Question 1
One of the aspects that can help in identifying a patient’s pain is any past use of painkillers. The ambulance officers only asked about any pain killers that the patient had taken. Although they did not enquire about any health problem that could have been the probable cause of the pain, Mrs. Markantonakis informed that ambulance officers that the patient had a heart problem. The ambulance officers were also informed about the hospitalization of the patient. His wife mentioned that Flinders Medical Centre was his preference since most of his notes and records pertaining his health were there. The respondent of most of the patient’s medical history questions, Chrisoula (his daughter), did not have much knowledge about the health of her father in the past. She could not recall her father having a motor vehicle accident reportedly in July 2002 in which he had suffered both neck and shoulder injuries (pp. 4). She could not even recall of him receiving any physiotherapy. His wife later admitted to the fact that the patient had physiotherapy after the accident. The officers did not examine the patient. The patient’s wife was able to disclose the time when the pain had started i.e. shortly after midnight on 6/03/2004. They tried to relieve his pain by using pain killers namely Panadeine Forte which did not work for him.
Question 2
The following variables would be included in the diagnosis:
- Physical: This includes its location, spatial distribution, as well as its symptomotology
- Cognitive and behavioral factors include the number of doctor visits and hospitalizations, drug usage, verbal as well as nonverbal behaviors
- Affective or emotional factors include depression and anxiety
- Functional measures: Include uptime, and productivity
- Economic factors include costs and lost workdays
- Social and cultural factors include independence, productive family involvement, quality of life, and patient goals.
For collecting this information from the client, I would use a combination of questionnaires. First I would seek to get the physical descriptors of pain intensity and qualities using the McGill Pain Questionnaire (MPQ). This would give me the details about the physical sensation of the pain, its intensity, the anatomic location and radiation pattern, the current severity, as well as the frequency or rather the occurrence (Vercellini, 2011, pp. 28; Lynch, et al., 2010, pp. 56). The location and the pattern of the radiation, physical sensation and intensity, frequency, and the duration of the pain are the initial elements of the pain history. Date of onset, proximate cause, exacerbating and mitigating factors and activities as related to the pain are additional historical points that can be realized through the MPQ. I would also administer the Wisconsin Brief Pain Questionnaire that consists of 17 questions and catalogs not only the information captured by the MPQ but also a history of the pain and its effects on mood and activity (Holstege et al., 2008, pp. 96; Micheo, 2010, pp. 16).
As the patient as well as his family had disclosed that he had a heart problem, I would first establish to condition of his heart and administer the necessary measures based on the results.
Question 3: Style of Communication by Ms Bell
Jennifer Bell had poor communication or rather interpersonal skills. She was rude to the client. After been told that the client had used Panadeine Forte, (a painkiller) to ease his pain, she replied that he should have taken some more. This is not an appropriate manner of answering or rather responding to a patient (Albarran and Tagney, 2008, pp. 105).
She did not listen to the explanations that were offered by the patient’s family members. For instance, they did not pay attention to the fact that the patient had a heart problem. Chrisoula notes that “they did not appear to acknowledge the fact this fact nor the medications that Mrs. Markantonakis told them about which were by the side of Mr. Markantonakis’ bed” (pp. 6). While in the kitchen, Jenniffer Bell nonverbally ‘said’ that Mr. Markantonakis was exaggerating his pain (pp. 3). According to the Mrs.Markantonakis and her daughter, the ambulance staff had a bad attitude towards the patient as well as his family (pp. 4).
While in the ambulance, Ms Bell was rude to the patient. She could be heard telling him “stop it be quiet” (pp. 6). Healthcare professionals should not be harsh when dealing with their patients (Norlander, 2008, pp. 66; Carr et al., 2009, pp. 102). This hinders the patient form expressing himself thus unable to unveil all the aspects of his pain which could have been important in managing the pain effectively. Poor communication is also exhibited when Ms Bell failed to report the problems that the patient had developed en route to hospital i.e. suprapubic and epigastric pain (pp. 22).
The strategies she should have applied are:
- Listening properly
- Identifying the nonverbal cues used by the client
- Proper diction i.e. choice of words
- Transparency
- Establishing a good environment
Question 4
The handing over strategy at the hospital could have been improved by providing all the information that the nurse at the reception required. This comprises of the condition of the client i.e. his history. Ms Bell should have disclosed all the information that she had gathered about the patient. A s aforementioned, she did not disclose the complications that the patient developed en route the hospital. Such information would have been used in granting the patient priority as far as getting immediate medical attention is concerned. Additionally, Ms. Bell should have allowed the patient’s family to disclose all the information that they knew about the patient to the receptionist. Alternatively, the nurse should have chosen to question the patient’s family members on issues about the health of the client (Sheppard, 1991, pp. 66; Wright, 2007, pp. 25). By so doing, she could have established the truth and awarded the patient the medical priority or rather care that he needed. Moreover, the nurse should not have made any assumptions about the health condition of the patient. She kept on telling his family that he was next on line since she thought that he was not in a serious medical condition that required immediate intervention.
