Hospitals “Nurses” Pain Management
There are a number of factors involved in regards to a nurse’s best practice associated in pain management. To ask a patient ‘do you have pain? ‘ is not an adequate intervention for effective pain management by nurses.
As the literature shows, pain assessment is a much more comprehensive and important aspect of best practice. Firstly, the assessment of pain is both integral to understanding the patient and their experience of pain, and allowing the management of this pain to be of the highest standard.Pain management can only be executed to its full degree if the assessment is accurate and comprehensive, relating specifically to the individual. As Seers & Friedli (as cited in Manias et al, 2002) explains ‘Indeed, pain is more than ‘an unpleasant sensory or emotional experience associated with actual or potential tissue damage; it is also determined by the…[individuals’] specific context and the meaning they give to their pain.
‘ Another important factor to look at is the interpretation and analysis of this assessment.This is essential in deciding what interventions are appropriate for the individuals care (Daly, L 1999). These topics will be further explored and discussed throughout this essay and supported by the relevant literature. Pain assessment must be accurate. To achieve this, the nurse must firstly provide an environment in which the patient is able to speak freely about their pain.
The nurse should therefore create a trusting, non-judgemental therapeutic relationship with the patient.As McCaffery et al (as cited in Horbury et al 2005) states ‘… the patients’ self-report of pain is the single most reliable indicator of pain.
‘ The honesty of their self-report of pain coincides with a healthy therapeutic relationship with the nurse. Mistrust between the patient and the nurse can cause ineffective pain management due to the underreporting or exaggerated reporting of pain (Daly 1999). Therefore, for the integrity of patient assessment, it is vital that there is trust and understanding between the nurse and patient.From this discussed therapeutic relationship, there is a basis from which the nurse can converse the patient’s experience of their pain. Carr et al (1997) describes pain as ‘whatever the experiencing person says it is and exists when ever they say it does. ‘ Therefore, to give holistic care, the nurse must work to understand the patient and their individual experience then correlate this with their knowledge of pain as a practitioner in the assessment and management stages of care.
To do this, the nurse must be thorough and constantly observant and aware while discussing pain with their patient, being guided by certain topics of discussion. As Godfrey (2005) discusses ‘the assessment should include a description of the pain: its location, duration, frequency, intensity, aggravating and relieving factors, and the patient’s cognitive response to pain. ‘ The nurse can assist the patient in explaining their pain through a range of tools ranging from a numerical scale (zero being no pain, ten being the worst imaginable) and pictures which can assist in describing the location.The nurse should be skilled in deciding the appropriate methods and tools used for pain assessment so that the information gained is reliable and appropriate to their care (Godfrey 2005). When interpreting the data collected by the assessment, the nurse must be educated in different types of pain, for example, whether the pain is somatic, visceral or neuropathic (Daly 1999). This is why it is so important in the assessment stage to gather information regarding where the pain is located, what type of pain it is, when it started, and how bad it is (Daly 1999).
This is all information needed to understand the nature of the pain so that the appropriate interventions can be chosen in its management. This is also important when looking at whether or not to use pharmaceutical or non-pharmaceutical interventions. Interventions must also be looked at holistically so that not one intervention is focused on, but that interventions would coincide with one another to be used to their full potential, gaining maximum pain management and comfort. As discussed, it is the individuals’ experience of pain which is important in deciding the interventions used by the nurse.
It is important that the nurse is not influenced too greatly by their previous experience of others pain. Although they will have seen many people manage pain, they must constantly be reminded that pain is subjective. With this understanding underlying their care, they must then accurately assess the patient using a variety of tools appropriate to the individual. They must be able to locate the pain and understand or seek to understand why this pain is occurring so they can manage it from the source if possible, or treat the symptoms if otherwise. References ListCarr, ECJ & Thomas, VJ 1997,’Anticipating and experiencing post operative pain the patients’ perspective’, Journal of Clinical Nursing, vol.
6, pp. 191-201, viewed 5 October 2007, EBSCOhost database CINAHL, item: AN1997041746. Daly, L 1999,’Clinical update. Cancer pain assessment’, Australian Nursing Journal, pp. 1-3, viewed 4 October 2007, EBSCOhost database CINAHL, item: AN1999065177. Godfrey, H 2005,’Pain management.
Understanding pain, part2: pain management’, British Journal of Nursing, vol. 14, no. 17, pp. 904-908, viewed 4 October 2007, EBSCOhost database CINAHL, item:AN2009041123.Harboury, C, Henderson, A, Bromley, B 2005,’Influences of patient behavior on clinical nurses’ pain assessment: implications for continuing education’, The Journal of Continuing Education in Nursing, vol.
36, no. 1, p. 18, viewed 4 October 2007, EBSCOhost database CINAHL, item:AN2009191473. Manias, E, Botti, M, Bucknall, T 2002, Observation of pain assessment and management—the complexities of clinical practice,’ Journal of Clinical Nursing’, vol. 11, pp.
724-733, viewed 4 October 2007, EBSCOhost database CINAHL, item:AN2003041243.
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