Evidence-Based Nursing Practice for Pain Management: A Report

This report focuses on evidence-based nursing practices for pain management, emphasizing the critical role of nurses in caring for patients experiencing both chronic and acute pain. It highlights the importance of sensitive patient assessment, including pain history, disability, and medication consid...Read More

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14 Aug 2019
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Introduction
The nurses having a specialization in pain management have the responsibility to take care of
patients suffering from either chronic or acute pain. The critical situation comes in cases of
chronic pain, where they need to take care of medications, doses form, and adverse events
associated (Arumugam, MacDermid, Walton & Grewal, 2018). The nurses’ expertise in pain
management requires sensitive analysis of patient’ disability, the reason for pain in the
patient, along with patient history. In addition to this, they also need to know the scale of
measurement, medication of usage, their contraindication and appropriate usage. Likewise,
the nurses are also responsible for administering the medications to the patients with
reference to pain management chart tool, Samuels’ scale, and summative index for quality of
acute pain (Walton & Marsh, 2018). Overall, their task is to ease and manage the patient’s
pain.
The present report is based on “evidence-based nursing practice for pain management”. The
topic is considered of high importance because it will draw significant information for the
healthcare employees, especially nurses to adequately and efficiently manage pain. The
evidence-based practice towards relieving pain will also help in amazing the negative
physical and psychological outcomes of the patients and their family members. The report
will further outline peer-reviewed evidence as a part of secondary research.
Importance of pain management: Linking with evidence based practice
According to the report of Snyder & Handrup (2018), it has been found that inadequate pain
management by nurses will lead to unfavourable psychological and physical outcomes for the
patient and the family members. The prime reason associated with such failure in clinical
proficiency comes with improper documentation. Considering a case example, demonstrated
by the report of Mack, Hunnicutt, Jesdale & Lapane (2018), where the patient was suffering
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from constant and unrelieved pain. Later, on proper assessment of condition, it was found
that the pain activate the pituitary-adrenal axis and further suppress the immune system. This
finally result in poor healing of the wound and create a post-surgical infection. In this case,
the lack of adequate competency and missing practices based on evidence leads to critical
conditioning in the patient. The post-surgical complications not only affect the economy of
the patient but also increases the rate of patient readmissions in the hospital. However,
according to the report by Shoqirat, Mahasneh, Dardas, Singh & Khresheh (2019), it is
important for nurses to go through documentation, review the medical decision in previous
(similar) cases as well as to make use of the relevant literature. Improper nursing care related
to pain management tends to reduce the mobility rate of patients which can finally create
serious complications pulmonary embolus, deep vein thrombosis, and pneumonia. On the
other hand, failure in pain management will also have a psychological impact on patients and
their families, such as anxiety, helplessness, and chronic depression (Snyder & Handrup,
2018). Thus, it is highly relevant for nurses to have knowledge about palliative care, empathy
in communication, and counselling attitude for the patient as well as the family members.
Note that clinical cases of poor pain management, also accompany the risk of legal action
against the healthcare centre, physicians and nurses. This has been appropriately documented
by Jukić & Puljak (2018), which emphasise on the fact that lack of proper evidence based
practices can lead to severe consequences. As per the current standards of pain management
mentioned in the Joint Commission on Accreditation of Healthcare Organization, the
Healthcare organization need to immediately address and manage the pain of patients
(Agrawal, Smith, Garbuz & Masri, 2018). Nurses being part of the Healthcare team is equally
responsible for managing the pain of patients during the time of hospitalization and are also
liable for any type of legal action. This type of situation loses the profit and reputation of the
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hospital. Furthermore, the author also mentions that effective pain management during
hospitalization is directly correlated to patient satisfaction.
Importance of evidence-based pain management
Evidence-based practice in nursing has been proven to deliver high-quality care to the patient.
Evidence-based practice on pain management is conducted on the basis of research evidence
of the most appropriate practice which takes into consideration the needs and preferences of
patients. Some of the evidence-based practice which has shown continuous positive outcomes
eventually becomes standard of care by translating from the research to the medical practices.
Another report by Shuman, Xie, Herr & Titler (2018) mentions that in Healthcare centres
90% of nursing practices are based on evidence-based pain management indicators. In severe
cases like cancer pain management, nurses prefer to follow evidence-based pain management
practices through a proper evaluation of pain documentation. The pain documentation is
reviewed by using the evaluation tool which is a modification of the cancer pain practice
index. The pain documentation comprises of the care plan, pain assessment pharmacological
intervention and non-pharmacological interventions. However, it is the responsibility of
healthcare professionals to conduct deep research on evidence-based practices to avoid any
kind of failure.
Some of the commonly used evidence-based pain management practices
Arguments were also reported in conjunction of the fact that nursing decisions are mainly
governed through doctors and physicians. However, the usage of tools for management is
primarily dependent on the competency of nurses (Smith & Saiki, 2015). There are several
effective ways to treat pain, which can be either through medications or through physical
therapy. Based on the evidence, it is identified that most of the people find relief tromping
through massage therapy. In addition to this, there are some relaxation techniques used in
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nursing practices related to gentle movement, biofeedback, and breathing techniques (Caes,
Fisher, Clinch & Eccleston, 2018). These relaxation techniques help the patient to get relief
from anxiousness. Acupuncture is also found an effective pain-relieving technique for
patients suffering from chronic illness such as cancer. Apart from non-drug pain management
practices, prescribing drugs such as opioids is also an effective evidence-based practice in
nursing.
Recommendation and conclusion
Clinical evidences that are relevant in these cases include (i) types or classes of pain. For
example, use of NSAIDs, corticosteroids, and opioids have their relevance to specific cases.
Likewise, the use of neuro-drugs such as anti-anxiety, anti-depressants, anti-convulsant, and
muscle relaxant requires extensive pharmacological and human physiological knowledge
(Smith & Saiki, 2015). Other than this, the contraindications such as addictive effect of
opioids, nausea and vomiting as common side effects, lowering of blood pressure, slowing of
heart rate, and urinary retention, requires appropriate counselling to patient and adequate
knowledge to make clinical decisions (Coyne, Mulvenon & Paice, 2018). Additionally,
according to the recent report by Naqib et al. (2018), the nurses are required to have updated
knowledge about marketed drugs, banned drugs, and medications which are contraindicated
in specific cases including pregnancy, infants, and heart patients. These continuous
knowledge updates and critical information can only be achieved with the help of practising
clinical routines based on evidences. Important, it is the lack of proper orientation of nurses
as well as regular assessment of their performance, which brings a knowledge gap in clinical
practices (Mohan, Chakravarthy, George, Devanahalli & Kumar, 2018).
In summary, the present report discusses the importance of nursing practices in conjunction
to pain management. It is learned that evidence based practices are highly relevant for
improving quality of life years in patient, to reduce clinical error, and to avoid legal
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infringement cases. Additionally, the existing gaps in the clinical practices were identified
that are responsible for bringing gap in present cases. Overall, nurses are required to
continuously improve their competency level as well as to use evidence based practices for
betterment in clinical standards.
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References:
Agrawal, Y., Smith, R. M., Garbuz, D. S., & Masri, B. A. (2018). Opioids in Arthroplasty:
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Caes, L., Fisher, E., Clinch, J., & Eccleston, C. (2018). Current evidence-based
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Coyne, P., Mulvenon, C., & Paice, J. A. (2018). American Society for Pain Management
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Jukić, M., & Puljak, L. (2018). Legal and Ethical Aspects of Pain Management. Acta medica
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