Running Head: Assessment
and Therapeutics in Healthcare
Introduction
Following a surgical operation there
is a significant phenomenon of pain exhibited by the patient that needs close
monitoring to assist the patient to relax, heal and assume normal duties fast. Surgical
operations involve remarkable damages to the skin, manipulation of body
structures and the neuropathic pains. This procedure of incision and tissue
damage also affects the sensory neurons of the body eliciting an unpleasant
feeling. This emotional and sensory feeling due to the damage of body tissues
is called pain Perkins C (2008). The post operative pain differs in degree
depending on the availability of other sources of pain that may include
inflammation and pressure to an existing wound among others. Even though these
surgical procedures occur under the influence of analgesia, pain arises when
the effect of analgesia subsides. The intensity of pain is only known by the
patient and using a Numeric Rating Scale (NRS) nurses and caregivers can assess
and manage pain effectively.
Importance
of Pain Management
Pain is part of the hard experiences
that patients have to go through after surgery and if not well assessed and
managed, has significant implications to the patient. Post operative pain has
been used by doctors and nurses to establish complications arising from the
operation even though the operation was done under the influence of analgesia. Higuchi and Donald (2002) noted that pain assessment
is done through verbal communication with the patient and using the Numeric
Rating Scale; the nurse establishes the level of pain and decides on the
intervention method.
Post operative pain control is
important as it relaxes the patient and thus focuses on the healing of the wounds
and assuming normal duties as quickly as possible. This reduces the time the
patient takes in hospital. The preoperative anxiety due to the fear of the
outcome and its subsequent physiological and psychological implications may
have lowered the immunity thus relaxation sets back the patient to the healing
process. When a patient is in pain, the psychological
torture of the patient may increase the effects of the underlying disease thus
healing process is delayed.
Uncontrolled
pain
Sloman, Rosen, Rom and Shir (2005),
noted that pain reduces the level of immunity of the patient and promotes lack
of concentration. Patients with increased levels of post operative pain and
anxiety have shown to have a reduced interest in taking simple duties thus Josie
Elliot is likely to take
a long time to heal the wounds. The anxiety and the pain will suppress most of
Josie’s normal physiological processes like hormone production and increase
psychological attention thus prolongs the healing process.
Uncontrolled pain also causes stress
which has proved disastrous in patients that may be suffering from diabetes as
the stress response in the sugar conversion is overwhelming to the patient and
may cause death. Sloman et al (2005)
Making
a clinical judgement
Polit and Beck (2004) stated
that clinical judgement
involve nurses and other care givers making observations related to the
patient’s needs and health problems and make decisions to act and modify
responses in relation to the patients mode of response. This process is complex
and requires the deliberation of the nurse to reflect on what the patient
requires so that the intervention programme will attend effectively to the patient.
The four major phases involved include
Noticing
On several occasions, nurses have experience
in dealing with post operative pains and are thus able to ascertain the
patterns of behavior by observing. The first stage in the clinical judgement
process involves the nurse realizing a change in the patient’s pattern and
response resulting from the experience before hand in the management of other
patients who have had similar operations or based on their knowledge of similar
patients. Oshodi (2007). Josie Elliot’s
changing pattern of behavior and response can be realized from his initial
behavior and signs. In this regard if the nurse understands and was in previous
contact with Josie and other patients after a similar operation, it will be
easier to determine the level of pain experienced by Josie. This noticing and
observation of Josie pain behavior is important as it will help the nurse in
reasoning out the appropriate action to take given the underlying changes and
behavior.
Interpreting
Following the noticing of the
patient’s changes, the nurse develops a mind set pattern of dealing with the
situation. This is the understanding and interpretation phase in which the
nurse integrates what is being observed and develops a hypothetical approach in
attending to the patient or deduces from the observations the best clinical
step to deal with the patient. Fearon et
al 2005. With the Josie’s observable pattern of reaction to the pain, the
nurse through the verbal engagement to ascertain the level of pain makes it
easier to understand and either interprets it as seen or relates to other
situations before hand and formulates the best intervention approach to manage
Josie’s pain. It is through the reaction and actions of Josie to the method of
intervention given by the nurse that will determine the continuity and
improvement of the methods at hand to help in total pain management.
