Nurses must coordinate care, provide infornation, perform thorough and objective
ID: 237971 • Letter: N
Question
Nurses must coordinate care, provide infornation, perform thorough and objective pain assessments, and take into account the ethical and legal ramifications of treating patients who are experiencing pain. Nurses must have knowledge and experience with theories on pain and how it is treated serves to make nurses better able to treat patients who have pain- whether it is chronic or acute. Nurses must be cognizant of the methods of treating pain-including methods that are behavioral, pharmaceutical, and non-pharmaceutical. Discussion Topic: 1. How can the nurse address issues concerning under treatment of pain? 2. How does collaboration impact a patient's pain management goals? 3. Discuss special considerations for older adults in relation to pain assessment and management.Explanation / Answer
Ans:
Compared to our understanding of vision and hearing, the perception of pain and exactly which factors that influence it are not well understood.Nurse discuss three of the most well known pain theories: Specificity Theory, Pattern Theory, and Gate Control Theory. None of these theories, however, can explain all of the phenomena associated with pain perception.
Specificity Theory:Specificity theory is one of the first modern theories for pain. It holds that specific pain receptors transmit signals to a "pain center" in the brain that produces the perception of pain.
Pattern Theory:Pattern theory holds that pain signals are sent to the brain only when stimuli sum together to produce a specific combination or pattern.
Gate Control Theory:Ronald Melzack and Patrick Wall proposed the Gate Control Theory in 1965. The theory can account for both "top-down" brain influences on pain perception as well as the effects of other tactile stimuli (e.g. rubbing a banged knee) in appearing to reduce pain. It proposed that there is a "gate" or control system in the dorsal horn of the spinal cord through which all information regarding pain must pass before reaching the brain.
The nurse also should be confident about the types of pain
There are different types of pain:
Ans:
This domain focuses on collaborative approaches to decision making, diversity of treatment options, the importance of patient agency, risk management, flexibility in care and treatment based on appropriate understanding of the clinical condition.
Patient-centered comprehensive approach to chronic pain management that includes team-based care, use of best practice guidelines, and implementation of workflows that use standard processes and procedures. Identified set of “key changes” for chronic pain management that participating practices were asked to implement.
These “Chronic Pain Key Change” concepts are summarized below,
1.Leadership and culture of safety
2. Team-based approach to care
3. Risk stratification & population management
4. Comprehensive assessment & evaluation of chronic pain
5. Comprehensive approach to co-management of chronic pain
6. Mindful approach to initiating opioids for pain management
7. Safety first with patients receiving opioid therapy
8. Inclusion of patients & families
9. Integration of community & clinical resources
10. Optimal use of health information technology to support effective chronic pain management & safe prescribing, including use of Maine Prescription Monitoring Program (PMP).
3 Discuss special considerations for older adults in relation to pain assessment and management.
Ans: Assessment
Older adults are at high risk for undertreatment of pain due to a variety of barriers. These include lack of adequate education of health care professionals, cost concerns and other obstacles related to the health care system, and patient related barriers, such as reluctance to report pain or take analgesics. Unrelieved pain in the older adult has significant functional, cognitive, emotional, and societal consequences. Pain control begins with a thorough assessment, including an extensive history and physical examination.
Because nurses are often the first health care providers to hear a patient’s report of pain, their ability to perform a comprehensive pain assessment in the older adult is critical. A comprehensive pain assessment incorporates a thorough pain history, a complete physical examination, and laboratory or other diagnostic procedures when indicated.
Management:
Without any known biological markers or diagnostic tests that measure pain, the patient's self-report remains the only reliable indicator of the existence of pain and its intensity.
The most important components of pain assessment in older adults are regular assessment, standardized tools, and consistent documentation.
Strategies for Successful Nursing Care
The Interdisciplinary Team
Caring for elderly patients receiving pain medications requires the home healthcare nurse to integrate the primary care provider and all disciplines involved in the patient's ongoing care. "Team-based healthcare is the provision of health services to individuals, families, and/or their communities by at least two health providers who work collaboratively with patients and their caregivers-to the extent preferred by each patient-to accomplish shared goals within and across settings to achieve coordinated, high-quality care" .
For team-based healthcare to be successful, it is important to have adequate communication among all involved in care, maintain purposeful team collaboration, and provide the best evidence-based practices. Healthcare provided by a well-developed team approach empirically demonstrates positive patient outcomes, more efficient care, and patient and professional satisfaction . Shared goals require the whole team, including the patient, family, or other caregiver all working together toward establishing, understanding, and following through on well-founded goals supported by all involved. Each team member's functions, responsibilities, and accountability should be clearly articulated. Having a clear understanding and expectations of each role improves the team's efficiency.
MacSorley Communication Model: Elderly Pain
The home healthcare nurse is in a vital position to determine the patient's response to pain and to treatment. The team approach is used when the home healthcare nurse visits the patient, performs a health assessment, reviews medications, and determines the need for a comprehensive pain assessment due to the patient's status and pain medication usage. From this assessment a determination is made of the need for collaborative care partners to become involved. Collaborative care may include a: (a) primary healthcare provider, (b) home healthcare nurse, (c) pharmacist, (d) dietitian, (e) clergy (or spiritual leader), (f) social worker, and (g) rehabilitation therapist.
The MacSorley Communication Model: Elderly Pain Model (Figure 3) has been developed as a comprehensive model for providing home healthcare nurses with a means of caring for the elderly patient and their family while communicating their needs to the interdisciplinary healthcare team. With the advancement of technology there are multiple means of providing and transmitting communication. Some means are: (a) telemedicine, (b) smart phone, and (c) voice over Internet protocol and instant messaging client. Telemedicine involves telemonitoring the patient from a remote location. It allows the interdisciplinary healthcare team to provide remote visualization, supervision, and transmission of recorded data to determine what further education and care is needed for the patient and family. Regardless of the method, it is important to maintain patient confidentiality when using these alternatives. The following bullet points are meant to help guide the home healthcare nurse when providing care to the patient and communicating potential problems to the interdisciplinary healthcare team.
Figure 3. Communication Model-Elderly Pain.
* Providing a comprehensive pain assessment, which consists of:
* obtaining a history and physical;
* determining pain etiology through diagnostic studies; and
* establishing a medication regimen.
* Maintaining the home healthcare nurse's role by:
* providing pain management education for the patient and the family/caregiver;
* keeping up with a pain diary/log;
* performing a comprehensive pain assessment and pain assessment scale each visit;
* assessing for medication compliance, adverse effects, and medication effectiveness;
* initiating team conferences as needed; assess and monitor bowel function; and
* providing ongoing pain management education.
* The involvement of a pharmacist, dietitian, clergy and social worker (interdisciplinary healthcare team) and their role by:
* providing patient and family counseling regarding dose sensitivity, dietary restrictions, and contraindications between medications and/or food (pharmacist/dietitian);
* monitoring comorbidity and changing patient status (pharmacist/dietitian);
* providing patient and family dietary teaching (dietitian);
* providing spiritual support (clergy);
* providing counseling and therapy (dietitian/social worker);
* placement for care with changing patient status (social worker); and
* referral to resources as needed (social worker).
* The involvement of the rehabilitation therapist's (speech, physical therapist and occupational therapist) interdisciplinary healthcare teams role by:
* providing services such as assessment of swallowing and communication difficulties; monitoring and evaluating patient's progress; therapeutic touch; massage therapy; hot/cold therapies; electrophysical modalities; and exercise therapy.
Figure 3. Communication Model-Elderly Pain.
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