...Vol. 14 No. 3 September 1997 Journal of Pain and Symptom Management 175 Special Article Nurses' Knowledge of Pain Assessment and Management: How Much Progress Have We Made? M a r g o McCaffery, MS, RN, FAAN, a n d Betty R. Ferrell, PhD, FAAN Nursing Consultant (M.M.), Los Angeles, California and Nursing Research (B.t~E ), City of Hope National Medical Center, Duarte, California, USA Abstract Uadertreatment of pain and lack of knowledge about pain management have been evident for approximately two decades. Because nurses are often the cornerstone of pain management, nurses' knowledge in this area is especially important. This paper explores indications of progress in the level of nursing knowledge about basic aspects of pain management. The literature is reviewed and findings from recent (1995) surveys of nurses' knowledge are compared with results of similar surveys conducted beginning in 1988. Improvements in nurses' knowledge of pain assessment, opioid dosing, and likelihood of addiction seem to have occurred. However, knowledge deficits continue. Fewer than one-half of the nurses surveyed understand that the patient's self report of pain is the single most reliable indicator of pain and that the nurse should increase a previously safe but ineffective dose of opioid. Findings from surveys on addiction reveal that the longer the patient receives opioids the more concerned nurses become about causing addiction. Nevertheless, results of current knowledge surveys...
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...Path physiology Of Pain Within this essay I plan to discuss: one current view of path physiology of pain, two ages appropriate pain tools for babies and toddlers and will also be exploring the nursing management of acute pain experience in babies and toddlers, including a strategy for ensuring the safe delivery of care. There have been a range of theories put forward in attempt to explain the path physiology of pain, one of these is the gate control theory (Fraser.L 1996) which states that a stimuli that enters the spinal cord can be manipulated through a process of opening and closing gates, which in turn determines if impulses proceed or not. The Gate control theory provides the most plausible explanation for the process involved in the perception of pain. As there are many factors to a person’s perception of pain. When the nerve impulses from the nociceptors (a free ending nerve which is present in almost all types of tissues which act to sense and transmit pain) reaches a critical level, the T cells in the substantia gelatinosa (which regulates impulses) is triggered, therefore the gate opens. This then in turn allows the transmission of impulses to proceed to the thalamus and cerebral cortex where the perception of pain is defined (Wall and Melzack 1989). However there are scenarios when the gate remains closed even though there are impulses from the nociceptors. For example if a child...
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...Technological Advancements in Pain Management Dishon Abbs 10/18/2010 Gabi Vosteen BIO 181 Lab Technological Advancements in Healthcare Throughout the world, many people live with pain every day. Some have never sought medical treatment, and others have received low quality and ineffective treatment. The approach to treating pain and illness depends on the culture and geographical location of the professional appointed to treat pain. In Western Tradition, physicians are considered to be experts on treating illness and pain by utilizing chiropractic manipulation, acupuncture, physical therapy and synthetic medicines. In Navajo tradition, medicine men are the experts on curing illness and pain with religious ceremonies and the use of natural herbs and remedies. Today, the most advanced practice in the health industry is pain management because of the combination of herbal medicines created by Navajos, and synthetic medicines created by Western Scientists. The study of medicine all began in the 1700s when Christopher Columbus came in contact with Indian people in the 1700s. The Indians and Europeans traded food, weapons, shelter and worked together, in a sense, to discover land and natural resources. Shortly after, Small pox, measles, and tuberculosis broke out and killed many people. This encouraged Western Scientists and Navajo People to try and discover cures for infectious diseases. Western Scientists engineered micro-organisms that would search and destroy harmful...
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...Running Head: Postoperative Pediatric Pain Management Postoperative Pediatric Pain Management: A Multidisciplinary Concept Analysis Postoperative Pediatric Pain Management: A Multidisciplinary Concept Analysis Acute pain following a surgical procedure is one of the most common stimuli experiences by pediatric patients. Pediatric postoperative pain management has long been overlooked and treated differently than adult pain management. There tend to many misconceptions when it comes to pediatric pain management stemming from the belief that children do not experience pain the same way as adults. Since the pediatric population is not legally allowed to make medical decisions, guardians must make these decisions for them. Postoperative pain in the pediatric patient may be hard to assess and therefore healthcare professionals have begun to involve family members and caregivers in the pain management process. Pain can stem from many sources and thus must be holistic, involve multiple disciplines, provide education and apply to each individual patient. In practice, advocacy for these young children is important in helping them and their families understand about the situation and make education decisions on how to proceed with care. The concept of postoperative pediatric pain management must be analyzed to help resolve these misconceptions and not ignore the population who at times cannot speak for themselves. Review of Literature After a surgical procedure, the pediatric...
