Research Articles Base: Pain Assessment Tools

The Anatomy of Heart

This is biology essay has to cover the anatomy of heart, this will help to lead to Angina, therefore the Pathophsiology & physiology of Angina. (this is a degree level essay). Question Write an account of a patient that you are familiar with. Show how nursing care, nursing intervention or patient education are supported by your understanding of Human Biology. Assignment guidelines The assignment will be marked on depth of understanding of Applied Biology shown relating to the care and treatment of the patient in the case history. â€¢ Identification of the anatomy, physiology, and Pathophsiology of the condition (or disease) relevant to understanding the nursing care of the patient. â€¢ A critical review of up to date treatments for that condition including (if appropriate) pharmacology, surgery, therapy, life style changes, or clinical interventions that are relevant. â€¢ Current issues in choices of treatment which can be discussed analyzed and critically evaluated. This is a case study: MRs Smith admitted in the ward after experienced left side chest pain, it started when she got up to use the bathroom. She is 5 feet 10 inches tall, weighs about 97kilograms (kg), has past medical history of type 2 diabetes, which means her diabetes is normally controlled by diet and oral hypoglycemic medication and also she smokes forty cigarettes a day. Usually her BP at home ranges between 162/90 and 179/98, but BP during her hospitalization has been consistently around 130/80, and she is not being treated for hypertension. On admission, she said that, she has no history of heart problems this is the first time she experienced chest pain. Pain assessment tool was used to identify tenseness of her pain by using a number scale tool. One stands for least pain and number ten for most pain. She ranks the pain as severity at 6 on a scale. Also she mentions that her only regular exercise at home is housework and her father died of a heart attack at age 50. Because MRs Smith was admitted with chest pain, is important that she undergo a thorough evaluation to assess the possible presence of angina. A careful past medical history and physical examination is critical to accurately establish the diagnosis of angina, and to exclude other causes of chest pain. Understanding of angina â€¢ Definition of angina â€¢ Anatomy (Formation of angina) â€¢ Physiology (Cause and types of angina (pain patterns)) â€¢ Path-physiology (Myocardial ischemia) â€¢ Factors determine myocardial ischemia &#61662; Heart rate &#61662; Systolic blood pressure &#61662; Myocardial wall tension or stress &#61662; Myocardial contractility Treatment â€¢ Nursing care and intervention â€¢ Pharmacology and non pharmacology liaise with NSF (CHAD) â€¢ The reason of a chosen treatment (Clinical governance, trust protocol and guidance, and NSF (CHAD)) Credit:ivythesis.typepad.com

The Anatomy of Heart

This is biology essay has to cover the anatomy of heart, this will help to lead to Angina, therefore the Pathophsiology & physiology o...

