How would you handle a patient who constantly complains of pain?

How would you handle a patient who constantly complains of pain?

LEARNING OUTCOMES:-

The Bachelor of Nursing (BN), Bachelor of Nursing (Enrolled Nurses with Diploma in Nursing) (BNENDN), Bachelor of Nursing (Mental Health) (BNMH) and Bachelor of Nursing/Bachelor of Business Administration (BNBADM) course are professional programs that require development of particular attributes for accreditation purposes. These are also included in the Learning Outcomes.

There are five (5) key themes that link all the content in the online modules ensuring students have a deeper understanding of the complexity of the issues addressed in each. These themes are:

  • leadership;
  • collaborative care;
  • evidence based practice;
  • transition to practice and;
  • information technology.

On successful completion of this unit students should be able to:

1. Distinguish the transformation in skill acquisition from novice to expert;

2. Analyse the major theoretical foundations of leadership and teamwork skills in nursing; (GA 4,7)

3. Explain clinical governance in relation to nursing practice;

4. Apply communication theory, conflict resolution and negotiation skills to challenging interactions and situations in nursing practice; (GA 9)

5. Assess and effectively utilise information technology within health care contexts;

6. Apply the skills and attitudes of self-directed, reflective learning in setting and meeting your current and future learning needs ;

7. Evaluate selected models of care in relation to the needs and safety of health care consumers across the lifespan;

8. Synthesise evidence to support proposals for innovation and change to enhance service delivery and improve health outcomes; (GA 8)

9. Debate the legal and ethical implications of advocacy in professional nursing practice. (GA 3).

Solution

How would you handle a patient who constantly complains of pain?

How would you handle a patient who constantly complains of pain?

As a registered nurse practitioner, the foremost objective is to ensure maximum recovery of a patient in the perioperative environment. Pain management is one of the crucial elements that must be observed to help the patient feel better than in their previous condition(Colvin & Fallon, 2012). During my practice at Holy Spirit Northside Private Hospital, I was tasked with handling post-surgical total knee replacement. Within this scenario, I was able to manage a patient who complained of pain after a total knee replacement. This paper will utilize the 5R’s of reflection to analyze my experience at the facility in regards to my interview question.  

Pain Protocol

Satisfactory pain management after total knee replacement (total knee arthroplasty) is imperative in expediting patients develop mobility and range of motion after surgery. Wadsworth (2012) credits Jean Watson analogy that caring is the core goal of nursing and as such a nurse is obliged to be compassionate, patient, and caring towards the patient. Therefore, nurses would always offer the best of treatment to ensure the best patient outcomes(Bain, 2002). The International Association for the Study of Pain(IASP) defines pain as an emotional and unpleasant sensory experience associated with physical tissue damage which can cause an uncomfortable phenomenon to a patient (Moayedi & Davis, 2013). Also, it is important to note that pain management is critical in shaping the daily activities of individuals

First, it is necessary for a registered nurse to understand that different patients have a different degree of pain as well as they can interpret pain differently(Santana, 2014). With this analogy in mind, a thorough assessment of the criticality of pain will be administered to the patient so that both the physician and the nurse can come up with specific pain management goal. Regarding an experience at the recovery room at Holy Spirit Northside Private Hospital, the patient had chronic pain, and the physician administered a pre-operative pain modifying agent, Pregabalin because the patient had to be relieved of pain. Arguably, the use of pre-operative pain modifying agents is not recommended at the peri-operative stage. Furthermore, just after the surgical operation, the use of novocaine will come in handy to relieve patient’s pain in the first few hours immediately after the operation(Grosu, Lavand’homme, & Thienpont, 2014).  

Research suggests that depression is a contributing factor which needs to be addressed in patients who complain of constant pains in that pain tolerance is significantly reduced in cases where patients are depressed (Li, 2015). Arguably, depressed individuals tend to find it hard to be relieved of pain. As such, for better pain relief after a TKR surgical operation, the patient has to undergo appropriate psychotherapy that cognitively alters the perceptions of pain, For example, RNs must shift patient’s focus on the achievement of function rather than the pain. This can be done by the use of cognitive-behavioral therapy(CBT) focused on changing the cognitions of pain on the side of the client. Evidently, during my practice, I used my skills of compassion to help change the patient’s perception of pain.  

Morever, Artz et al. (2015) suggest that physiotherapeutic exercise is closely associated with in managing pain after total knee replacement surgery, even though it has a minor impact on reducing pain after TKR. Consequently, Huber, de Bie, Roos, & Bischoff-Ferrari (2013) suggests that general fitness is important for pain relief after a TKR surgical operation. Therefore, the patient must be able to fit body-wise to escalate quick recovery. As such, RNs are advised that patients should not just stay on their beds, but they must exercise their body to trigger quick recovery on the affected area of the body. During my practice, the patient I was able to conduct basic exercises with the client that later enabled patient’s pain relief in the affected area.    