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...DOI: 1/22/2013. Patient is a 50-year-old male cook/crew member who sustained a work-related injury when he lifted a 40-pound tray of chicken and felt back pain. Per OMNI, he had a lumbar sprain/strain with right sciatic component. Based on pain management follow up evaluation report dated 06/26/15, the patient complains of lumbar spine pain, which he rates at 5/10. He notes that the pain has decreased since his last visit ( 05/29/15) due to a sacroiliac joint injection on 06/08/15. He reports that the procedure helped (100%) and he is pain free for two weeks and he was not taking any medication. He states that he had better mobility and he slept well. Now, he is indicating that the pain has returned. He has been taking his medication regularly and...
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...included pain in the back and side effects from the medication he was prescribed. Mark was prescribed dozens of medications and the only medication that seemed to work caused depression. For a short period of time, his quality of life had been decreased. Mark barely talked to anyone including close family members and chose to stay at home most days. He began to realize how this medication begun to negatively affect his ability to live his life so he looked for other treatments. His favorite two treatments include counseling which provided him with hope and motivation and his electronic messaging device. The electronic device stops...
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...1.2 Pain management Under treated pain is one of the most common complains reported by patients, especially chronic pain which represents the main health problem for people seeking medical help(Heit, 2003). Regarding chronic pain management, treatment goals should include relieving pain or decreasing its severity, improving patients’ functionality thus restoring the ability of self-care and performing simple daily tasks and most importantly improving general health quality of life. Due to the complex nature of chronic pain, management and treatment plan usually include multidisciplinary approaches. 1.2.1 Pharmacological approach: The first approach used to control pain is the pharmacological approach represented by the use of analgesic drugs....
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...Administration and Pain Management in the Terminally Ill Cancer Patient: Case study of a patient in the terminal phase of breast cancer. This case study is based on Ms. D, a 48-year-old married woman diagnosed with Bilateral Breast Cancer. She underwent a bilateral mastectomy 4 years ago. Lymph involvement was noted at the time of the surgery. Recent metastases of the bone has been diagnosed and she is in the terminal phase of the disease process. Up to this point, she has been on a regimen of Oxycodone 5 mg P.O. every 6 hours as needed for pain, Zantac 150mg P.O daily for heartburn, Docusate 100mg P.O. twice a day to promote bowel movements, Celexa 40mg PO daily for depression and enteric coated aspirin 81mg PO daily for prophylaxis of transient ischemic attacks and MI. She remains in her home and is receiving care at home. Ms. D has complained recently of significant increased pain and trouble sleeping, most likely due to the bone metastases in the area of the lumbar spine. She has stated that the pain has dramatically decreased her quality of life recently also. She has expressed the desire to remain at home during the terminal phase of her disease, but needs more adequate pain management to preserve her quality of life for as long as possible. She is married and her husband is very loving and supportive of her desire to stay in the home during this phase. He has voiced some concerns about drug dependency if the patient were to receive stronger pain medication. I have...
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...Pain management: Comparison of application times for ice packs used to relieve perineal pain after normal birth I have chosen this article for my critique because my client was a mother who experienced 1st degree perineal lacerations during the birthing process and was being treated with cryotherapy as an alternative to narcotic pain relief. This article addressed the trends of using cryotherapy to promote healing and pain reduction in perineal lacerations and episiotomies. I found this article to be extremely insightful as it addresses one of the key nursing interventions used to treat perineal lacerations to this day, as well as its rationale. This particular article is the second part of a two-stage study that was performed using controlled parallel, randomized clinical trials, with the evaluator blind to the outcome regarding the use of an ice pack to relieve perineal pain after normal birth. While evidenced based practice shows that using ice packs for perineal pain is effective this study asks the question, whether applying ice packs to the perineal area to relieve the pain after birth for 10, 15, or 20 minutes made any difference? The results confirm the hypothesis that there is no difference in the analgesic effectiveness of the ice pack applied for the three different application times on women who report moderate or intense pain. The results showed that all postnatal women submitted to cryotherapy responded favorably despite the high number of women who refused to...
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...Literature Review: Does Effective Pain Management Improve the Overall Quality of Life? What is pain? Generally, it is an unpleasant sensory feeling that is triggered by the body's nervous system in response to an adverse affect and is often categorized as acute or chronic. Because of the many different aspects of pain, it varies from each individual. Experiences that may cause pain in one individual may or may not cause pain at the same level which makes this a highly subjective symptom. Previously, medical professionals relied solely on their patients report of pain. However, as time and medicine have evolved, pain has been incorporated into general patient assessments and has further been referred to as the fifth vital sign, revealing its objective qualities as well. Nurses are being trained to assess pain along with the standard vital signs so that appropriate pain management interventions may be implemented when necessary (McCaffery, Pasero, & Wells, 2008). Pain management has evolved and continues to evolve through the many advancements of medicine. The management of pain is critical to the overall well being of patients. The research that has been performed based on the article, "Pain Management: A Human Right" (Brennan, Carr, & Cousins, 2007), reveals that lack of effective pain management can lead to many adverse conditions such as increased heart rate, systemic vascular resistance, and circulating catecholamines, which place the patient at risk for myocardial...