Pain Assesment in Sedated and Ventilated Patients

Pain Assessment in Sedated and Ventilated Patients   Introduction Nursing refers to the functions and duties carried out by persons who have had formal education and training in the art and science of nursing. To promote the restoration and maintenance of health in their clients, nurses become more particular in enhancing their knowledge through integration with health and biological sciences ( 1993). As an applied discipline, the vocation of nursing evolves within a dynamic body of knowledge. The quality of nursing practice is dependent on the knowledge of individual practitioners as well as their willingness to engage in professional relationships and behaviors. Nurses are required to have the skills and know-how to explore, confirm, and direct the progress of nursing practice. Five value concepts uphold professional development: the (1) knowledge base, which is the foundation knowledge base upon which clinical practice decisions are made, (2) continuing education which comprise of the continuing learning activities that are crafted to benefit the individual and the profession, (3) mentoring and networking which are the professional relationships that are instituted with the intent of supportive growth for the individual as well as the profession, (4) research which is the qualitative and/or quantitative investigation of the factors which affects the professional nursing practice, and lastly (5) career development which are purposeful, planned strategies that are designed to boost short and long term professional goals ( 1998). It has not been long since nurses have had specialized training especially on patient management; these specialized trainings include the situation in which they are more likely to find themselves, thus affecting how they will react to the situations presented before them. The differences of their actions mean very much to the patients, and thus they must learn how to distinguish the different factors and be able to help their patients in achieving the best method of improving their health and returning to their vigorous states. This paper discusses the pertinent issues related to pain assessment among sedated and ventilated patients critically analyzing the current concerns in the nursing practice to present the applications and implications of the issues and provide sound recommendations.     Issues on Pain Assessment among Sedated and Ventilated Patients Nurses are advocates and health educators for patients, families, and communities. When providing direct patient care, they observe, assess, and record symptoms, reactions, and progress in patients; assist physicians during surgeries, treatments, and examinations; administer medications; and assist in convalescence and rehabilitation. Nurses also develop and manage nursing care plans, instruct patients and their families in proper care, and help individuals and groups take steps to improve or maintain their health. While state laws govern the tasks that the nurse may perform, it is usually the work setting that determines their daily job duties.  Pain assessment is a key aspect in the nursing management and delivery of care within the clinical environment in which nurses utilize many aspects of knowledge including that of the underlying Pathophsiology, pharmacological knowledge of the drugs available for use, and knowledge of the patient being assessed. Such use of the wide range of knowledge is important when caring for a variety of patients to ensure accurate pain assessment based on sound judgment to achieve a pain-free status whenever possible and ensure that the patient achieves the best possible treatment (2003). According to (2000) there are several advantages of monitoring the patients’ sedation outcomes. These include (a) reductions in intensive care unit (ICU) stay, (b) duration of mechanical ventilator support, and (c) some diagnostic tests that will assess the function of the central nervous system. However, there are issues that are in need of attention so as to address the proper and accurate procedures of assessing pain among sedated and ventilated patients. These include the difficulties encountered in assessing pain and the accuracy of pain assessment tools and methods. Several studies have been conducted in the discipline of medicine and care giving in order to improve the condition of the patients who are suffering from discomfort due to their physical condition before or after undergoing medical procedures. These studies were conducted so as to determine the accuracy of the tools and measures of determining the discomfort levels of the patients in order to help the patient recover easily and immediately from the illness that he or she is experiencing as well as to contribute to the ways of overcoming the difficulties of pain assessment. Some of these studies which investigated the cases of sedated and ventilated patients are briefly presented below.  Pain and theories on pain. Pain is one of the most common human experiences, as no one is spared from such suffering, whether such to the physical or emotional. Yet for the longest time, pain has never been fully considered as a medical problem. It may be due to the fact that it is a subjective and a highly personal experience.  For centuries, people have been puzzled by pain and its nature. Hence, several theories have been formulated to describe the mechanisms of pain. Though pain can be measured you, it can not be diagnosed, felt (unless it’s your own), imagined or proved its existence.  Pain as a sensation differs from one person to another. Hence no person can exactly feel the same degree of pain at the same time.  But pain is as real as the symptoms it shows, it is the reason why approximately 70 million visits were made by people to health care professionals every year. Pain is the body’s natural way of sending a warning to the brain that something is amiss.  Aches are felt when pain is being transmitted, carried by chemicals called neurotransmitters, which travel from the nerves, along the spinal cord to the brain. In the brain, pain messages are combined with thoughts, emotions and expectations that mold our interpretation and response to the pain (2004). Early theories on the psychology of pain were primarily based on global factors such as age, gender, personality and culture. Little was known about the psychology of pain for specific age groups. It was believed that women were more likely to experience more frequent pain and higher risks of disability after the pain than do men. Those who were not exposed to hardships would have less tolerance of pain and would be more complaining on pain (2001). Theories have noted that pain is related to various psychological aspects. Several psychological mechanisms are involved in the manifestation of pain. Through sensation, nerves within the body are stimulated. This sensation travels to the brain, resulting to the perception of pain. As this causes unpleasant sensations, pain is commonly related to illness (1992).  Indeed, the gate control theory as well as the study on cognitive coping and upload blockade has shown that psychological factors affect the development of pain ( 2003). One theory that provides a variable link between injury and pain is the gate control theory of  ( 1999). This theory suggests that the gates or the nerve fibers found in the nerve pathway should be open so as to let pain sensation travel to the brain. The theory then supports the concept that the gates is capable of closing when there is an absence of sufficient stimulus, resulting to the prevention of more pain sensations.  (2001) supported this by stating that pain is dependent on physiological, affective, behavioral and socio-cultural dimensions.  (1996) conducted a study which claimed that psychological or cognitive coping of pain is capable of decreasing the perception of pain. When upload receptors are pharmacologically blocked, the benefits of cognitive coping become enhanced. Thus, the study concluded that psychological coping does not depend on endogenous uploads alone and that coping is based on situational and stimulus characteristics. Every year there have been several researches done concerning the removal of pain, whether temporarily or permanently (King, 1991) and recent studies have shown that nursing knowledge has continued to increase when it comes to the nurses’ identification of pain (1997). This highlights the significant role of health professionals particularly nurses when it comes to pain assessment. Difficulties in pain assessment. Assessment of pain for the sedated patient is often complicated by the patient’s inability to report pain levels. As such the sedated patient undergoing painful procedures depends on the nurse to interpret physical signs to quantify his or her distress both on the physiological and behavioral responses to pain for assessment when the patient’s self-report is absent. Even though an individual’s self-report of pain intensity and distress is the most accurate assessment measurement, the validity of a sedated patient’s elicited response about pain is questionable that the nurse attempts to assess through observation.  (2003) claimed that the accurate assessment of pain in nonverbal patients is difficult because nurses often rely on different methods of determining medication impact. Moreover, commonly used indicators of pain may not effectively measure the true extent of distress in patients as on going studies continue their initiatives to provide more accurate measures of assessing pain to benefit patients who are not in the condition to communicate their sufferings.  (2005) on the other hand stated that understanding the Pathophsiology of pain facilitates the assessment of the objective components of pain. According to  (2001) careful thought and planning may allow the nurse to adapt usual assessment tools for use by patients who have difficulty in communicating. This includes (1) using all means possible to document the patient’s self-report of the pain experience, (2) supplementing ratings with behavioral and physiologic indicators of pain status, and (3) documenting findings to communicate the patient’s pain to concerned individuals. But the study conducted by  (2004) which described (1) the pain indicators used by nurses and physicians for pain assessment, (2) the pain management, including pharmacological and no pharmacological interventions undertaken by nurses to relieve pain, and (3) the pain indicators used for pain reassessment by nurses to verify the effectiveness of pain management in patients who are incubated concluded that pain documentation in medical files is incomplete or inadequate due to the lack of a pain assessment tool. Accuracy of pain assessment tools and methods. In the last few years, experiments and other forms of studies have been designed in the medical arena to evaluate the validity and reliability of the different agitation and sedation scales including the Sedation-Agitation Scale and the Motor Activity Assessment Scale. Other assessment tools have been developed from the results and observations made among patients that helped clinicians in the area of patient care. Such studies recommended further investigation on the impact of these monitoring techniques in relation to the aim of improving patient comfort, minimizing adverse events, and reducing resource consumption as well as more accurate pain assessment methods. Assessing pain and sedation in no responsive patients is a challenge primarily because of the confounding effect of sedation on objective indicators of pain. As such, clinicians might interpret incorrectly because the behavioral responses to pain and anxiety/agitation have many similarities. Hence, additional research is needed to establish the validity, sensitivity, and specificity of pain indicators in sedated patients. Moreover, in the case of no responsive sedated patients, clinicians should integrate actual or potential risks of pain and risks of pain-related functional impairment into their pain assessment (2004). According to  (2003) pain assessment and management for critical care patients, present challenges to clinicians and researchers as pain assessment methods and clinical trials of pharmacological interventions continue to investigate procedural pain assessment methods. There have been studies that investigated the validity and reliability of pain assessment tools that medical practitioners are currently using.  (2002) conducted a study on estimating the comfort levels of sedated patients who undergone gastrointestinal examination in order to determine the validity and reliability of the Colorado Behavioral Numerical Pain Scale in which interpreter reliability showed 82% agreement on the observations made on the patients. The study likewise included the participation of nurses from other hospitals and a medical person from an ambulatory facility which illustrated a 92% agreement that the words described what they observed during a gastrointestinal examination and 94% felt it was a better descriptor of pain than a patient self-report numerical scale. Meanwhile,  (2001) tried to establish the validity and reliability of a new behavioral pain scale (BPS) for critically ill sedated adult patients for prospective evaluation among ten-bed trauma and surgical intensive care units in a university teaching hospital. The results of the study indicated that the expression of pain can be scored validly and reliably by using the BPS in sedated, mechanically ventilated patients providing warranty on the utility of the BPS in making clinical decisions about the use of analgesic drugs in the intensive care unit.  (2002) on the other hand conducted a study which (1) described the Pain Assessment and Intervention Notation (P.A.I.N.) tool, (2) detailed critical care nurse participants’ evaluations of the P.A.I.N. intervention tool when used during care of postoperative patients in pain, and (3) evaluated the tool’s usefulness in practice and education. the results of the study indicated that P.A.I.N. tool provides a consistent, systematic method of quantifying their assessment of patient pain and analgesic responsiveness and that it improves practice with regard to pain and sedation assessment. However, the usefulness of the tool presented limitations since it is too detailed to be used routinely when caring for critically ill patients.  (2005) reviewed available researches which investigated the three commonly used pain rating scales: (1) the Visual Analogue Scale, (2) the Verbal Rating Scale, and (3) the Numerical Rating Scale to provide information for the understanding of the main properties of the scales. Their investigation indicated that all three pain-rating scales are valid, reliable and appropriate for use in clinical practice, although the Visual Analogue Scale has more practical difficulties than the Verbal Rating Scale or the Numerical Rating Scale. The Numerical Rating Scale generally has good sensitivity and generates data that can be statistically analyzed for audit purposes as preferred by patients who seek a sensitive pain-rating scale would. Meanwhile, patients prefer the Verbal Rating Scale because of its simplicity despite the fact that it lacks sensitivity which could result to misunderstood data. However, mere evaluation of existing pain assessment tools seem inadequate as   (2002) addressed the need for a systematic, objective pain assessment tool development among adult intensive care units. The pain assessment tool consist a numerical and verbal rating scale to facilitate documentation and audit through ongoing adjustment and evaluation. The tool scores the patient’s pain by incorporating behavioral and physiological indicators and is used in conjunction with the Glasgow Coma Score and the modified Sheffield Sedation Scale to achieve a comprehensive neurological assessment wherein assessment is carried out at rest and during procedures such as suctioning and manual handling introducing a flow chart and a clinical guideline. Preliminary evaluation established the effectiveness of the tool as a means of estimating and recording pain levels in individual patients. Skills and knowledge of nurses. Other studies have been performed to investigate other areas of pain assessment among critically ill patients particularly with an interest in the nursing practices in the medical field.  The study performed by (1998) highlighted that the patients’ experiences of pain and distress do not fully agree with nurses’ and assistant nurses’ assessments; nor was there consistency between the views of nurses and those of assistant nurses. Nurses overestimated patients’ breathing and intellectual problems while assistant nurses assessed that patients received more assistance to relieve physical pain, physical discomfort, fatigue, and fear than patients reported. Furthermore, compared with nurses’ assessments, assistant nurses also perceived patients to suffer less from physical discomfort, breathing problems, and fatigue. As such, they concluded that nurses need more systematic procedures to assess patients’ distress and pain experiences and that organization of care should optimize the possibilities for the caregivers to carry out the desired assessments and interventions with a high degree of continuity and communication among staff to reduce the discrepancies observed between nurses and assistant nurses. On the other hand,  (2003) examined strategies for changing pain management practices in critical care by reviewing documentation practices, the utilization of guidelines and algorithms to augment clinical decision making, and increasing educational opportunities available to critical care nurses. They recommended that pain assessment be given a higher priority within the clinical context, since inadequate pain assessment and management has been linked to increased morbidity and mortality within critical care. Meanwhile, studies that focused on the indications of pain among patients were also undertaken which are relevant to the need for accurate pain assessment tools to improve health care services among critically ill patients.  (2001) characterized the symptoms experienced of intensive care unit (ICU) patients at high risk for hospital death. Patients’ self-reports of symptoms using the Edmonton Symptom Assessment Scale (ESAS), and ratings of pain or discomforts associated with ICU diagnostic/therapeutic procedures and of stress associated with conditions in the ICU were used as tools to measure the symptoms of the cancer patients. The results indicated that hospital mortality for the group was 56% as fifty patients had the capacity to respond to the ESAS, among whom 100% provided symptom reports. Between 55% and 75% of ESAS responders reported experiencing pain, discomfort, anxiety, sleep disturbance, or unsatisfied hunger or thirst that they rated as moderate or severe, whereas depression and dyspnea at these levels were reported by approximately 40% and 33% of responders, respectively. Moreover, significant pain, discomfort, or both were associated with common ICU procedures, but most procedure-related symptoms were controlled adequately for a majority of patients. The patients’ inability to communicate, sleep disruption, and limitations on visiting were particularly stressful among ICU conditions studied.   Conclusion Nursing is a helping profession, one that has sworn to protect and help those who are in need, and thus they must live to that promise and continue to give priority to their patients. The reduction of pain that their patients are having through proper methods and accurate means of assessing pain particularly among sedated and ventilated patients is a sure sign of their success and enough reason for their glory. Nurses should do more than administer methods or means to control and manage pain. It is first important for nurses to be able to assess the pain of their patients. As care providers, they should be able to accurately determine the levels of pain that their patients endure for them to act according to their needs and comfort. This perhaps implies the important correlation of theories and the role of nurses to pain assessment as well as the success of the initiatives that were undertaken to improve and develop ways of providing better facilities through honing specific skills among nurses to assess pain. Nurses must learn how to quickly assess the painful sufferings of their patients, and thus must be able to give sound judgments based on their nursing knowledge, techniques, and most of all experience in order to ensure the improvement of health (either physically or emotionally) of the patient. They must be able to judge how the patient will fare during the next few days or if immediate actions should be undertaken. By these quick assessments that are deemed true and follows their knowledge and competence, they may be able to give judgments that will say much about their capabilities. Most importantly, nurses should serve as the patients’ pillar of strength and their motivator towards immediate recovery. They must also know how to assess the psychological conditions of the patients and attempt to put them into some ease in order to better perform the medical profession.   Recommendations In order to use pain-rating scales well clinicians need to appreciate the potential for error within the tools, and the potential they have to provide the required information. Since interpretation of the data from a pain-rating scale is not as straightforward as it might first appear, critical care nurses need not only be aware of research-based pain management practices, but also lead the way in implementation and continuous evaluation as a measure of decreasing patient pain in the future. Early exposure to learning experiences among student nurses would be relevant to introduce them to the complexities of caring particularly pain assessment. Guidance and monitoring responsibilities among medical professionals should be provided to facilitate improved caring practices as well as to minimize cases of errors that might lead to grave consequences both on the part of the patient as well as the nurse. More initiatives for research and development should be realized not just in the academe but most importantly among practitioners of medical professions to support the continuous improvement and development in the current medical environment. Participation and cooperation among patients in research initiatives as well as pioneer studies in the medical files will be also necessary to carry out investigations that will highly contribute to public health care. Support of the medial institutions, government, academe and the public in general will be helpful in motivating members of the medical discipline to enhance and provide better medical services to the public   Credit:ivythesis.typepad.com

