Why_Is_Pain_Poorly_Assessed

Pain Management and Nursing Practice (NSB602) “Why is pain still not being assessed adeqately”' Rebecca Francis – (N8537305) Robyn Nash Pain is a fundamental form of physical suffering and discomfort caused by illness or injury and the types of pain varies for each individual. Merskey & Bogduk (2013) defined pain as “an unpleasant sensory or emotional experience associated with actual or potential tissue damage”. It is important to have effective pain management within health care settings as pain can have a negative impact on a patient’s healing process and overall health outcome (Vadivelu, Mitra, & Narayan, 2010). This could lead to further decreased health conditions as well as increase the length of stay in hospital (Vadivelu, Mitra, & Narayan, 2010). Unfortunately there are many factors and barriers that could hinder a patient from receiving effective pain management. Pain is entirely individual. The perception as well as coping mechanism for one person may be completely different for another (Nielsen, Staud, & Price, 2009). Pain can affect everyone differently in different situations, however in a health care setting pain is more commonly found in the elderly, the ill, as well as in sports persons. The prevalence is due to pathophysiology of disease, aging and lifestyle choices (Hayek, Elias, Narouze, & Mekhail, 2011). Long term physical as well as mental health can be affected if the pain is not managed or treated properly (May, 2008). A common barrier in the front line of pain management in hospitals is a lack of staff education and training regarding correct and new pain management interventions and strategies (Wright, & Adeosun, 2009). Ineffective communication between medical professionals and their patients is another critical factor. Developing a good rapport with a patient is highly important when building a trusting relationship, which is vital in health care settings (Fleischer, Berg, Zimmermann, Wuste & Behrens, 2009). This allows the patient to share information for example regarding their pain status as well as demonstrate cooperation with their pain management cares (Fleischer, Berg, Zimmermann, Wuste & Behrens, 2009). Having a lack of communication can lead to poor patient education regarding their pain management, miscommunication and misinterpretation, which could lead to inadequate or improper management of their pain (Fleischer, Berg, Zimmermann, Wuste & Behrens, 2009). Research and studies have shown that other factors on top of the patient’s pre-existing condition could create barriers to receiving effective pain relief (Gardner, Woollett, Daly & Ritchardson, 2009). Other over stimulating triggers can enhance a patient’s perception of their pain (Gardner, Woollett, Daly & Ritchardson, 2009). Some of these other factors might include the patient experiencing uncomfortable positioning, dryness in the mouth, and loud and irritable environments, for example a busy hospital ward (Gardner, Woollett, Daly & Ritchardson, 2009). By eliminating some or all of the triggers, this can help reduce the intensity or eliminate patient’s pain and discomfort (Gardner, Woollett, Daly & Ritchardson, 2009). Some busy wards may not have the power to minimise extra stimuli due to the ward set up as well as a lack of resources. Health care professionals who experience increased workload can often overlook these simple interventions, which could be another barrier to poor pain management (Kath, Stichler, Ehrhart & Sievers, 2013). Analgesics are commonly used to help manage acute pain, particularly strong opioid medication. A combination of inadequate pain assessment, incorrect or incomplete prescription as well as the improper practices for administration of analgesics can lead to ineffective pain management or even maltreatment. Effective strategies to encourage better attitudes and behaviours towards the administration of opioids can help result in better pain management for patients (Kamdar, 2010). A person’s perception and experience of pain is individual, which is why is it is important to perform adequate pain assessments for each patient, even if their pain changes (Hawker, Milan, Kendzerska & French, 2011; Nielsen, Staud, & Price, 2009). A full thorough pain assessment can define the type and severity of pain and give detailed information to receive the right treatment and management (Hawker, Milan, Kendzerska & French, 2011). If the assessment is not completed properly the patient could receive inadequate pain relief which could lead to intense pain (Hawker, Milan, Kendzerska & French, 2011). The types of assessments that can be used include numerical rating scales, face pain scales and pain questionnaires for the patient (Hawker, Milan, Kendzerska & French, 2011; Wright, & Adeosun, 2009; Wells, Pasero, & Mccaffery, 2008; Narayan, 2010; Gililland, 2008). There are many recommendations and guidelines for what constitutes as an adequate pain assessment, although some acute care practice recommendations seem to be impractical (Van Dijk, 2012). The assessment boundaries should be explicitly directed by hospital or unit policies and protocol (Turk & Melzack, 2011). It is necessary for there to be a balance between population-based studies with what we know about individual variation in response to treatment and the risks associated with it (Miller-Saultz, 2008). Evidence based medicine does not address the needs for patients to have diagno¬sis, prognosis, guidance, and sympathy which must remain part of the health care system (Ballantyne, 2012; Barondess, 2011). Maintaining a standard of care applies to all health care professionals when in practice. Today’s clinical standards for pain management as described by national standards by the Joint Commission, requires that pain is promptly managed (Wagner, Mcdonald, & Castle, 2012). Breach to these standards could lead to potential legal actions taken further. For example law suits can be filed against physicians for poor pain management outcomes (Ashley, 2008; Jowers Ware, Bruckenthal, Davis, & O'Conner-Von, 2011). Nurses, as part of the collaborative team are responsible for managing pain during hospitalisation and may also be liable for legal action (Wegenera, Castillo, Haythornthwaite, Mackenzieb, & Bossed, 2011). The hospital may lose its reputation and profiability if patient’s pain is not managed properly. Patient care and their satisfaction is strongly tied to the experience of staff during their hospitalisation. Evidence shows increased levels of pain and depression connected to poor satisfaction with care in ambulatory settings (Breivik, et al, 2008). Taking medical history is an essential part of pain management, often revealing important aspects of co-morbidities contributing to a complex pain condition as well as setting a base line to monitor any changes. The pain history must indicate the location, intensity, pain descriptors, temporal aspects, and possible pathophysiological and aetiological issues (Beaton, et al., 2013; Fine, et al, 2010). The following essential points are to be considered for developing a program to monitor the provision of pain relief: • Patient’s satisfaction to current pain interventions and its impact on their quality of life. • Family satisfaction with pain management and its impact on their quality of life. • Pain management and its appropriate options available within a particular practice setting. • The effective pain management options utilized to prevent and treat pain. • The prevalence and severity of side effects and complications associated with pain management. One of the first quality improvement programs was developed by the American Pain Society (Gordon, 2005). The guidelines for quality improvement was refined and expanded in 2005, based upon a systematic review of pain quality improvement studies conducted over the past 10 years (Gordon, 2005; Apolone et al, 2009). Analgesics are the primary treatment for acute pain, particularly opioid medications (Meissner et al, 2008; Vargas-Schaffer, 2010). Analgesic medications should comply with two basic principles: non-invasive and oral analgesics route of administration are used whenever possible and administered in accordance with orginsations policies and procedures (Meissner et al, 2008; Vargas-Schaffer, 2010). Health care settings, should work to improve and maintain effective pain management in order to comply with the legal requirements, as well as to help lower the risk of patients suffering severe pain. There are many barriers and factors that can prevent pain management from being effective. However, by addressing some of these factors with strategies such as more education and training for health care professionals regarding safe effective pain management, these obstacles can be reduced. Effective pain management can help patients achieve set health goals as well as reduce their hospital stay. 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