Furthermore, adequate iron stores in the body come in handy for surgery(Petersen et al., 2014). Notably, it is recommended that a patient must have a specific dietary intake before and after surgery.  As such, it is the duty of the nurse practitioner to observe the dietary intake as a pre-operative measure in managing pain after TKR. In my case, the patient had to undertake a diet that is rich in irons. Having adequate iron stores decreases the risk of transfusion escalated by infections. Also, the presence of anemia and levels of iron should be assessed pre-operatively in patients who have undergone a TKR surgery by the use Dr. Holt’s GP to measure the iron levels. Also, there are other pre-operative measures such as post-medication, primarily used by anesthetists to trigger sedation that relieves a patient of nervousness. These drugs include morphine, hydromorphone, and pethidine.  

Conclusion

Pain management is imperative in case of post-TKR surgical operations. Even though, it is needed of RNs to monitor a patient in the perioperative environment actively. My philosophy lies with the Jean Watson analogy of caring as well as the use of the biopsychosocial model in the treatment of pain. These models are helpful to offer maximum recovery from pain. The biopsychosocial model of pain entails that the psychological, physiological and social elements surrounding the client must be assessed to help in pain relief(Wijma, van Wilgen, Meeus, & Nijs, 2016). When coupled with the compassionate, patient and caring nature as stipulated by Jean Watson, patients can receive the best out of the RNs.

References

Artz, N., Elvers, K. T., Lowe, C. M., Sackley, C., Jepson, P., & Beswick, A. D. (2015). Effectiveness of physiotherapy exercise following total knee replacement: systematic review and meta-analysis. BMC Musculoskeletal Disorders, 16, 15. https://doi.org/10.1186/s12891-015-0469-6

Bain, J. D. (2002). Reflecting on practice : student teachers’ perspectives. Post Pressed. Retrieved from https://books.google.co.uk/books/about/Reflecting_on_Practice.html?id=1pGiAAAACAAJ

Colvin, L., & Fallon, M. (2012). ABC of pain. John Wiley & amp. Retrieved from https://books.google.co.uk/books?id=qSJV66nd8HkC&printsec=frontcover&dq=ABC+of+Pain&hl=en&sa=X&ved=0ahUKEwiZr9nX-NvSAhVmBsAKHeAvCZcQ6AEIIDAB#v=onepage&q=ABC of Pain&f=false

Grosu, I., Lavand’homme, P., & Thienpont, E. (2014). Pain after knee arthroplasty: An unresolved issue. Knee Surgery, Sports Traumatology, Arthroscopy. https://doi.org/10.1007/s00167-013-2750-2

Huber, E. O., de Bie, R. A., Roos, E. M., & Bischoff-Ferrari, H. A. (2013). Effect of pre-operative neuromuscular training on functional outcome after total knee replacement: a randomized-controlled trial. BMC Musculoskeletal Disorders, 14, 157. https://doi.org/10.1186/1471-2474-14-157

Li, J. X. (2015). Pain and depression comorbidity: A preclinical perspective. Behavioural Brain Research. https://doi.org/10.1016/j.bbr.2014.04.042

Moayedi, M., & Davis, K. D. (2013). Theories of pain: from specificity to gate control. Journal of Neurophysiology, 109(1), 5–12. https://doi.org/10.1152/jn.00457.2012

Petersen, W., Rembitzki, I. V., Brüggemann, G.-P., Ellermann, A., Best, R., Koppenburg, A. G.-, & Liebau, C. (2014). Anterior knee pain after total knee arthroplasty: a narrative review. International Orthopaedics, 38(2), 319–28. https://doi.org/10.1007/s00264-013-2081-4

Santana, L. (2014). Pathophysiology of pain. In Essentials of Pediatric Anesthesiology (pp. 213–229). https://doi.org/10.1007/9781107375338

Wadsworth, A. M. (2012). Theory-Based Exemplar of Jean Watson ’ s Theory of Caring. International Journal for Human Caring, 16(1), 64–68.

Wijma, A., van Wilgen, C., Meeus, M., & Nijs, J. (2016). Clinical biopsychosocial physiotherapy assessment of patients with chronic pain The first step in pain neuroscience education. Physiotherapy Theory and Practice, 32(5), 368–384. https://doi.org/10.1080/09593985.2016.1194651

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