Pain Assesment in Sedated and Ventilated Patients

Pain Assessment in Sedated and Ventilated Patients Introduction Nursing refers to the functions and duties carried out by persons...

Assessment of Pain is Complex due to the Personal Nature of the Experience and Other Variables. It is Particularly Problematic in the Pediatric Setting

Assessment of Pain is Complex due to the Personal Nature of the Experience and Other Variables. It is Particularly Problematic in the Pediatric Setting       Name of Student University Professor/Instructor     DATE       Introduction             Humans express many emotions during the span of their lives. Most of these emotions result from different circumstances and from different situations. Humans can express diverse emotions at the same time and change them according to the given condition. One of the distinct characteristics of humans is expressing pain in different ways. Every individual, especially patients, experiences and suffers pain. It is associated with a myriad of causes, and is described depending on the range of its intensity. Pain can be felt and expressed either physically, mentally, and emotionally, and often times, this emotion can lead to serious problems. However, a disease or a sickness causing pain must be the biggest challenge a person will experience. This pain may or may not be endured by the person and may even result to death. This may affect how the person may function and perform on his or her daily activities. With these, many treatments are being improved and used, to at least, alleviate the pain being experienced by many persons inflicted with a disease.             With such information, it can be perceived that assessing the pain that can be experienced by children, particularly in terms of sickness or illness may be one of the most tedious activities to be encountered by healthcare practitioners. As such, this paper aims to present a review of different literatures in support of the argument being presented. A number of articles would be used in order to support the argument. In the end of the paper, a conclusion would be presented in order to highlight the different points emphasized in the paper.   Review of the Literature             As argued, the statement emphasizes that the assessment of pain is complex due to its personal nature and experience. In this sense, it becomes problematic in the pediatric setting. This statement can be deemed true, even without proof, as many healthcare practitioners would perceive treatment of infants, children, or adolescents in pain may provide them less information on how to treat them accordingly, due to (a) lack of effective means of communicating to adults, (b) hesitation to express pain due to shame or fear, (c) confusion as to the location of pain, and (d) fear of treatment, such as through injections or medicines. With such known factors, it can be perceived that the parents, guardians, and healthcare practitioners are equally burdened with the responsibility to find ways on how to assess the pain being felt by children, find ways on alleviating them, and find ways in managing them.             Peden et al. (2005) are supporting the argument or statement stressed, as they state that a longstanding issue within pediatric pain management has been the difficulty of assessing pain in children, in which pain is deemed as a complex, multi-dimensional phenomenon. The objective assessment of children’s pain constitutes a challenge for all healthcare professionals. In this sense, accurate and timely pain assessment has been found to be a key factor in improving pain management of children (as cited in Peden et al. 2005). As such, the statement of the authors supports the argument of this paper, as they emphasize that, the pain in children is complex and multi-dimensional, thus, contributing to the complexity in terms of assessment and treatment.             More importantly, it is essential to define pain. This is because pain is the most vital component of pain assessment and management, and is the dilemma of the child, his or her parents and guardians, and the healthcare practitioners. It has been emphasized that pain is an important component, and at times, the only component of most disease processes. Healthcare professionals have a moral, ethical, and legal obligation to ensure that children in their care are relieved from pain and suffering. It has been reported that over the last decade, practitioners have realized that pain might have profound deleterious effects on children. This is because the pain of children is being perceived as low priority. Pain is an issue in potentially every clinical area, as it is understood that it is everyone’s duty but no one’s responsibility. The lack of pain as a priority could explain a fundamental obstacle to implementing emerging evidence that would require substantial changes to some pain management practices (Simons and MacDonald, 2004). In addition, pain is deemed as unpleasant, delays recovery and adds to the trauma of illness, injury, and clinical procedures (as cited in Simons and MacDonald, 2006). Thus, from the definition and information of pain, it can be understood that the lack of priority, assessment and management of pain in children can provide them with psychological, emotional, and physical effects that they could be taking with them as they grow up. Children endure an array of painful medical treatments starting at birth and continuing through adolescence. Such procedures include heel sticks, circumcision, immunizations, catheter insertion, chest tube placement and removal, lumbar punctures, bone marrow aspirations, venipuncture, dental restorations, burn wound treatments and many others. For each of such painful procedures, children’s fear and anticipatory anxiety increases the likelihood of their experiencing more pain and distress during the actual procedures (as cited in Blount et al., 2006).             In order to illustrate the extent of pain in children and its difficulty in terms of assessment and management, several clinical situations can be cited. One of the three situations to be cited is the incidence of headache, which can demonstrate pain in children. It has been demonstrated that headache is a common disorder in children and adolescents. Chronic daily headache or CDH is a collective term for primary headaches, with an estimated prevalence of 0.9% in children. In the second revised edition of the International Classification of Headache Disorders, 4 types of CDH have been included, namely, chronic migraine or CM, chronic tension-type headache or CTTH, new daily persistent headache, and hemicrania continua, which are only developed for adults. However, there are no specific criteria for children, making it difficult to classify their headaches. In conclusion, it has stated that CDH is a serious disorder that can occur at any age and leads to significant school absenteeism and sleeping problems in children (Wiendels et al., 2005). Another clinical situation is when a child has been subjected under the process of tonsillectomy, which is a procedure most often done in the same-day surgery setting. It has been reported that children having a tonsillectomy have been observed to experience moderate to severe pain levels in the days following the surgery. As a pain reliever, analgesics were given to the participants, and data were taken through diaries (Van Kuiken et al., 2007). In relation to this, pediatric day surgery is another situation wherein pain in children can be demonstrated. It has been emphasized that rapid-acting anesthetic and analgesic drugs, which hasten recovery from anesthesia with fewer side effects, accomplish the goals and desirable ends of day surgery by facilitating early discharge. However, the management of post-operative pain remains a continuing problem, both for the child and his or her parents. Apparently, increasing the use of non-sedating drugs, such as Paracetamol, non-steroidal anti-inflammatory drugs, and local anesthetic blocks ensure that a large proportion of children are leaving hospital pain-free following day surgery. However, children can experience extreme pain when the local anesthetic block wears off if no other analgesia has been given, which may be in the middle of the night when parents have limited access to health professionals (Jonas, 2003). As such, such situations or experiences would mean difficulty in managing the pain being felt by children, with the burden of the responsibility on their parents or guardians.             