2016
Introduction
The purpose of this dissertation is to investigate the barriers to effective pain management in palliative care nursing. The essay will be divided into five parts the first section will be the introduction. The second section will be the research methodology and the critical appraise of literature followed by a section discussing the emerging themes from literature. Recommendations of how to overcome the barriers that may hinder effective pain management in palliative care will be analyzed in the fourth section and the last part will be the implication of future nursing practice and conclusion of the dissertation. This structure will serve to answer the research question since it provides a comprehensive overview and analysis of the chosen topic.
Nurses play a critical role in pain management in palliative care, nursing terminally ill patients. Nurses are known to act as educators, motivators and advocators for such patients (Hebert et al, 2011). Nurses in palliative care are responsible for the pharmacological management, spiritual, emotional and physical symptoms of pain, (Rome et al, 2011). Nurses should also address and educate the patient and patient's family members on pain management based on the current evidence. All family members play a vital role when the transition from hospital to home care takes place. Further, they play a role of a caregiver and bring out a positive impact to the well-being of the patient. Researchers mentioned above have found that palliative care reduces to a certain extent emotional and physiological stress, as well as improves healing in patients who suffer from acute pain or improve the quality of life in patients with chronic pain.
Moral support, pain relief and psychological care are a key focus area that nurses needs to focus while providing pain management in palliative care (Bowen, 2014). Thus, it is utmost importance to identify the barriers to pain management for the nursing profession. This paper provides an overview of the various barriers observed in pain management in palliative care through a systematic review of current evidence. Pain management can be successful when performed by health professionals and, in some cases, by the family. Often family members choose to be present when implementation of pain management strategies takes place.
Palliative care has been highlighted as one of the areas where nurses deliver total care of patient when the patient's disease is no longer responsive to curative treatment (Noble, 2015). The survey conducted by Public Health England - PHE, and the National Council for Palliative Care - NCPC (2014) have shown that 46% of deaths recorded were of people receiving palliative care nursing. This type of medical care process is enough complex and demanding especially when it comes to specialist workforce within the NHS sector. Therefore, nurses play a crucial role in delivering palliative care to terminally ill patients on a daily basis, (Steinberg, 2011). Palliative care is associated with two major components. The first component is related to the emotional and psychological care of the patient and family members. The second component is based on the identification of pain and utilizing pain relief interventions based on current evidence, (Rome et al, 2011). The primary objective of palliative care is relieving the patient from pain and any other distressing symptoms. Palliative care and effective pain management are the cornerstones for a terminally-ill patient. The process of pain management varies depending on the healthcare settings, the phase of illness and organizational policies (Gott et al, 2011). Pain usually helps in diagnosing a medical problem or illness that is either acute or chronic and needs treatment. Thus, taking care of the problem is crucial and specialist diagnosis of pain management is required.
According to Creedon and O’Regan (2010), 85% of patients living with a terminal illness can experience intense and unbearable pain (moderate to severe level). Pain can stem from organ failure, damaged skin, muscles and bones. Pain can exist without an evident physical cause, thus, such a type of pain needs to be evaluated instead of attributed to psychological causes. Nurses have to assess the level of pain as pain varies from patient to patient as well as to determine the cause and type of pain. This can help the nurses to establish the dosage of medication and alternative route of medication administration to ensure fast action of the drug, (Wilson et al, 2013). The treatment of pain needs to be as individual as is experienced by the patient.
