The main objective of any health care system is to provide patient care with desirable patient outcomes. Simply put, a health care system strives to promote well-being and heath status of all human beings. It is also important to note that most aspects of the healthcare focus on prevention and management of pain among patients because freedom from pain is an essential dimension of health. Additionally, pain among patients is a multidimensional phenomenon that requires a broad, integrated and a comprehensive care model (Glare et al., 2014). Many studies that have been carried out by various scholars on health show that nurses play a key role in the provision of patient care services which among them is pain management. This is due to the fact that nurses spend most of their time with patients compared to other healthcare professionals. Therefore, nurses have greater role and responsibility of ensuring that patients under their care receive the best patient-centered care which is holistic in nature and that meets the needs of the patient. By so doing, nurses will achieve their core objective of providing care that improves the general well-being of the patients (National Council of State Boards of Nursing, 2015). For this capstone evidenced-based paper, using the inquiry skills that I have gained from the baccalaureate nursing program, I will seek to identify one clinical issue that we as nurses have the ability to provide a solution to or impact on it positively. Besides identifying the clinical issue, I will also seek to develop a plan that can address the identified issue effectively, clearly spelling out the roles of the nurse in the plan as well as roles of other interdisciplinary healthcare teams.
The clinical issue which I will focus on for this assignment is pain management among cancer patients. Among the four main categories of the National Council Licensure Examinations for Registered Nurses (NCLEX-RN) examination blueprint, the issue of pain management falls under the second category which is Health Promotion and Maintenance of Health. The four categories of NCLEX-RN are normally organized based on client needs in a variety of settings throughout their lifespan (National Council of State Boards of Nursing, 2015). Nursing practice is usually regulated by a number of licensing authorities within the jurisdictions of the National Council of State Boards of Nursing. NCLEX-RN is licensure examination developed by NCSBN and is used to measure the competencies of newly registered nurses to perform nursing duties safely and effectively. The NCLEX-RN exams ensure safety and protection of the public by ensuring that only candidates who meet the set requirements are licensed to practice as registered nurses. Moreover, the NCLEX-RN exams evaluate the abilities, knowledge, and skills critical for the entry-level nurses who are important in meeting the needs of patients such as promotion, maintenance and restoration of health (National Council of State Boards of Nursing, 2015). Generally, the practice of nursing is an integrated process that takes into consideration all the four categories of NCLEX-RN test plan client needs.
The clinical issue at hand which is pain management in cancer patients is directly and indirectly linked to Health Promotion and Maintenance, which falls under the second category in the NCLEX-RN examination blueprint. According to this blueprint, it is the role and duty of a nurse to provide and direct nursing care for clients that incorporate the understanding of expected growth and development principles. Such principles include early detection of health problems and prevention, as well as developing approaches and plans to achieve optimal health (National Council of State Boards of Nursing, 2015). Some of the aspects related to this NCLEX-RN blueprint includes but not limited to techniques of physical examination, health screening, developmental stages and transitions, self-care, health promotion and disease prevention. In relation to NCLEX-RN blueprint of Health Promotion and Maintenance, nurses have a duty of coming up with strategies that will help patients under their care achieve optimal health and better patient outcomes. Therefore, in caring for patients experiencing pain, nurses should ensure that they put into use the knowledge gained from NCLEX-RN category two concepts of health screening to determine pain levels of their patients so that they can effectively manage the pains and achieve improved patient outcomes and satisfaction.
Moreover, addressing pain being experienced by patients aligns with category two of NCLEX-RN examination blueprint of health promotion and well-being of patients which requires licensed nurses to provide unique and inclusive evaluation of health status of the patient that applies the principles of nursing process, ethics, health promotion and patient safety (National Council of State Boards of Nursing, 2015). After successfully carrying out the assessment, registered nurses are then required to develop and implement a precise plan of care that puts into consideration the relevant standards of care, the distinctive cultural and spiritual preferences of patients as well as legal requirements. Effective management of pain by nurses involves putting into use NCLEX examination concepts of nursing process which requires licensed nurses to assist clients to promote health, deal with health problems, adjust to or recover from the effects of an injury or illness as well as ensuring that the right to a dignified death is guaranteed (Silvestri, 2016). In relation to NCLEX category two examinations’ blueprint, pain management in cancer patients should focus on preventing the deterioration of the present health condition by using a care plan that alleviates pain. In this particular case, care providers caring for cancer patients undergoing treatment should strive to ensure that the patients achieve desirable outcomes which are reduced pain and suffering. By realizing the goal of pain reduction, nurses will have complied with the principles of nursing processes that requires them to promote health and patient safety.
Importance
One of the factors that have been associated with negative patient outcomes in most healthcare organizations is the pain issue. Poor management of pain in patient care is most likely to lead to physical and psychological problems. It is, therefore, imperative that pain management in patient care is handled well so as to achieve better patient outcomes and increased patient satisfaction (Hökkä, Kaakinen & Pölkki, 2014). Treatment and care for cancer patients in many oncology care settings is one of the most challenging aspects. Despite tremendous progress that has been made in cancer treatment and control, its prevalence still remains high and patients still have problems especially associated with pain management. This is due to myriad needs of cancer patients coupled with the problem of pains that compromise their well-being.