Given such difficulty, a number of measures or tools are used in healthcare settings in measuring pain in children, namely, self-report observational, and physiological. Self-report methods are preferred and referred to as the ‘gold standard’ within pediatrics due to the subjective nature of pain. Faces scales and visual analogue scales are available for children to use, as some children are unable to self-report for a variety of reasons (Peden et al., 2005). The FLACC scale includes five categories of pain behaviors, namely, facial expression, leg movement, activity, cry, and consolability (Willis et al., 2003). Others include the TPPPS or The Toddler Preschooler Postoperative Pain Scale, and the CHEOPS or the Children’s Hospital of Eastern Ontario Pain Scale. With such scales, it can be deemed that assessing and managing pain in children can be easier. However, this is not the case. This is because an important reason for the lack of utilization has to do with the issue of practicality and versatility of the instruments for use in the practice setting. Although many pain measures have been developed and validated, the clinical relevance of many of the tools has not been adequately tested, thus, hindering their integration into clinical practice (Gharaibeh and Abu-Saad, 2002). This has been supported by the fact that all the other studies mentioned, cited, and included in this paper speaks of the limitations in relation to the studies done, involving the different pain management tools. According to the study done by Peden et al. (2005), pain management tools can be evaluated in terms of their internal consistency, thus, it must be homogenous to the extent that all sub-parts are measuring the same characteristics. This was not performed in their study and would require consideration in future studies. Another study is the study done by Van Kuiken et al. (2007), which considered using the paper diary as inconsistent in data collection. This is because the number of entries on each diary and the interval between entries are varied. In this regard, relying on written reports, such as through using the paper diary may be one good source of error in pain management. In relation to this is the study done by Wiendels et al. (2005), which used a retrospective study design. Through the design, the study had to rely on data recorded by different physicians with varying expertise in headache. Missing data could not be retrieved, thus, leading to erroneous classification of participants. In this sense, relying on personal, manual, and subjective recordings of results may lead to errors and inconsistent findings. Moreover, analysis of the statement would lead one to consider the issues involved to answer the question, as to why pain assessment and management in children is one of the most tedious tasks in the provision of healthcare. One of such issues is passing the burden of healthcare practitioners in terms of pain management and assessment to the hands of the parents, particularly, after the child’s discharge from the hospital. The study done by Jonas (2003) emphasized that the problems associated with day surgery are not over when children and their parents leave the hospital, thus, a constructive written and verbal information must be given by a healthcare practitioner. Another issue is the lack of opportunity to spend time delivering information, which would only benefit the patients, but the nursing or healthcare staffs as well. The study done by Simons and MacDonald (2006) demonstrated that when a new intervention in pain management is necessary, there are very real obstacles to implementing change. In this sense, the use of the pain management tools becomes difficult to correct, including the perceptions of the ones administering them. This was supported by the study done by the same authors in 2004, wherein they stated that limitations in providing effective pain management and assessment in children involves the needed education of nurses to help them implement pain tools and the lack of a culture, which is supportive of change. As such, it has been emphasized that the lack of experience, lack of support, and lack of communication among staff members (Contro et al., 2004), and between the staff members and the family of the patient are considered primary factors of the lack of effective pain assessment and management in the practice setting. Such factors also support the fact that some healthcare practitioners lack the needed and adequate knowledge over pain and pain assessment methods, need educational preparation, the lack of instrument appeal to the child, the age of the child, and difference between the cultural background of the child and the healthcare practitioner (as cited in Gharaibeh and Abu-Saad, 2002).   Conclusion             From the discussion and analysis of the articles, it can be deduced that the lack of effective and appropriate pain assessment and management among children can be attributed to a variety of factors. Such factors depend on the skills, knowledge, and competencies of the healthcare practitioner, the ability and the willingness of the child/children to cooperate, and the knowledge, skills, and cooperation from the parents or guardians of the child/children. Based on the different limitations and issues discussed, it can be perceived that such issues are the main reasons why pain assessment in children is difficult. Despite the variety of pain assessment tools available to the utilization of healthcare practitioners, their lack of experience and proper skills, knowledge, and competencies may hinder them from providing effective care for their patients.   References Blount, R.L., Piira, T., Cohen, L.L. and Cheng, P.S. (2006). “Pediatric Procedural Pain”. Behavioral Modification, 30(1): 24-49. Contro, N.A., Larson, J., Scofield, S., Sourkes, B. and Cohen, H.J. (2004). “Hospital Staff and Family Perspectives Regarding Quality of Pediatric Palliative Care”. Pediatrics, 114(5): 1248-1252. Gharaibeh, M. and Abu-Saad, H. (2002). “Cultural Validation of Pediatric Pain Assessment Tools: Jordanian Perspective”. Journal of Transcultural Nursing, 13(1): 12-18. Jonas, D.A. (2003). “Parent’s Management of their Child’s Pain in the Home Following Day Surgery”. Journal of Child Health Care, 7(3): 150-162. Peden, V., Choonara, I. and Vater, M. (2005). “Validating the Derbyshire Children’s Hospital Pain Tool in Children Aged 6-12 Years”. Journal of Child Health Care, 9(1): 59-71. Simons, J. and MacDonald, L.M. (2004). “Pain Assessment Tools: Children’s Nurses’ View”. Journal of Child Health Care, 8(4): 264-278. Simons, J. and MacDonald, L.M. (2006). “Changing Practice: Implementing Validated Paediatric Pain Assessment Tools”. Journal of Child Health Care, 10(2): 160-176. Van Kuiken, D.M., Lin, L. and Huth, M.M. (2007). “The Difficulties of Studying Children’s Pain at Home”. Western Journal of Nursing Research, 29(4): 432-447. Wiendels, N.J., van der Geest, M.C., Neven, A.K., Ferrari, M.D. and Laan, L.A. (2005). “Chronic Daily Headache in Children and Adolescents”. Headache, 45: 678-683. Willis, M.H., Merkel, S.I., Voepel-Lewis, T. and Malviya, S. (2003). “FLACC Behavioral Pain Assessment Scale: A Comparison with the Child’s Self-Report”. Pediatric Nursing, 29(3): 195-198.                                             Credit:ivythesis.typepad.com

