Analysis of Emerging Ethical Issues in Pain Management Today

This report identifies and analyzes emerging ethical issues in pain management within acute care settings. It begins by highlighting the prevalence of pain medication and patient confidence in pain management. The report then explores the importance of both effective pain management and ethical considerations in healthcare. The research methodology involves analyzing existing research papers, conducting patient surveys, and performing interviews. Ethical considerations such as beneficence, non-maleficence, justice, and autonomy are discussed in detail. The report emphasizes the need for healthcare professionals to assess their own biases, treat each patient as an individual, and actively listen to patient self-reports to provide ethical and effective pain management.

Running head: EMERGING ETHICAL ISSUES IN PAIN MANAGEMENT 1
Emerging Ethical Issues in Pain Management in the Acute Care Setting
Name of the Student
Name of the university

EMERGING ETHICAL ISSUES IN PAIN MANAGEMENT 2
Emerging Ethical Issues in Pain Management in the Acute Care Setting
Introduction
Initially, for many patients, being free from pain is just a memory. It was a scenario that
they can only dream about. However, A recent survey by HCAHPS shows that about 70%
reported that they were under pain medication, which was very effective (Wolf, Berlinger, &
Jennings, 2015). The research being conducted in this field has led to nurses and doctors having
a better understanding of pain management and other pain related issues. Patients have also
contributed a lot to research by giving their feedback about pain reduction. They have expressed
confidence in the pain management of the different healthcare facilities that they attend
(Samuels, 2010).
The statement of research is identifying some of the emerging ethical issues in pain
management in the acute care setting. The second question is identifying how to resolve some of
the emerging ethical issues. These two research questions will help this report in the analysis of
data (Wolf, Berlinger, & Jennings, 2015).
The relevance of this study is to find a new method of solving the emerging issues there
has been any publication about the effect of poor pain management and the effect of the ethical
issues in healthcare facilities, however, there have been very few about the combining the two.
This research will greatly help health research department (O'keeffe et al., 2016).
Literature Review
Pain management is a science that incorporates the use of technology, pharmacology and
complementary therapies in order to provide comprehensive treatment. The major problem of
this report is pain management and ethics (Siouta et al., 2016). Appropriate pain management
helps the patient to be comfortable and relieved allows them to have proper well-being. Through

EMERGING ETHICAL ISSUES IN PAIN MANAGEMENT 3
effective pain management, major operations can be done with ease. It also helps to reduce the
length of the stay at the hospital and improves the overall quality of life in general. On the other
hand, ethics are important. They help the healthcare facility to run more smoothly and with
transparency. Through ethics, rules and regulations of the hospital are followed and the overall
quality of treatment is enhanced (De Witt Jansen et al., 2017).
The major weakness of pain management is bias in treatment. Most of the decisions in
pain management are influenced by the inherent perception of pain. Having healthcare ethical
principles help the doctor or nurse to be able to make the correct decision form an ethical
approach. All the decisions of pain management should be made with transparency and a lot of
consideration (Meloncon & Frost, 2015).
The strength of the various studies conducted in line to this problem is they are very
comprehensive. They give a lot of detail about various case studies. Hurlock-Chorostecki (2016)
explains how through mechanical ventilation the pain is reduced. He is just one of many
researchers (Myburgh et al., 2016).
Pain management should also be given high importance in the overall curriculum of
nursing courses (Nelson et al., 2015)
Research Design and Methodology
The method and design will be analyzing research papers and publications. The inclusion-
exclusion criteria will be
- Articles that have been published in the last five years will be included.
- Peer-reviewed articles will be included;
- Books and papers will be excluded.

EMERGING ETHICAL ISSUES IN PAIN MANAGEMENT 4
The articles chosen will be five of them. They will all be analyzed keenly. The results
obtained from this method will be presented accordingly (Jovin et al., 2015)
Sampling will also be used to collect data. Patient form selected hospitals will be
randomly selected. They will be handed questionnaires. Interviews will also be collected. The
sampling size is 60 patients (Smyser et al., 2016).
The instrument used to collect the data will be hard copies of the questionnaire and
recording devices for recording the interview. The questionnaires are very reliable because the
patient is confined to the hospital and there is no risk of losing the questionnaire (Young-Hyman
et al., 2016). The only downside to this method is that the patient may be in too much pain to
answer the questionnaire. Interview ensures that the data provided is honest and credible. It is
difficult to give false information during an interview. Any answers that need clarity can be
asked again (Finke et al., 2018). Data analysis will be done by analyzing the interviews
conducted and the reading through the answers in the questionnaire. The overall result that is
obtained is presented in point form (Lichtner et al., 2016).
Ethical Consideration
Painkillers are commonly used to provide temporary relief from pain. They range from
mild painkillers to strong ones. However, these medicines do not cure the cause of the pain. Most
of the painkillers usually have some side effects. The medicines affect the liver function since the
liver has to work hard to remove the excess toxin produced by the liver. In addition, these
medicines interact very severely with alcohol intake. A strong painkiller causes dizziness,
respiratory problems and drowsiness. Although the side effects may subside over time, the
problem may persist (Grady, 2015).