Patients in oncology care units are normally under strong treatment processes that subject them to a lot of pain which if not effectively alleviated can significantly affect their quality of life. The pain cancer patients go through can be attributed to a number of factors, one is due to the tumor growths which press on bones, fractures due to the extension of cancer to bodily bones, nerves and other body organs as well as pains due to side effects of chemotherapy. Therefore, it is evident that providing care to cancer patients is a complex process that requires a comprehensive care plan which not only focuses on treatment but a holistic approach that meets the patients’ needs and improves his/her quality of life (Glare et al., 2014). As a result, nurses caring for such patients should partner with other healthcare professionals and relevant stakeholders to design an appropriate care plan based on available evidence to help their patients achieve optimal care outcomes.
Most studies show that cancer patients suffering from intense pains also undergo physical and emotional problems that normally affect their daily activities and ways of life. Emotional problems associated with cancer pain include feelings of hopelessness, helplessness, isolation and nervousness (Hökkä, Kaakinen & Pölkki, 2014). From the above-described involvedness of cancer pain, it is evident that the problem of pain management among cancer patients is demanding. However, there is need to address the problem by putting in place measures that will help ease the pain since leaving it unresolved will lead to undesirable patient outcomes such as progression to chronic pain, opioids abuse, physical discomfort, distress, loss of bodily functioning, negative impact on the daily normal life activities of the patient such as sleep patterns, mental health problems such as nervousness, depression and anxiety, low self-esteem and social isolation.
Patient Population
Basically, patients seeking care in an oncology unit are affected by different types of pain. According to the American Cancer Society (2015), as of January 1, 2014, more than 14.5 million Americans were suffering from cancer. The society also projects that more than 1.5 million new cases of cancer were expected to be diagnosed by the end of 2015, with more than 0.5 million deaths due to cancer expected during the same period. This, therefore, means that with approximately more than 1000 deaths per day, cancer is ranked the second most cause of death in the United States, coming after heart disease which is the leading cause. Thus, in every 4 deaths in the U.S, one is most likely to be caused by cancer.
Moreover, cancer affects almost all people regardless of their socio-economic status, racial or ethnic background. However, there exist some disparities in cancer burden among different sections of the US population. Cancer prevalence varies among different groups of Americans defined by sex and sexual orientation, geographic location, race/ethnicity and socioeconomic status (American Cancer Society, 2015). Consequently, due to the nature of the diversity of human population affected by cancer, it is expected that cultural values will influence the success of the proposed solution of managing pain since patients from different cultural backgrounds have different views on the proposed care plan. This shall be addressed in detail under the barriers sub-topic of this paper.
Proposed solution
Several measures have been put forth to alleviate pains associated with cancer and its treatment, they include the use of pharmacological therapies such as the use of analgesics, medications and non-pharmacotherapy options such as patient education, cognitive therapy and physical therapies. However, due to the chronic nature of cancer pain, it requires a multi-modal approach in its management with emphasis on non-drug techniques due to undesirable side effects associated with traditional analgesics (Glare et al., 2014). I would, therefore, propose the use of massage therapy to relieve pain in cancer patients. The use of massage therapy has been shown to be more effective and does not have any side effects, unlike analgesics which are linked to vomiting and nausea in cancer patients (Smith & Saiki, 2015). Examples of massage therapies that have been established to relieve cancer pain are deep massage therapy, trigger point massage, Swedish massage therapy and aromatherapy.
In aromatherapy, some scented plants which are known to bring about relaxation and reduction of stress hence reducing pain are added in the massage process. Deep tissue massage employs the use of slower strokes around muscle grains with the aim of reducing deep-seated pains which are usually felt in connective tissues and deeper muscle layers. Moreover, deep back massage is known to be effective in reducing the side effects of cancer such as vomiting and nausea. Compared to analgesics, massage therapy is cheaper and do not pose the risk of addiction to painkillers (Lee et al., 2015). In addition, massage therapy seeks to address the root cause of pain hence leads to better patient outcomes and general body relief. While developing a care plan for massage therapy, nurses should factor in ethical considerations such as allowing the patient the freedom to choose his/her preferred massage therapy.
Goals
The main objective of the above-proposed intervention is to reduce pain in cancer patients (Smith & Saiki, 2015). The short term goal the intervention will seek to achieve is to alleviate the suffering of cancer patients by reducing pain and improving their quality of life. This short-term goal will be measured by interviewing and recording feedback from patients after undergoing a massage therapy. The short-term goal of the intervention will have been achieved if the patients’ feedback shows that they do not feel pain or its severity reduced after the massage therapy. On the other hand, the long-term goal of the intervention will be to trigger a paradigm shift from reliance on pharmacological therapies to massage therapies to manage pain in cancer patients. Attainment of this goal shall be measured by the number of cancer patients who seek massage therapy to relief pain as opposed to the use of traditional analgesics. For instance, if the number of cancer patients booking an appointment for massage therapy increases; this means the goal will have been attained. Moreover, the intervention will seek to create an improved nurse-patient relationship in the long-term, to a point where a patient can open up to the nurse and share all his/her medical challenges and how best he/she can be helped to address them.
