RESEARCH REPORT 1 Essay Example

  • Category:
    Nursing
  • Document type:
    Assignment
  • Level:
    Undergraduate
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    3
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    2076

Research Report on Pain Assessment and Control in Older Patients with Chronic Pain

Abstract

The aim of the research report is to analyze pain assessment and control strategies used by nurses caring for elderly patients. The descriptive study collected data from 6 nurses working at a nursing home. Their responses to five open-ended interview questions recorded, transcribed and analyzed using content analysis. Themes were identified as pain assessment, awareness of pain assessment techniques, use of pain assessment tools, perceived roles, relevance of assessment, professional judgment and standardized pain management guidelines. The findings revealed that nurses at the nursing home were aware of pain assessment strategies and tools but did not use them. They did acknowledge the use of pain assessment as part of their perceived responsibility. In addition, the nursing home did not have standardized pain management guidelines to help nurses to assess and control pain experienced by their patients. The study proposes that the nursing home should adopt a pain management guideline, which would emphasize the need for pain assessment, education to detect pain syndromes, training on the use of Short-Form McGill Pain Questionnaire (SF-MPQ) for accurate pain evaluation, repeated observation and assessment of pain per day, and seamless incorporation of evidence-based pain therapy with actual nursing practice.

Introduction

Nurses are increasingly paying attention to pain management in elderly patients. This is because the prevalence of chronic pain increases with age (Herr, 2011; Rastogi & Meek, 2013). Moreover, the demand for surgical procedures by the elderly has continued to increase over the years (Bettelli, 2010). Consequently, the demand for surgery as well as the patient’s declining function and multiple health pathologies have increased the patient’s need for pain medication. The challenge for nurses is that pain is a subjective experience that most patients find hard to communicate (Wikstrom et al., 2014). This makes it challenging for nurses and healthcare professionals to understand the degree of the pain and impact on the patient’s wellbeing. Secondly, standardized management policies on effective pain control for elderly patients are lacking. A nurse would have to make personal judgments on appropriate pain strategies based on the patient’s age, suitability of pain medication, and knowledge of different pain management strategies and experience in helping patients to control chronic pain (Marit et al., 2011). Thirdly, scholarly research on pain management in the elderly population is limited and does not address the unique challenges of caring for elderly patients such as multiple chronic health conditions, frailty, age and declining function. Consequently, nurses lack adequate education and training on how to manage chronic pain in elderly patients.

The aim of the research report was to analyze pain assessment and control strategies used by nurses caring for elderly patients. The proposed outcome was a standardized pain management guideline for nurses. Constraints of time when the research was be submitted meant that the study had be conducted at a local hospice. The researcher specifically reviewed pain assessment and treatment practices, which equip them to control chronic pain in elderly patients.

Literature Review

Peer-reviewed articles on pain control in elderly patients were obtained from scholarly databases such as the National Library of Medicine (NLM), Elsevier and Wiley Online Library. The following search terms were used: pain management, chronic pain, elderly patient, older population, barriers, pain management guideline, and nursing practice. Ten peer-reviewed articles were finally selected on the topic. The articles revealed that the assessment of pain in elderly patients was a challenge for nurses. Wikstrom et al. (2014) observed that nurses had difficulties using pain scales for postoperative pain control. They stated that pain scales were not commonly used in postoperative care and thus research on the nurses and physicians’ experiences of the pain scales was quite limited. Their explorative study on 25 healthcare professionals revealed that pain scales helped nurses and physicians to understand postoperative pain and facilitated treatment. The pain scales, however, were affected by different work conditions and required a multidimensional approach, which incorporated patient observation and dialogue for proper pain assessment. Hawker et al. (2011) concurred that studies on the use of pain scales are limited. Their explanatory study on different pain scales (such as the visual analog scale and chronic pain grade scale) showed the importance of measuring persistent arthritic pain. Their research showed that most of the pain scales do not require training, can be self-administered and have been tested for validity. It revealed that the Short-Form McGill Pain Questionnaire (SF-MPQ) was most effective multi-dimensional pain management tool for assessing the intensity of pain.