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...Annotated Bibliography “What is the evidence of positive benefits with using T.E.N.S. (Transcutaneous Electrical Nerve Stimulation) unit for pain management?” Bi, X., Effects of transcutaneous electrical nerve stimulation on pain in patients with spinal cord injury: a randomized controlled trial. Journal of Physical Therapy Science 27: 23-25 (2014). Xia Bi, Department of Rehabilitation Medicine, Shanghai Gongli Hospital, China, focused his research on investigating the effectiveness with using transcutaneous electrical nerve stimulation on patients in pain due to a spinal cord injury. Bi states that there have been many clinical papers that have reported positive effects of TENS in pain management but controversy exists over which conditions can be treated using this method. He states that if TENS were shown to be effective method of alleviating pain in Spinal Cord Injury (SPI) patients, it would decrease medical costs and improve quality of life. Bi discusses how their results are consistent with those of previous studies (Celik EC, The effect of low frequency TENS in the treatment of neuropathic pain in patients with spinal cord injury) which reported the effectiveness of TENS in the pain relief of SCI patients. The study had several limitation which were mention in the paper stating that the sample size of subjects was insufficient for generalization of the results, a follow up was not performed, and lastly they did not compare the efficacy of low frequency TENS...
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...Symptom Trends in the Last Year of Life from 1998 to 2010 A Cohort Study The article, Symptom Trends in the Last Year of Life From 1998 to 2010 is about a twelve year study about pain management and end of life care. This was an observational study to analyze and describe trends in pain severity and symptoms occurring in the last year of life. The study consisted of 7204 participants over the age of 51 all of whom died during the study. Data collection was done by an interview process. These interviews were conducted with family members of the deceased within two years of the participants’ death. Survey questions were asked about pain levels, depression, confusion and quality of end of life care. Data has shown that pain severity has increased by 11.9% during the twelve years study. The biggest increase was in cancer patients that reported the highest pain levels. My take on this article comes in two forms. On one hand, it calls for drastic improvements in end of life care and pain management. On the other it used very subjective forms of data collection using the family members, making it hard to for me to take all the numbers and charts provided in the study as absolute. All in all this article brings to light the need to improve end of life care for the patient and family member. Work Cited Singer, Adam E., Daniella Meeker, Joan M. Teno, Joanne Lynn, June R. Lunney, and Karl A. Lorenz. "Symptom Trends in the Last Year of Life From 1998 to 2010." Annals of Internal...
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...enhancing care for end of life patient, including collaboration with physicians and surrogate decision makers or a power of attorney (POA), as well as pain management policies. However, all aspects of care for end of life patients are taken into consideration when determining which facet is most important. The group’s research consists of quantitative and qualitative articles focusing on transitioning to hospice programs, new measures of care, acceptance of death and experience of caregivers for the dying patient. According to the Journal of Health Politics, Policy & Law (2008), three of every four Americans do not fear death as much as they fear being in pain at the time of death. End-of-life care can be a challenge requiring the full range of a family physician's skills. Significant pain is common but is often undertreated despite available medications and technology. Physicians must overcome their own fears about using narcotics and allay similar fears in patients, families and communities. Drugs such as corticosteroids, antidepressants and anticonvulsants can also help to alleviate pain. A considerable amount of research has compiled over time to aid in reducing the amount of pain in the dying patient (Health Care in America, 2004). Side effects of pain medications should be anticipated and treated promptly, but good pain control should be maintained. The physical, psychological, social and spiritual needs of dying patients are best managed with a team approach. Home...
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...but their family as well. The patient’s quality of life was my main concern but health promotion among the family members was in my mind as well. I saw that if the family was well taken care of and were not burnt out on caring for the patient then everyone had a much better quality of life. By providing resources for the families I was better able to keep them in good health and therefore have them provide better and more loving care for their dying family member. The first thing that I would try to implement with the Thomas family is to get Mrs. Thomas’ pain under control. Pain is very debilitating and it is hard for loved ones to see each other in pain. Mrs. Thomas has not been taking her pain medication for fear of becoming addicted to pain medications. As her nurse I would talk with her about the pros and cons of taking various pain medications. I would talk with her primary care physician about different pain medications available. There are many different medications available that are not so addictive and that still provide...
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...concepts; displays patience and the ability to ease patient anxiety * Capability to manage and coordinate several activities efficiently EDUCATIONAL QUALIFICATIONS & CERTIFICATIONS * AAS Degree, Clark College, Vancouver, Washington; August 2013 * Certificate, Everest College, Vancouver, Washington; June 2010 * Certificate, Apollo College, Portland, Oregon; June 2002 * Current CPR, First Aid, AIDS Education WORK SUMMARY Clinical Medical Assistant Summit Specialists of Pain Rowlett, TX September 2013- Current Responsibilities: * Provide support to the physicians, nurse practitioners, and physician assistants accurately and promptly * Provide support to physician with setting up office-based surgical procedures, surgical instruments, C-Arm operation * Assisting the physician in the performance of procedures to include pain injections for chronic headache and other spine related pain management procedures * Communication with the patients to gather information about...
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