EMERGING ETHICAL ISSUES IN PAIN MANAGEMENT 5
Ethics is the rules and morals of society. It involves doing what is good. Many ethical
challenges arise in pain management and become more intense if they involve older adults,
children, non-communicative patients, minorities and patients with mental health issues or
substance abuse issues.
Before using any time of painkillers the following steps should be followed
- Ensure that the policy on pain management has been reviewed and is being implemented
in the healthcare facility. If a certain facility is not using any pain management medicine,
the healthcare professional should consult with the clinician in charge of analgesics used.
- Patients who have a history of drug abuse should be referred to a specialized nursing care
programme called pain management service for treatment. Alternatively, they can be
registered under the abuse of a substance treatment program
- The patient and their relative should be informed about a new pain management program
being implemented. The nurse should accompany the physician in informing them that
they were taking pain management that was not as effective and as a result, new pain
management will be done.
- The nurse should consult the physician about any issues concerning the ethics of a pain
killer administration. The main task is to provide the patient to relieve through a plan of
care.
- Anny ethical issues raised about the use of a certain pain management treatment plan
should be taken to the hospital ethics committee.
- The hospital risk manager should always be informed if there is any legal liability that
may arise because of a failure to manage them effectively.

EMERGING ETHICAL ISSUES IN PAIN MANAGEMENT 6
Four ethical principles and standards are involved in pain management. The first is
beneficence and non-maleficence. The desire to do what is good for the patient while considering
their values and desires is defined as beneficence. It involves doing no harm, removing the
patient from harm, preventing harm, supporting, and encouraging the patient. Non-maleficence is
the duty to protect the patient from harm. Achieving proper pain management while keeping the
patient safety as a priority can be challenging mostly because the adverse reaction caused by
medicines are related to the dose. An example is acetaminophen can cause liver damage in
excess dosage while opioid cause addiction. The more the pain medication is administered the
higher the risk involved. Nurses should analyze the clinical status of the patient and determine
whether their request for more pain medication is appropriate and safe. Beneficence requires
nurses to decide how they will advocate for patients.
The second principle is justice. Patients who have similar illnesses should receive the
same treatment while those with different illness should receive a different treatment. An
example is all patients who are admitted to the hospital because of a broken leg should be treated
in a similar way regardless of their race, gender, ability to pay or ethnicity. The same applies to
those with a broken ankle, backaches or any type of illness in general. It is important to apply
this principle in opioid-tolerant patients since they will require additional medication to address
the pain as compared to opioid naïve patients. The principle of justice is challenging when two
patients with the same diagnosis or injury have different reports of pain with differing
expectations of pain management. This ibis because pain is unique to every patient and can be
defined as what the patient experiencing the pain defines it.
The nurses measure pain through a self-report. It is difficult for a nurse when the self-
report indicates that the patient is in severe pain but their behaviour is different. For example, a

EMERGING ETHICAL ISSUES IN PAIN MANAGEMENT 7
patient complaining about severe pain yet she is observed reading a magazine. This sends a
conflicting message to the nurse. Patients usually have a cultural background that influences their
perception of pain through non-verbal communication. Another example where ethics is
questioned is when a nurse is dealing with a patient who has had a similar injury or diagnosis
that the nurse once had. The nurse may fail to understand how the patient is quite despite the
severe pain that they are experiencing.
The third principle is autonomy. This means that the nurse should advocate, support and
respect the patient decision about their healthcare. The patient should be able to understand all
the information about the healthcare choice and should be free from any external pressures or
influences. For example, a patient may insist on being given a particular medication that was not
prescribed and insists that the medicine is administered in a particular route. The healthcare
professional may consider this treatment inappropriate, undesirable and compromising o the
safety of the patient. The patient, on the other hand, may be aware of medications that have been
effective in the past
Finally, the last principle is looking for meaning. Pain is sometimes intertwined with fear.
A patient may become concerned when the pain they are experiencing is greater than what they
expected. Other may be worried about the post-surgical pain. Understanding what the pain
means to the patient can help the nurse with the appropriate information for ethical pain
management.
A healthcare professional should follow a few key steps in providing proper ethical care.
The first step is assessing their beliefs and experiences about pain. This will help to reduce the
possible biases that may arise about pain. The nurses’ attitude towards patients who have been