On the practitioners’ experience, Coker et al. (2010) observed that nurses perceived various barriers in their pain assessment. A key barrier was incongruence between evidence-based practices on pain assessment and the actual nursing practice. This contrast affected the nurses’ decisions to offer pain relief, collect pain reports, use non-pharmaceutical alternatives, and use pain assessment tools on patients with cognitive impairments. Barry et al.’s (2012) exploratory study revealed that nurses had poor attitudes towards pain assessment and treatment guidelines in the nursing homes. The nurses had good knowledge of pain but said that it was difficult to use pain assessment tools on elderly patients with dementia. Their low adherence was linked to lack of training and education, and ambivalent attitudes towards pain assessment. Herr (2011) concurs that accurate pain evaluation is often neglected by practitioners despite the variety of pain etiologies demonstrated by older patients. This is because nurses rely on self-report which is unobtainable in some cases (such as dementia). Herr (2011) and Fine (2012) proposed the direct observation of older patients and the use of pain behavior tools to understand the severity and impact of pain on the patients.

On research gaps, Reid et al. (2011) observed that there was a need to identify gaps on opioids and non-steroidal medication use to chronic pain in older patients. A fifteen-member interview revealed that pain treatment did not address the nurses’ uncertainty of analgesic, epidemiology (insufficient knowledge of pain syndromes), lack of understanding of evidence-based pain therapies, and implementation incongruence of evidence-based pain therapies in actual practice. Lobbezoo, Weijenberg and Scherder (2011) agreed that there was a research gap in a the assessment of dental or orafacial pain while Paice and Ferrell (2011) proposed a multidisciplinary pain intervention strategy which incorporates the patient’s physical, social, psychological and spiritual needs.

Methods

Descriptive research design was adopted for the study to help the researcher to describe nursing practices on the assessment and treatment of older patients in a nursing home, and to describe gaps for a standardized nursing guideline for chronic pain management. No actual experimentation on nursing medication or procedures was carried out. Interview method was used to collect primary data from 6 nurses at the nursing home. Interview method was found to be more effective because the sample population was quite small. The researcher drafted four open-ended interview questions and scheduled appointments with each nurse to last for one and a half hours. The responses were recorded using an audio recorder and later transcribed by the researcher. Content analysis was used to help the researcher to code the transcribed data and identify common themes (Walsh & Downe, 2006).

Findings

All six nurses said that they were aware of pain assessment scales but only two used the scales to determine the intensity of pain experienced by their patients. Of the four nurses, one said that she did not use a pain assessment scale because it was too difficult to use; another said that he was not trained to use the scales while the remaining two said that they did not think the assessment scale was relevant to understanding and treatment of pain. On the perceived role or responsibility in pain assessment, all six nurses said that it was important that they evaluated and recorded the patient’s pain. Only three acknowledged that the use of pain assessment scales was part of this responsibility. On the relevance of pain assessment in pain treatment, all six nurses said that it was important that they determined the degree of pain before administering pain treatment. Four nurses assessed the patient’s pain levels several times a day and recorded this for treatment purposes. Lastly, all six nurses said that the nursing home did not have standardized pain management guidelines. They exercised their own judgment, based on their expertise and knowledge, on the need for pain assessment and treatment.

Interpretations

Firstly, pain assessment scales were not deemed relevant in helping the nurses understand the patient’s pain and treatment needs. Literature concurs that nurses have good knowledge of pain but find it difficult to use pain assessment tools on older patients because of lack of training and ambivalent attitude towards pain assessment (Barry et al., 2012; Wikstrom et al. 2014). Secondly, nurses did not acknowledge the use of pain assessment as part of their responsibility in pain assessment. They relied on observation (Fine, 2012; Reid et al., 2011) or unreliable self-reports from patients (Herr, 2011). They did not consider a multidimensional approach to pain management which incorporates the use of pain behavior tools, non-pharmacological treatments and the evaluation of the patient’s psychological, spiritual and social wellbeing rather than just physical pain assessment (Paice & Ferrell, 2011; Wikstrom et al. 2014). Lastly, it was observed that the nursing home did not have standardized pain management guidelines. The nurses exercised their own judgment. This could explain why practitioners neglect accurate pain evaluation despite the variety of pain etiologies demonstrated by older patients (Herr, 2011).

