Health care disorders contribute to severe distress of various degrees among patients. Especially, a pain developed while suffering from a disorder or condition could induce severe concerns. Apart from this, it is essential to realize that one should experience some kind of pain at some stage in life.
Problem: There are some failures among nurses and other health care professionals in measuring and responding to the patient’s pain.
Background: The area of precise pain management has become understudied in terms of its control, treatment, assessment and evaluation of harmful effects. So, pain management continues to present several challenges and has become a main focus of today’s health research.
Purpose: The purpose of the study is to identify the strategies followed by the nurse/ health care professionals in various care settings in addressing the pain issues confronted by the patients with various health ailments.
Question: Is there a sufficient identification of factors contributing to pain in patients and its poor assessment?
Variables: The variables in the description appear to be length of hospital stay, Nurses' knowledge and attitudes.
Statement of significance: The association between information dissemination about pain management and patients’ continued pain suffering appears significantly high. Likewise, significant differences in nurse’ knowledge and attitudes on pain management are also apparent.
Briefly, a pain could be a) chronic pain that occurs in a continuous fashion and is classified into cancer-associated pain and nonmalignant pain such as peripheral neuropathy, low-back pain and arthritis. b) Acute pain is most probably a postoperative pain. It reduces when a healing occurs. Evidence mentions that nearly 80 percent of patients encounter pain following an post-operative procedure. Here, a 20% of people suffer from severe pain. Although, there is access to analgesics and standard guidelines to control pain, postoperative pain remained unchanged since the past few years. As a result, acute pain linked with diagnostic and surgical procedures surgical has become a common occurrence in health care settings and for many years this area is not attaining any progress for many patients in terms of management. So, the present description is concerned with carrying out a literature review and writes a mini proposal.
a) Assessing and measuring the pain intensity among patients and
b) Evaluating the pain management procedures followed by nurses. The conditions experienced by patients also appear to vary from one study to the other.
For instance
Hovind et al. (2013) mentions that the breast cancer patients experience pain because of short hospital stay periods. As a result, such patients need to take care of their own pain.
Whereas others mention that the subjective well-being of amputees (amputated patients) is associated with the effect of amputation and phantom pain (Bosmans et al., 2007).
Pubtillo et al (2003) reports that pain in patients admitted in emergency departments (ED) is high because of discordance between patients' and nurses' pain assessment. So, all these three studies have different rationales but all leading to pain suffering among patients.
Both authors Hovind et al. (2013) and (Bosmans et al., 2007) have used qualitative study design where as Pubtillo et al (2003) depends on quantitative time study.
The purposes of these studies appear slightly similar to certain extent.
Hovind et al (2013) aim to
a) Acquire an awareness of how women perceive pain and pain treatment following THEIR breast cancer surgery and
b) Recognize pain management areas believed by patients that need improvement.
Bosmans et al. (2007) intends to determine the effect of an amputation and of phantom pain on the amputees in the context of the subjective well-being.
Likewise the study of Pubtillo et al (2003) aims at determining the efficiency of nurse assessment of their patient’s pain. Say, the patient’s pain rating in response to a nurse care of pain.
The methods followed by these studies are similar but with minor differences.
Say the study of Hovind relied on in-depth interviews where as Bosmans’s is a semi- structured interview. The study of Puntillo is not an interview or questionnaire but it relies providing self –answers on rating scale.
The sample size and the instruments/ tools used the studies appears different. Say, Hovind’ study recruited 8 women patients, Bosmans – 16 patients and Puntillo – has 15 patients. Both Hovind and Puntillo have used an itemized scale but Bosman relied on two novel socio-medical models, 'The Disablement Process model' and the 'Social Production Function theory', was used. The characteristics of the patients in these studies are also different.
So, the data collection in all these studies appears to depend on interviews and rating scales.
The observation differed to much extent in terms of information about pain, influence of factors and patient ratings.
Say, in Hovind’s study that pain among the interviewees (patients) was not present, as expected previously. The women did not recall any situations where they received pain related information. The women who took medications were little skeptical but they did not receive any explanation on chronic pain assistance. They began to work outside the home actively.
Bosmans study’s observation is that certain factors appear to support the patient’s well being. The factors are patients' clinical history, their daily activities, the social help they received, their phantom sensations and phantom pain, and the impact of an amputation and phantom pain on behavior for a prolonged period.
