Thursday, February 7, 2013

Assessment and Therapeutics in Healthcare



Running Head: Assessment and Therapeutics in Healthcare


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.