Project Report on Nurses Role in Pain Management
Introduction
Pain after surgery is distressing to patients and it is an issue of concern for nurses working in PACU. Ineffective pain management during the immediate postoperative period can prolong patients stay in the PACU especially if the necessary measures are not implemented.. Nurses in PACU have a responsibility to continuously assess and give proper pain treatment to the patient (Tedore, 2015).
During my placement, I noted that nurses play an important role in management of pain during the postoperative period. Therefore they should be equipped with the proper skills and knowledge to be able to provide the best pain management. Furthermore, I realized that, despite the availability of guidelines and variety of tools for pain management, post-operative management of pain is still a challenge (Abrahamson, Fox & Doebbeling, 2012).
Moreover, increased knowledge on pharmacological and non-pharmacological pain management results in better patient outcomes. Also, these nurses should be given ample time to be able to follow the pain management guidelines to ensure proper pain management. My report aims at analyzing from the relevant peer reviewed articles on nurses’ role in management of post-operative pain and nursing issues relating to management of pain during postoperative period putting my experience in the unit into consideration.
Literature Review
Tedore, 2015 conducted a research and found out that proper management of post-operative pain benefits patients in a number of ways. Mostly it contributes to better patient comfort which is key, less cardiac complications and reduced risk of development of deep vein thrombosis and finally the patient recovers within a short period of time.
According to Wilding, Manias & McCoy, 2012 research article, it explained that that improper management of pain is majorly contributed by nurses. The factors that contribute to this include poor assessment of pain, reduced knowledge and skills on pain management, fear of side effects associated with pain management, (Wilding et al. 2012).The research conducted by (Wilding et al., 2002) explored the contributing factors to increased pain during discharge of patients from PACU.
Use of pharmacological and non-pharmacologic therapies in pain management is highlighted in an article by Joshi, Schug & Kehlet , 2014.The article outlined that morphine was mainstay for pain management in PACU. It further suggests the use of the WHO recommended ladder, starting from mild non opioids including acetaminophen and NSAIDs to strong opioids such as morphine which can be used according to severity of the pain score.
None the less, use of ice packs, distraction by use of music and positioning are some of the non-pharmacological therapies. A study was done in PACU and the findings were that use of non- pharmacological therapies together with analgesics yielded better outcomes in pain management(Joshi, Schug & Kehlet, 2014). However, the outcomes varied depending on the type of surgery performed .
According to Ramnytz, Wells & Fleming 2015, the PACU nurse has a role in assessing the associated side effects of the pharmacological agent administered. Relieving pain is the major goal of postoperative pain management and ensuring that minimal side effects results. Opioids are the mainstay of pain therapy.
However they are associated with unwanted effects such as respiratory depression, hypotension and reduced bowel movement (Ramnytz et al., 2015). In PACU, a pulse oximetry is the best tool that can be used to monitor respiratory depression during administration of opioids. However, the best method of monitoring respiratory depression is through observation of the respiratory pattern and the patient’s level of consciousness.
Methodology
During my placement in the Post Anesthetic Care Unit, I interacted and engaged the nurses in discussions pertaining their role in pain management with observations being the key technique.
Discussions
Postoperative nurses have a responsibility in assessment of pain. They should assess paints level of pain using the most effective tool to have the best outcomes. The 10 pain assessment scale is most preferred tool. However, it is important to incorporate both the subjective and objective information to be in a position to determine the most appropriate therapy for pain.
There should be continued documentation of the progress of the patient so as to determine the effectiveness of the therapy and there will be any alteration. The nurse should as well note the source and severity. In the event there is no relationship between the site and severity of pain, it will warrant investigations to determine if there is any related pathology.
Cultural background as well as anxiety is some of the patient factors determine the management of pain therefore the nurse has a responsibility of assessing them and determine if they have an effect on the patient perception. Therefore, these nurses have a role in establishing these factors.
Reflecting my placement in PACU, I appreciated that the hospital has a protocol for management of pain after surgery. For moderate pain, no opioids drugs were used while for severe pain, strong opioids were utilized. I also appreciated use of non-pharmacological therapies in pain management. Use of both pharmacological and non-pharmacological therapies increases efficiency (Ramnytz, Wells & Fleming ,2015). Non pharmacological therapies that were utilized included ice packs, music therapy and in deed they were found to be effective.
Literature suggests use of different pharmacological agent in management of pain. Similarly, during my placement, I identified those agents being utilized. For severe pain , opioids were being used while for moderate and mild pain, agents such as tramadol, diclofenac as well as acetaminophen were used.
Nurses were very vigilant and it encouraged me when they assessed the patients often after administration of these agents as the doses were given continuously until the level of pain subsided. According to WHO, recommends the use of a ladder for drug management, during my clinical placement, it was however not applied.Mariano, Miller & Salinas (2013), advocated for use of weak opioids, and NSAIDs in management of moderate pain. However, this was not practiced during my placement.
It is the nurse’s integral duty to assess the side effects of the analgesic agents. Knowledge on mode of action ,drug interaction as well as unwanted side effects so that they can be in a position to observe any side effect of the agent s and act accordingly. Likewise, I noticed that the nurses were aware of the associated side effects of the analgesic agent and they acted appropriately whenever they noticed any deviation from normal. After administration of morphine, the PACU nurses were keen to observe the respiratory pattern of patients to identify if there was any respiratory depression associated with the use of morphine.
Conclusion
My experience in management of postoperative patients in PACU enlightened me on the role of nurses in management of postoperative pain. I realized that continued provision of PACU nurses with the relevant skills and knowledge will go a long way in better management of pain after. The information I found was relevant for them included variety of pain management tools, factors influencing pain management, different therapies of pain management as well as the side effects associated with pharmacological managements. Finally I would recommend the utilization of the WHO ladder for pain management.
References
Joshi, G., Schug, S., & Kehlet, H. (2014). Procedure-specific pain management and outcome strategies. Best practice & research. Clinical Anaesthesiology, 28(2), 191-201.
Kobelt, P., Burke, K., & Renker, P. (2014). Evaluation of a standardized sedation assessment for opioid administration in the post anesthesia care unit. Pain Management Nursing, 15(3), 672-681.
Mariano, E., Miller, B., & Salinas, F. (2013). The expanding role of multimodal analgesia in acute perioperative pain management. Advances in Anesthesia, 31(1), 119-136.
Marshak, C., Bertignoli, T., Mulackal, E., Reyes, E., Duran, M., & Rojo, L. et al. (2014). Excellence in PACU pain management: How is our PACU team terforming? Journal of Perianesthesia Nursing, 29(5), e17.
McLean, G., Martin, D., Cousley, A., & Hoy, L. (2013). Advocacy in pain management: The role of the anaesthetic nurse specialist. British Journal of Anaesthetic and Recovery Nursing, 14(3-4), 43-48.
Ramnytz, L., Wells, V., & Fleming, E. (2015). An Exploration of the post-anesthesia care unit (PACU) nurses’ knowledge level of sedation scoring and pain management options. Journal of Perianesthesia Nursing, 30(4), e44.
Tedore, T., Weinberg, R., Witkin, L., Giambrone, G. P., Faggiani, S. L., & Fleischut, P. M. (2015). Acute Pain Management/Regional Anesthesia. Anesthesiology clinics, 33(4), 739-751.
Wilding, J., Manias, E., & McCoy, D. (2012). Pain assessment and management in patients after abdominal surgery from PACU to the postoperative unit. Journal of Perianesthesia Nursing, 24(4), 233-240.
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