EMERGING ETHICAL ISSUES IN PAIN MANAGEMENT 8
reported to have opioid misuse or are drug and substances abuse should also be analyzed when
dealing with patients requesting opioid.
The nurse should view each patient as an individual. When there is a problematic
connection, the nurse should constantly remind himself or herself that every patient is unique. It
is human nature to get along easily with people who have at least something in common with
you and to disagree with people who have an undesirable behaviour or a remind us of someone
with distasteful behaviours. The nurse should treat each patient without any biases from his or
her previous experiences. Impressions that have been laid by other healthcare professional tend
to influence the proper assessment of the patient. When a patient is labelled as ‘drug seeking’, it
can influence negatively the perception of other nurses who have not even met the patient. A
patient deserves to have the chance to become acquainted with the nurse at an individual basis
without any prior judgment a nurse will only be able to understand the pain that a patient is
experiencing when they interact and the nurse actively listens to the self-report without any
biases
Working with a patient that constantly self-reports high levels of pain can be frustrating
to the nurse, especially if the nurses have done their best in managing the pain. It may stir up a
latent prejudice. The healthcare should be able to acknowledge their own experiences and
understand them in order to be able to handle the patient in an ethical approach.
Finally, in order to capture the true distinctive quality of the pain, interact with each
patient without having any expectations or notions. The nurse should listen to the patient and
observe some of the verbal and non-verbal cues. The nurse should attempt to understand the
patient especially if they show contradictory behaviour. This can be done by asking questions

EMERGING ETHICAL ISSUES IN PAIN MANAGEMENT 9
such as, ‘Please help me understand how you relax and yet the pain score is high.' This will
encourage the patient to open up about their feelings and emotions.
The intensity, impact and character of pain are unique to each individual. It is not
possible to know the pain being experienced by an individual by simply knowing the aetiology
of the disease. A patient may have a neuropathic pain when suffering from herpes zoster or they
may have an aching pain if they are suffering from arthritis, however, the nature of the pain may
be different. Pain management can only be effective if the nurse listens to the patient
experiencing it. If a patient is having difficulty in communicating the pain, the health care
professional can consider their medical history. Through this, they will found out if they have
had chronic pain before if they have been taking an analgesic medicine if the illness generally
causes pain and their previous reactions to pain.
Conclusion
Possible limitations of this study include the presence of too many resources that touch
on the issue of pain management. It makes it difficult to filter out the necessary information.
Over the years, several researchers have advanced in the fields of pain management and
published several papers (Finkel et al., 2018). Another limitation is that it is difficult to collect
data from the patient as a first person because most of the patients are in too much pain to have a
proper conversation. Other patients keep interrupting the interview because of episodes of pain,
while others the interview is terminated completely because of extreme pain (Dowding et al.,
2018).
Another limitation is that pain is a subjective experience. It cannot be measured or seen.
Only the person experiencing it can explain how they feel. The healthcare professional has no

EMERGING ETHICAL ISSUES IN PAIN MANAGEMENT 10
choice but to accept the fact as a self-report. Pain is multifaceted. It is felt beyond the physical
sensations. Pain has cognitive, emotional and spiritual aspects. A patient’s culture and
experiences influence the copping mechanism. This is why it is difficult to access the severity
The time constant are a major challenge. The nurses may be limited causing inadequate
treatment of pain. The nurses may lack the time to listen actively to the patient. The patients
may lack an insurance cover for a pain management specialist. Most insurance covers do not
cover physical therapy, biofeedback or cognitive behavioural therapy.
Treatment of pain is, therefore, an obligatory option. All healthcare facilities should train
healthcare professionals about proper ethical pain management. When a patient is admitted into a
healthcare facility, pain management should be the first priority. A well-established framework
in ethical pain management results in quality and assurance of the treatment. The platinum rule
should be applied in pain management. The rule encourages people not to treat other people as
you would have liked to be treated, like the way the golden rule states, but instead treat other
people as they would have liked you to treat them (Bollig, Gjengedal & Rosland, 2016).
In conclusion, the significance of pain management cannot be underestimated. Cases of
improperly pain management can result in adverse physical and physiological effects on the
patient and their families. Patients who have had a poor experience with pain management at a
specific clinic are usually dissatisfied. They may never prefer the same facility for treatment.
Managing pain is important to all patients. Pain hinders the normal functioning of the patient. It
also affects mood and the ability to concentrate. Severe pain results in insomnia and lack of
appetite. There other secondary diseases that develop because of severe pain, for example,
depression, blood pressure, increase heartbeat and other cardiovascular issues (Pullman, 2013).

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