On the other hand in Puntilo’s study, the observation involved an average pain intensity score of patients. The triage nurses’ rating score was lower p <.001. But in the clinical settings, patients’ score was much above than the nurses’ at p <.001.
Hovind's study infers that following a low hospitalization period, sufficient data and follow-up after discharge could enhance pain management schedule. Individuals who contract chronic pain must obtain further information and assistance for their pain management.
Puntilo’s study infers that pain intensity score differences between nurses' and patients' rely on the main complaints from the patient. People in health care settings underestimate a patients’ pain. This could continue to yield negative results unless a proper treatment is provided.
There is a need to reduce patient-nurse discrepancies in pain intensity ratings through appropriate evaluations and agreeing with the patient’s self report. The final outcome of such practice would help in enhancing pain management in the Emergency Department.
Bosmans’s study infers that the factors would influence the subjective well-being if there is an involvement of one or more factors. Replacing some activities with others could facilitates a lower sense of subjective well-being. Hence, all essential factors appear necessary in influencing the pain management in amputees.
Next the studies of Pizzi, Chelly and Marlin (2014) and Rahimi-Madiseh, Tavakol, and Dennick (2010) appear to focus on solely evaluating the nurse’ attitudes about pain management in various settings. These are different from other studies that have emphasized on patients attitudes in association with nurse’s activity in pain management.
However, the purpose of Pizzi and Rahimi is different. Pizzi’s study is to analyze the time required for completing the needed steps associated with the administration of PRN oral analgesics. Rahimi’s study is intended to determine the existing knowledge and attitudes of
nursing students about pain.
The methods in Pizzi’s study rely on latest technology while that of Rahimi’s is a conventional method. Say, Pizzi’s study employed a personal digital assistant (PDA) to note the time required of completing the steps related to pain drug administration. Rahimi’s study relies on employing a
reliable questionnaire 'Knowledge and Attitudes Regarding Pain Tool (KARPT)'.
The sample size in Pizzi’s study involved 28 nurses from 28 nursing shifts where as Rahimi’s study involved 205 nursing students. Measurements in Pizzi’s study involved the time measurement using PDA while that in Rahimi’s involved the measurement of attitude and knowledge using KARPT. In both these studies that data was collected using the PDA and KARPT, respectively. The observations in these two studies are from different view-points.
These are a) Time and b) Knowedge
differed to much extent.
In Pizzi’ study, that a time of 10.9 (mean) is needed to administer PRN oral analgesics in their center. In Rahimi’s study, the team observed inadequate or poor knowledge associated with pain and it managing efficiency.
The study of Pizzi infers that nurses prompt behavior in responding to the administration of oral analgesics could determine pain management. Such time saving attitude appears to form a strong basis for evaluating another phase, PCA drug administration.
In contrast, the study of Rahimi infers that undergraduate nursing education programs must strive to improve the knowledge of pain and its management. Such practice could help in providing optimum care delivery to the patients from nurses.
On the whole, the studies described here appear to possess a unique in their purpose, rationale, methods, observations and inferences. Especially, the pain rating scales, attititude measurement scaled adopted in studies appear show a difference in their structure and mode of out that would be generated with their application. However, despite a moderate to large differences, the ultimate goal of the studies is to contribute to improved pain management service and patient quality of life.
References
Bosmans, J. C., Suurmeijer, T. P., Hulsink, M., Schans, C. P., Geertzen, J. H., &Dijkstra, P. U.
(2007). Amputation, phantom pain and subjective well-being: a qualitative study
Int J Rehabil Res, 30(1),1-8.
Hovind, I., Bredal, I., & Dihle, A. (2013).Women's experience of acute and chronic pain following breast cancer surgery. Journal of Clinical Nursing, 22(7/8), 1044-1052.
Pizzi, L., Chelly, J., & Marlin, V. (2014).Nursing Time Study for the Administration of a PRN
Oral Analgesic on an Orthopedic Postoperative Unit. Pain Management Nursing, 15(3),
603-608.
Puntillo, K., Neighbor, M., O'Neil, N. &Nixon, R. Accuracy of emergency nurses in assessment
of patients' pain. Pain Manag Nurs, 4(4), 171-5
Rahimi-Madiseh, M., Tavakol, M., &Dennick, R. (2010). A quantitative study of Iranian nursing