Barriers
One of the potential barriers to the successful implementation of this intervention is cultural and religious beliefs of the patient population. An example is that of patients from the Muslim community whose religion does not allow the exposure of their body parts to people of opposite sex. Since massage therapy employs mostly body contact between the care provider and the patient, the plan should ensure that all the cultural and religious factors are included in the plan (Bauml et al., 2015). For this particular barrier, the solution will be employing female and male massage therapists to provide care for each of the genders. Another potential barrier to the success of proposed intervention is nurses’ attitudes and knowledge of non-pharmacological pain management. The success of the intervention will be determined by the willingness of nurses caring for cancer patients to implement it. This barrier can be addressed effectively by educating nurses on the importance of massage therapy and other non-pharmacological pain management techniques.
Benefits
One of the benefits of implementing massage therapy to cancer patients is the reduction of pain and better patient outcomes. Cancer patients will be able to enjoy a pain-free life without being subjected to the side effects of analgesic therapies such as nausea and vomiting. To the nursing profession, the benefit of implementing massage therapy plan is expanding their career choices. One may choose to specialize as massage therapist which compliments his/her nursing profession which in turn brings them closer to their patients. Furthermore, improved patient outcomes, as a result, the massage therapy technique will increase nurse’s job satisfaction.
Participants and Interdisciplinary Approach
Caring for cancer patients is a comprehensive process that involves various healthcare professionals. For the success of the above-proposed intervention of massage therapy to reduce pain, the contribution of the following participants is important: registered nurses, nurse informaticists, massage therapist, physiotherapists, a dietician and an oncology clinical nurse specialist (CNS). The clinical nurse specialist will act as the key professional in the multidisciplinary team and will use his/her experience and knowledge in the assessment process and pain alleviation among cancer patients (Henry, 2015). He/she will also act as an educator to the other participants, while the role of the dietician, on the other hand, will be to ensure a proper choice of food for the patients to avoid foods that might cause nausea after the massage therapy sessions. The massage therapists and physiotherapists will be assigned the task of performing pain relieving massages on the cancer patients and educating them on pain management (Bervoets et al., 2015). The nurse informaticists will ensure that the online medical records of the patients are maintained in a manner that is easy to retrieve whenever needed.
Conclusion
Conclusively, cancer patients undergo immense pain that affects their quality of life and well-being. Therefore, it is important that healthcare organizations come up with effective pain management techniques that will help them ease and cope with the pain. One such technique that studies have shown to be effective is massage therapy; the technique reduces pain in the cancer patient and has no adverse effects. The problem of cancer pain should be addressed because failure to address it might progress and become chronic hence affecting the quality of life for the affected patients.
References
American Cancer Society. (2015). Cancer Facts & Figures 2015. Retrieved from https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2015/cancer-facts-and-figures-2015.pdf
Bauml, J. M., Chokshi, S., Schapira, M. M., Im, E. O., Li, S. Q., Langer, C. J., & Mao, J. J. (2015). Do attitudes and beliefs regarding complementary and alternative medicine impact its use among patients with cancer? A cross‐sectional survey. Cancer, 121(14), 2431-2438.
Bervoets, D. C., Luijsterburg, P. A., Alessie, J. J., Buijs, M. J., & Verhagen, A. P. (2015). Massage therapy has short-term benefits for people with common musculoskeletal disorders compared to no treatment: a systematic review. Journal of physiotherapy, 61(3), 106-116.
Glare, P. A., Davies, P. S., Finlay, E., Gulati, A., Lemanne, D., Moryl, N., & Syrjala, K. L. (2014). Pain in cancer survivors. Journal of clinical oncology, 32(16), 1739-1747.
Henry, R. (2015). The role of the cancer specialist nurse | Nursing in Practice. Retrieved from http://www.nursinginpractice.com/article/role-cancer-specialist-nurse
Hökkä, M., Kaakinen, P., & Pölkki, T. (2014). A systematic review: non‐pharmacological interventions in treating pain in patients with advanced cancer. Journal of advanced nursing, 70(9), 1954-1969.
Lee, S. H., Kim, J. Y., Yeo, S., Kim, S. H., & Lim, S. (2015). Meta-analysis of massage therapy on cancer pain. Integrative cancer therapies, 14(4), 297-304.
National Council of State Boards of Nursing. (2015). NCLEX-RN® Test Plan. Retrieved from https://www.ncsbn.org/RN_Test_Plan_2016_Final.pdf
Silvestri, L. A. (2016). Saunders comprehensive review for the NCLEX-RN® examination. Elsevier Health Sciences.
Smith, T. J., & Saiki, C. B. (2015, October). Cancer pain management. InMayo Clinic Proceedings (Vol. 90, No. 10, pp. 1428-1439). Elsevier.