Question 5:
There was no much assessment done on the patient other than knowing the location of the pain. There were inadequacies in the pain assessment. The quality of pain perceived is determined by the physiological, psychological, emotional and cognitive variables. This means that pain is a biophysical phenomenon (Koestler and Myers, 2002, pp. 26). Some of the impacts that are associated with patient’s pain assessment may include reluctance to involve the patient in their pain assessment or disbelief of their pain assessment. This may lead to inaccurate recording of the pain score, which may result to inadequate analgesia and persistence /recurrence of the pain. As a result of a vicious circle of pain, disbelief and inadequate analgesia evolves. Inadequacies in pain assessment may also occur due to subjective assessments of pain made by the staff rather than the patient (Parsons and Preece, 2010, pp. 96; D’Arcy, 2009, pp. 96). Although the basic principle is that the individual should make the assessment of their pain, healthcare professionals within the multidisciplinary team must be familiar with the patient-centered barriers to achieve the best results for the well-being of the patient. Since pain is a biophysical phenomenon and is subjective, it is important to bear in mind that when assessing the patient’s pain, healthcare practitioners cannot make assumptions on how much pain another person is feeling (Jansen, 2008, pp. 12; Holstege et al., 2008, pp. 362). Other determinants that may positively or negatively influence the experience of pain include anxiety and perceived control over the pain.
My intervention plan would have the following components:
1. Pharmacologic intervention
- Pain assessment would be done by utilizing a numerical rating scale before and after intervention (0-10 scale).
- Use analgesic medications
- Assessment of the pain
- If after doing several pain assessment tests the pain has not disappeared, I would introduce the non pharmacologic treatments given below
- Physical therapy: This provides numerous options for pain management. I would let the patient know that various methods of the physical therapy can improve function and mobility and that a series of therapy may be beneficial. Older patients in particular can benefit from physical therapy in many ways (Twycross, 2009, p. 63). Muscle strengthening, balance, and gait are useful in preventing limited mobility.
- Exercises are also fundamental in the improvement of pain over time. Exercise enhance the relieving of pain since it helps in improving the range of motion, thus increasing strength and power. All exercise would be tailored to improve strength, flexibility and endurance.
- Aqua therapy would also be used in relieving pain.
- Cognitive and behavior strategies would also used in assisting the patient gain normalcy (Winterowd 2000, pp. 215)
2. Pharmacologic therapy
This is one of the most common therapy used for pain management in older adults. This entails the use of drugs. I would use two or more drugs. Research has shown that a combination of two or more drugs may have complimentary or synergic effect with less risk of adverse reactions or toxicity than a higher dose of single drug (Monga and Grabois, 2002, pp. 102). I would use NSAIDS and antidepressants.
References
Albarran, J., and Tagney, J., 2008. Chest Pain: Advanced Assessment and Management Skills. Chichester, GBR: Wiley.
Carr, E., et al., 2009. Advancing Nursing Practice in Pain Management. Hoboken,NJ: Wiley-Blackwell.
D’Arcy, Y. M., 2009. How To Manage Pain in the Elderly. Indianapolis, IN: Sigma Theta Tau International.
Holstege, C., et al.m 2008. Visual Diagnosis in Emergency and Critical Care Medicine. Chichester: Wiley.
Jansen, M. P., 2008. Managing Pain the Older Adult. New York: Springer Publishing Company.
Koestler, A., and Myers, J. A., 2002, Understanding Chronic Pain. Jackson, MS: University Press of Mississippi.
Lynch, M.E., et al., 2010. Clinical Pain Management: A Practical Guide. Hoboken,NJ: Wiley-Blackwell.
Micheo, W., 2010. Muscokeletal, Sports and Occupational Medicine. New York, NY: Demos Medical Publishing.
Monga, T., and Grabois, M., 2002. Pain Management in Rehabilitation. New York: Demos Medical Publishing.
Norlander, L., 2008. To Comfort Always. Indianapolis, IN: Sigma Theta TAU International.
Parsons, G., and Preece, W., 2010. Principles of Managing Pain: A Guide for Nurses and Allied Health Professionals. Berkshire: McGraw-Hill Professional Publishing
Sheppard, M., 1991. Mental Health Work in the Community: Theory and Practice in Social Work and Community Psychiatric Nursing. London: Routledge
Twycross, A. et al., 2009. Managing Pain in Children: A Clinical Guide. Hoboken,NJ: Wiley-Blackwell.
Vercellini, P., 2011. Chronic Pelvic Pain. Hoboken,NJ: Wiley-Blackwell.
Winterowd, C. B., et al., 2000. Cognitive Therapy with Chronic Pain Patients. New York, NY: Springer Publishing Company.
Wright, B., 2007. Interpersonal Skills. Cumbria, GBR: M&K Update Ltd.