Assessment of Pain is Complex due to the Personal Nature of the Experience and Other Variables. It is Particularly Problematic in the Pediatric Setting

Assessment of Pain is Complex due to the Personal Nature of the Experience and Other Variables. It is Particularly Problematic i...

Nurses’knowledge towards pain assessment and pharmacological management in ICUs

Nurses’knowledge towards pain assessment and pharmacological management in ICUs   Introduction Nursing refers to the functions and duties carried out by persons who have had formal education and training in the art and science of nursing. To promote the restoration and maintenance of health in their clients, nurses become more particular in enhancing their knowledge through integration with health and biological sciences (Gubrium & De Gruyter, 1993). As an applied discipline, the vocation of nursing evolves within a dynamic body of knowledge. The quality of nursing practice is dependent on the knowledge of individual practitioners as well as their willingness to engage in professional relationships and behaviors. Nurses are required to have the skills and know-how to explore, confirm, and direct the progress of nursing practice. Five value concepts uphold professional development: the (1) knowledge base, which is the foundation knowledge base upon which clinical practice decisions are made, (2) continuing education which comprise of the continuing learning activities that are crafted to benefit the individual and the profession, (3) mentoring and networking which are the professional relationships that are instituted with the intent of supportive growth for the individual as well as the profession, (4) research which is the qualitative and/or quantitative investigation of the factors which affects the professional nursing practice, and lastly (5) career development which are purposeful, planned strategies that are designed to boost short and long term professional goals (Angelucci, Quinn & Handlin, 1998). It has not been long since nurses have had specialized training especially on patient management; these specialized trainings include the situation in which they are more likely to find themselves, thus affecting how they will react to the situations presented before them. The differences of their actions mean very much to the patients, and thus they must learn how to distinguish the different factors and be able to help their patients in achieving the best method of improving their health and returning to their vigorous states. This research aims on analysing the Nurses’knowledge towards pain assessment and pharmacological management in ICUs. Statement of the Problem             As discussed in the introduction, studies have identified the inadequacy of proper  pain assessment among different  patient groups. This proposed research then intends to answer the following queries: 1.    What are the extent of nurses’ knowledge in terms of pain assessment as well as pharmacological management in ICU? 2.    How do nurses help their patients to alleviate and manage pain? 3.    Is there a need for a rigorous training programme for the nurses handling pain assessment and pharmacological management in ICU?   Objectives of the Study             The following statement will be the main objectives of the study, which the researcher will attempt to achieve: <li class="MsoNormal" style="text-align: justify; line-height: 200%; margin-bottom: .0001pt"> 	This study aims 	to identify the different the nurses’ knowledge in 	terms of pain assessment as well as pharmacological management in ICU</li> <li class="MsoNormal" style="text-align: justify; line-height: 200%; margin-bottom: .0001pt"> 	This study 	intends to know how nurses help their patients to alleviate and manage pain</li> <li class="MsoNormal" style="text-align: justify; line-height: 200%; margin-bottom: .0001pt"> 	This study aims 	to identify if there is a need for a rigorous training programme for the 	nurses handling pain assessment and pharmacological management in ICU.</li>   Literature Review Accuracy of pain assessment tools and methods. In the last few years, experiments and other forms of studies have been designed in the medical arena to evaluate the validity and reliability of the different agitation and sedation scales including the Sedation-Agitation Scale and the Motor Activity Assessment Scale. Other assessment tools have been developed from the results and observations made among patients that helped clinicians in the area of patient care. Such studies recommended further investigation on the impact of these monitoring techniques in relation to the aim of improving patient comfort, minimizing adverse events, and reducing resource consumption as well as more accurate pain assessment methods. Assessing pain and sedation in nonresponsive patients is a challenge primarily because of the confounding effect of sedation on objective indicators of pain. As such, clinicians might interpret incorrectly because the behavioral responses to pain and anxiety/agitation have many similarities. Hence, additional research is needed to establish the validity, sensitivity, and specificity of pain indicators in sedated patients. Moreover, in the case of nonresponsive sedated patients, clinicians should integrate actual or potential risks of pain and risks of pain-related functional impairment into their pain assessment (Puntillo, 2004). According to Puntillo (2003) pain assessment and management for critical care patients, present challenges to clinicians and researchers as pain assessment methods and clinical trials of pharmacological interventions continue to investigate procedural pain assessment methods. There have been studies that investigated the validity and reliability of pain assessment tools that medical practitioners are currently using.   Research Design This study will be conducted in order to identify the different causes of apprehensions among  patients in using opioid-based analgesics. In this proposed research, the descriptive method will be utilized, using a sample of 50  patients. According to Creswell (2005), the descriptive method of research is to gather information about the present existing condition.  Thus, this method is the most appropriate to use. Two types of data will be used for this study: the primary and the secondary data. The primary data will be derived from the answers respondents will give in the questionnaire and interview facilitated by the researcher. The secondary data on the other hand, will be derived from the findings stated in published documents and literatures related to the research problem. These will be based from the recent literatures related to factors that make  patient hesitant towards opioid-based analgesics. As this proposed study will utilize two different research instruments, both quantitative and qualitative approaches will be utilized in the process. Through this combined approach, the researcher will be able to address the limitations of either approach.           Reference Angelucci, D., Quinn, L. & Handlin, D. (1998) A Pain assessment Relief Plan. Nursing Management, 10th January.   Gubrium, J. and De Gruyter, A. (1993) Speaking Of Life: Horizons of Meaning for Nursing Home Residents Puntillo K., Stannard D., Miaskowski C., Kehrle K., Gleson S. (2002) Use of pain Assessment and intervention notation (P.A.I.N.) tool in critical care nursing practice. Nurses evaluations. Heart Lung; 31:303-314     Credit:ivythesis.typepad.com

Nurses’knowledge towards pain assessment and pharmacological management in ICUs

Nurses’knowledge towards pain assessment and pharmacological management in ICUs Introduction Nursing refers to the functions a...

