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
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