Reflection
During the intervention process to the
patient in the management of pain, the nurse through the course of action being
applied attends to the responses given to the nurse by the patient. The nurse
will observe Josie to determine the pain indicators and decide on the best
method to assist in the pain management and by so doing develop an action plan
of dealing with the behavior pattern. During the course of action, the nurse
will observe the responses of Josie to the intervention plan of the nurse and
this will also help the nurse develop further actions to fully assist Josie in
the post recovery. Reflection in the context of Josie, will assist the nurse
learn the clinical out comes of the intervention and in so doing make comparisons
with previous interventions thus giving Josie the best pain management
strategy.
Reviewing
The process of clinical judgement by
the nurse is determined by various observations made in relation to the
patient’s response to the pain. The process involve the noticing of the
patients reactions in the case of pain and this grasping of the pain pattern
helps in responding to it through the various actions by the nurse. Reviewing
involves the nurse reflecting on the intervention method at hand and how that
patient responded to it. During the process of managing pain in Josie, the
nurse will observe the changing behavior due to underlying pain and decide on
how to help Josie. By so doing, the nurse will realize the effective method of
intervention in dealing with such pains and the additional programmes that can
help in the pain management.
Progress
notes in pain management
The patient is monitored at all times while in
the health facility to determine the progress and the effectiveness of the
intervention method at hand. This is done through creating a medical record
reflecting the patient’s progress. Josie’s pain management and response can be
noted down in form of progress notes. Scott A. (2004). In this progress notes,
the timing of the intervention is determined and exact action noted. Josie’s
progress notes may be problem oriented where the nurse involves Josie in verbal
communication regarding the level of pain where Josie determines the level by a
value from the Numeric Rating Scale (example. I have a pain of 9 out of 10), Subjective
data based on what the Josie says, Objective data based on what the nurse
observes (Noticing by looking at the behavior of Josie), Assessment data based
on conclusion (Interprets) and Plan of intervention (reflecting) and determine the
effectiveness of the Intervention (Reviewing). This can be shown in the SOAPIER
format as in the table below.
Progress Notes
|
09:30: S: “I have a lot of pain to level 9
out of 10”
|
O: Patient sitting down
grimacing and holding a knee joint
|
A: Joint pain
|
P: Give medication for the
pain
|
I: Medicated with
Magnesium Salicylate
|
E: Patient pain relieved
from scale 9 to 2
|
R: Continue with
medication
|
Conclusion
There is need for the introduction of
pain intervention and management in patients suffering from post operative
pain. The clinical nurse should be careful in the observations and
determination of the patients pain requirements and follow the best practices in
the intervention procedures otherwise if pain is left untreated it could be the
major cause of poor response to treatment and healing of wounds.
References
Fearon KCH, Ljungqvist O, Von Meyenfeldt M et al (2005)
Enhanced recovery after surgery: a consensus
review of clinical care for patients undergoing colonic resection. Clin Nutr 24(3):
466–77
Higuchi, K.A.S., & Donald, J.G. (2002). Thinking processes
used by nurses in clinical decision making.
Journal of Nursing Education, 41, 145-153.
Oshodi TO (2007) The impact of preoperative
education on postoperative pain. Part 1. Br J Nurs 16(12): 706–10
Perkins C (2008) what are the experiences of patients
waking from fast track. British Journal of Cardiac
Nursing 3(8): 373–81
Polit DF, Beck CT (2004) Nursing
Research: Principles and Methods. 7th edn. Lippincott Williams & Wilkins, Philadelphia, PA, USA
Scott A. (2004): Managing anxiety in ICU patients: the
role of preoperative information provision. Nurs
Crit Care. 2004;9(2):72-79.
Sloman, R., Rosen, G., Rom, M., Shir, Y., 2005. Nurses’
assessment of pain in surgical patients.
Journal of Advanced Nursing 52, 125–132.
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