepel-Lewis, T. (2010). “Reliability and Validity of the Face, Legs, Acting, Crying, Consolability Behavioral Tool in Assessing Acute Pain in Critically Ill Patients.” American Journal of Critical Care. 19(1). 55-61. Print.