A Critical Analysis And Evaluation Of The Pain Assessment Methods Used In Non- Communicating Critically Ill Patients.

A Critical Analyses And Evaluation Of The Pain Assessment Methods Used In Non- Communicating Critically Ill Patients.   Introduction It has not been long since nurses have had specialized training especially on patient management; these specialized trainings include the situation in which they are more likely to find themselves, thus affecting how they will react to the situations presented before them. The differences of their actions mean very much to the patients, and thus they must learn how to distinguish the different factors and be able to help their patients in achieving the best method of improving their health and returning to their vigorous states. This paper discusses the pertinent issues related to pain assessment among Non- Communicating Critically Ill Patients. critically analyzing the current concerns in the nursing practice to present the applications and implications of the issues and provide sound recommendations.     Issues on Pain Assessment among Non- Communicating Critically Ill Patients Nurses are advocates and health educators for patients, families, and communities. When providing direct patient care, they observe, assess, and record symptoms, reactions, and progress in patients; assist physicians during surgeries, treatments, and examinations; administer medications; and assist in convalescence and rehabilitation. Nurses also develop and manage nursing care plans, instruct patients and their families in proper care, and help individuals and groups take steps to improve or maintain their health. While state laws govern the tasks that the nurse may perform, it is usually the work setting that determines their daily job duties.  Pain assessment is a key aspect in the nursing management and delivery of care within the clinical environment in which nurses utilize many aspects of knowledge including that of the underlying pathophysiology, pharmacological knowledge of the drugs available for use, and knowledge of the patient being assessed. Such use of the wide range of knowledge is important when caring for a variety of patients to ensure accurate pain assessment based on sound judgment to achieve a pain-free status whenever possible and ensure that the patient achieves the best possible treatment (Walker, 2003). According to Riker & Fraser (2000) there are several advantages of monitoring the patients’ sedation outcomes. These include (a) reductions in intensive care unit (ICU) stay, (b) duration of mechanical ventilatory support, and (c) some diagnostic tests that will assess the function of the central nervous system. However, there are issues that are in need of attention so as to address the proper and accurate procedures of assessing pain among Non- Communicating Critically Ill Patients.. These include the difficulties encountered in assessing pain and the accuracy of pain assessment tools and methods. Several studies have been conducted in the discipline of medicine and care giving in order to improve the condition of the patients who are suffering from discomfort due to their physical condition before or after undergoing medical procedures. These studies were conducted so as to determine the accuracy of the tools and measures of determining the discomfort levels of the patients in order to help the patient recover easily and immediately from the illness that he or she is experiencing as well as to contribute to the ways of overcoming the difficulties of pain assessment. Some of these studies which investigated the cases of Non- Communicating Critically Ill Patients. are briefly presented below.              Assessing pain and sedation in nonresponsive patients is a challenge primarily because of the confounding effect of sedation on objective indicators of pain. As such, clinicians might interpret incorrectly because the behavioral responses to pain and anxiety/agitation have many similarities. Hence, additional research is needed to establish the validity, sensitivity, and specificity of pain indicators in sedated patients. Moreover, in the case of nonresponsive sedated patients, clinicians should integrate actual or potential risks of pain and risks of pain-related functional impairment into their pain assessment (Puntillo, 2004). According to Puntillo (2003) pain assessment and management for critical care patients, present challenges to clinicians and researchers as pain assessment methods and clinical trials of pharmacological interventions continue to investigate procedural pain assessment methods. There have been studies that investigated the validity and reliability of pain assessment tools that medical practitioners are currently using.   Salmore (2002) conducted a study on estimating the comfort levels of sedated patients who undergone gastrointestinal examination in order to determine the validity and reliability of the Colorado Behavioral Numerical Pain Scale in which interrater reliability showed 82% agreement on the observations made on the patients. The study likewise included the participation of nurses from other hospitals and a medical person from an ambulatory facility which illustrated a 92% agreement that the words described what they observed during a gastrointestinal examination and 94% felt it was a better descriptor of pain than a patient self-report numerical scale.   Reference Riker, R. and Fraser, G. L. (2000) Monitoring Sedation, Agitation, Analgesia, Neuromuscular Blockade, and Delirium in Adult ICU Patients Department of Critical Care, Maine Medical Center, Portland, Maine.   Salmore, R. (2002) Development of a New Pain Scale: Colorado Behavioral Numerical Pain Scale for Sedated Adult Patients Undergoing Gastrointestinal Procedures. Gastroenterology Nursing. 25(6):257-262.   Walker J. (2003) Philosophy, knowledge and theory in the assessment of pain. British Journal of Nursing; 12(8):494-501           Credit:ivythesis.typepad.com

A Critical Analysis And Evaluation Of The Pain Assessment Methods Used In Non- Communicating Critically Ill Patients.

A Critical Analyses And Evaluation Of The Pain Assessment Methods Used In Non- Communicating Critically Ill Patients. Introduction...