Pain Management Article Critique (Article Critique Sample)

Pain Management
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Pain Management
Introduction
More often than not, postoperative or terminally ill patients experience pain that remains untreated or is poorly managed. One of the reasons for this is that healthcare workers lack the necessary skills and knowledge to assess and manage pain. The aim of this paper is to discuss how to improve the management of pain and answer the question: In adult patients younger than 45 years old with chronic pain, does pain education assist in pain management as compared to internal medicine?
Discussion
The article “Patient Satisfaction and Pain Management: An Educational Approach” by Jennifer I., Nancy B., Patricia P., Valerie Z. & Lorraine C. (2004) best supports the nurse’s intervention in pain management in hospitals and healthcare facilities. The project is a quality improvement carried out in a medicine unit at an urban teaching and referral hospital, which examined the impact of pain education on the satisfaction of patients with pain management. Low quality pain management is associated with impairment in health, reduced patient satisfaction, decreased quality of life, and increased cost of healthcare. Despite the fact that pain scores did not improve, tremendous improvements were made with respect to patients’ satisfaction, patient’s assessment and nursing skills and knowledge. Patients with untreated pain stay in hospital longer, visit the outpatient unit more frequently and have higher rates of readmission. Untreated pain increases stress levels, interferes with immune functions, and delays healing. All these factors result in increased cost of healthcare and decrease of patients’ satisfaction.
Benefits of pain management include lessening of patients’ pain, quick postoperative recovery, better quality of sleep, mobility, and patient satisfaction. All these result in a reduced number of readmissions, short stays in hospitals, and improved quality of live. The reason why patients have poorly managed pain is that healthcare workers often lack knowledge and skills to assess and manage pain. The lack of pain assessment is the most common barrier to pain management whereby clinicians fail to ask whether the pain is present. For better management of pain, healthcare providers must ask patients to describe their pain experiences.
This study was performed in an internal medical unit in a teaching hospital in Canada. The project was carried out to examine pain management as an indicator in achieving excellent patient outcomes. The hospital’s pain-related patient outcomes were studied, and an intervention tool was developed to improve the outcomes. The core goals of this project were to increase patient satisfaction regarding how well the pain was managed, enhance the skills and knowledge of nurses in pain assessment and management, and improve nursing documentation of patients pain.
The study of intervention was done through three processes:
Survey of patients to measure their satisfaction with pain management.
Survey of nurses to measure their knowledge and skills in pain management
Auditing of charts to measure documentation of pain assessment by nurses.
Nurses were then taken through pain education. The satisfaction of patients increased by 20%, the rate of nursing knowledge and skills went up by 12%, while the score on nursing documentation increased by 48%. The lack of accountability is a major barrier to appropriate pain management, and clinicians should be held accountable for pain assessment and management through chart auditing and reviewing of critical incidents.
According to Joanne and Susan (2009) in their article “Evidence-Based Pain Management: Analyzing the Practice Environment and Clinical Expertise”, evidence-based practice (EBP) allows for appropriate, safe, and effective patient care. Evidence-based pain management is among the first quality guidelines of health research introduced to the practice community in the early 1990s.
The guidelines of EBPM (evidence-based pain management) require rigorous initial and frequent further assessment using reliable and efficient tools, interventions based on the assessment, and further interventions grounded on the reassessment. Evaluation of EBPM compliance is done through a review of nursing documentation. Evaluation of pain management documentation allows for close monitoring of interventions developed to promote evidence-based pain management. This research tried to bring out the effects of nurses’ practice environment perception and expertise on the implementation of EBPM. These effects were evaluated using a sample of theatre nurses from three units of two teaching hospitals.
The data analyzed from this project showed that the clinical expertise of nurses contributed 4.4% of the variance to the quality pain management documentation, while the practice environment perception made no contribution at all. Expertise had negative consequences such that greater clinical expertise lowered the quality of PMD. The reason for this is that experienced nurses depended on their experience and knowledge when managing and documenting pain. Experts have also found that it is more difficult to incorporate new knowledge, such as pain management guidelines, into the practice of experienced nurses than their less experienced counterparts.
Challenges consistently identified by nurses include time management pressure of a busy unit, pain management practices of healthcare provider, and variables related to patients. All these factors contribute to pain management and can affect the adoption of EBPM.
The findings of this research article support the findings of the research article “Patient and Pain Management: An Educational Approach” whereby the quality of pain management is influenced by the skills and knowledge of nurses in assessment and management of pain.
Another study done by Kevin and Gloria (2012) explored the perceptions of nurses on barriers and facilitators to the effective pain management for terminally ill persons in an acute care rural setting. Their article “Pain Management in Persons who are terminally ill in Rural Acute Care” showed that the major barriers include the lack of knowledge and skills, limited time, themes of being judgmental, and fears. Facilitators of effective pain management include education, individualized care, and use of specialized services. This study was carried out to answer the question on what the nurses caring for terminally ill patients perceive as barriers and their recommendations to optimal pain management.
The nurses were strongly convinced that ineffective pain management was partly caused by the lack of knowledge and misconceptions on the parts of healthcare providers, patients, and their families. Nurses also cited time as a barrier. Fears, addiction, and other common misconceptions have been highlighted in other studies.
This research found that ineffective pain management in healthcare setups was mostly caused by the lack of knowledge and misconceptions. The findings support the first research article since pain education will impart the necessary knowledge and demystify the misconceptions.
In their article “Pain Management in Advanced Illness and Comorbid Substance Use Disorder”, Walsh and Broglie (2010) provided assessment and treatment plans for safe pain management in people with life-limiting illnesses and those with substance use disorder (SUD). Pain is a common undertreated symptom faced by people with terminal illnesses and those with SUD. The article brings out a case of a patient with advanced disease, pain, and Comorbid SUD who was attended by palliative care team in a home care setting.
Assessment of pain should include determining the location of pain, onset, duration, severity, relieving aggregating factors, symptoms, and adverse effects of medication used for treatment. The patient should also be assessed for the previous pain management treatments and their untoward effects. Nurses should take history of alcohol or substance abuse, which will help the clinician determine the amount of doses for pain medication depending on tolerance. Comorbid psychiatric conditions that could contribute to excessive drug taking behavior should also be assessed and treated to enhance pain management treatment strategies. Family and friends account for a higher percentage of non-medical analgesic drug use; as a result, it is important to assess the safety of the home environment.
The case study in the article revealed how the patient’s pain was mismanaged. It also gave the general guidelines of how such patients should be treated. The general findings call for a need of pain education, and this concurs with the findings of the first research article above.
The last article is a study entitled “Road to Excellence in Pain Management: Research, Outcomes and Direction (ROAD)“done by Vega-Stromberg, et al. (2002); it describes an interdisciplinary plan for improvement of processes within a health care system. Quality pain management is an important patient care, which is a mandate of many health care organizations. There is still room for improvement of management of pain across all health care sites.
Data from recent studies show that pain of all types in all age groups is undertreated; thus, the effective pharmacologic and non-pharmacologic treatments should be taken into account. In this study, an approach to pain management based on outcome resulted in four clinical indicators to be evaluated across care sites. These indicators include long-term care, acute care as well as home and ambulatory care. Plans for improvement of pain management focused on accountability of staff, visibility, education, and patient rights.
An outcome-based pa...