Conclusion and Recommendations

The aim of the study was to analyze pain assessment and control strategies used by nurses caring for elderly patients. Findings show that nursing home are aware of pain assessment strategies and tools but do not use them because of lack of skill and negative perceptions. In addition, the nursing home does not have standardized pain management guidelines to help nurses to assess and control pain experienced by their patients. The study proposes that the nursing home should adopt a pain management guideline, which emphasizes the need for regular pain assessment, education to detect pain syndromes, training on the use of SF-MPQ for accurate pain assessment and seamless incorporation of evidence-based pain therapy with actual nursing practice.

References

Barry, H., Parsons, C., Passmore, P., & Hughes, C. (2012). An exploration of nursing home managers’ knowledge of and attitudes towards the management of pain in residents with dementia. International Journal of Geriatric Psychiatry, 27(12), 1258-1266.

Bettelli, G. (2010). Anesthesia for the elderly patient: Preoperative assessment and evaluation, anesthetic technique and postoperative pain management. Current Opinion in Anesthesiology, 23, 726-731.

Coker, E., Papaioannou, A., Kaasalainen, S., Dolovich, L., Turpie, I., & Taniquchi, A. (2010). Nurses’ perceived barriers to optimal pain management in older adults on acute medical units. Applied Nursing Research, 23(3), 139-146. doi: 10.1016/j.apnr.2008.07.003

Fine, P. G. (2012). Treatment guidelines for the pharmacological management of pain in older persons. Pain Medicine, 13, S57-S66.

Hawker, G., Mian, S., Tetyana, K., & French, M. (2011). Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF_36 BPS), and measure of intermittent and constant osteoarthritis pain (ICOAP). Arthritis Care & Research, 63(S11), S240-S252.

Herr, K. (2011). Pain assessment strategies in older adults. The Journal of Pain, 12(3), S3-S13.

Lobbezoo, F., Weijenberg, R., & Scherder, E. (2011). Topical review: Orafacial pain in dementia patients. A diagnostic challenge. Journal of Orafacial Pain, 25(2), 6-14.

Marit, L., Watt-Waston, J.,McGillion, M., Costello, J., Elgie-Watson, J., & Patridge, K. (2011). Nurses’ educational needs for pain management of post-cardiac surgery patients: A qualitative study. Journal of Cardiovascular Nursing, 26(4), 312-320. doi: 10.1097/JCN.0b013e3181f806bc

Paice, J., & Ferrell, B. (2011). The management of cancer pain. CA: A Cancer Journal for Clinicians, 61(3), 157-182.

Rastogi, R., & Meek, B. (2013). Management of chronic pain in elderly, frail patients: Finding a suitable, personalized method of control. Clinical Interventions in Aging, 8, 37-46.

Reid, C., Bennett, D., Chen, W., Eldadah, B., Farrar, J., Ferrell, B., … Zacharoff, K. (2011). Improving the pharmacologic management of pain in older adults: Identifying the research gaps and methods to address them. Pain Medicine, 12(9), 133-1357.

Walsh, D., & Downe, S. (2006). Appraising the quality of qualitative research. Midwifery, 22, 108-119. doi:10.1016/j.midw.2005.05.004

Wikstrom, L., Eriksson, K., Arestedt, K., Fridlund, B., & Brostrom, A. (2014). Healthcare professionals’ perceptions of the use of pain scales in postoperative pain assessments. Applied Nursing Research, 27(1), 53-58. doi:
10.1016/j.apnr.2013.11.001