Case-Assignment: Pain Assessment Tool

Discussion Question 2
Scenario

Two nurse researchers are interested in studying whether a pain assessment tool for critical care patients is valid and reliable when applied to a group of patients who cannot communicate verbally due to mechanical ventilation.They design a validation study in which randomly selected patients will be assessed using the tool after a painful procedure (tracheal suctioning) and after a nonpainful procedure (oral care).If patient responses result in higher scores after the painful procedure than after the nonpainful one, then the researchers will conclude that the tool is effective for these patients in differentiating pain responses from responses to nursing procedures in general.Case-Assignment: Pain Assessment Tool Essay

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Using the checklist in the text, discuss and draw a conclusion as to whether this study will likely be exempt, expedited, or full review.Would the study be considered ethical? Explain your rationale.

You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.Case-Assignment: Pain Assessment Tool Essay
Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.

Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.

The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.Case-Assignment: Pain Assessment Tool Essay

Pain is defined as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage” (International Association for the Study of Pain (IASP), 1986). However twentieth century theories support the rationale that “Pain is a multidimensional phenomenon and includes the patient’s emotions, behaviours and functionality both physically and mentally in response to the pain” (Osborn et al, 2009 Pg.335). The World Health Organisation (WHO) confirmed its belief in the importance of pain control by making its 2004 motto ‘the relief of pain should be a human right’ (www.who.int, 2004)
A fundamental requirement of diagnosing and treating any patient’s…show more content…
Since then variations of the VAS have been used with an array of different descriptions for example “worst pain imaginable” and “pain free” (Waterfield and Sim, 1996), however the method remains the same (Williamson et al, 2005). The VAS has often been considered to be one of the leading methods of pain assessment (Scott et al, 1976). It provides a continuous scale and so is preferred over discontinuous methods such as numerical and verbal rating scales (Carlsson, 1983). Case-Assignment: Pain Assessment Tool Essay However it has been claimed that the VAS is difficult to complete for many patients and consequently may impact negatively on the validity of the tool (Kremer et al 1981 cited in Carlsson, 1983) Validity can be defined as ‘truthfulness: does the test measure what it intends to measure?’ (Mehrens et al, 1987). When measurements are made they must be representative, suitable for purpose and applicable to the setting in which they are used (Brooker et al, 2007). The intention of the VAS is to assess the intensity or severity of a patient’s pain. It is based on the assumption that the scale is completed by the patient, as scores taken from staff and/or family have been proven to be inaccurate (Stannard, 2004). “Pain is what the patient says it is” (McCaffery, 1983), ‘The foundation of pain assessment is the patient’s self report’ (Jacox et al, 1994).Case-Assignment: Pain Assessment Tool Essay

The Aging Adult
No evidence exists to suggest that older individuals perceive pain to a lesser degree or that sensitivity is diminished. Although pain is a common experience among individuals 65 years of age and older, it is not a normal process of aging. Pain indicates pathology or injury. Pain should never be considered something to tolerate or accept in one’s later years.
Unfortunately, many clinicians and older adults wrongfully assume that pain should be expected in aging, which leads to less aggressive treatment. Older adults have additional fears about becoming dependent, undergoing invasive procedures, taking pain medications, and having a financial burden. The most common pain-producing conditions for aging adults include …show more content…
Efforts are being made to tailor pharmacologic agents to improve pain treatment based on genetic sequencing. Culture and genetics  Case-Assignment: Pain Assessment Tool Essay
Please review the cultural variations in Chapter 2. As clinicians, adopt the habit of asking each patient how he or she typically behaves when in pain.
Most of the research conducted on racial differences and pain has focused on the disparity in management of pain for various racial groups—comparing pain treatment for individuals of color (e.g., Blacks, Hispanics) with the standard treatment for all individuals with similar injuries or diseases. Various studies describe how Black and Hispanic patients are often prescribed and administered less analgesic therapy than whites, although the majority of these differences is quite small.16
Subjective Data
Pain is defined as an “unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage. Pain is always subjective.”2
The subjective report is the most reliable indicator of pain. Because pain occurs on a neurochemical level, the diagnosis of pain cannot be made exclusively on physical examination findings, although these findings can lend support.Case-Assignment: Pain Assessment Tool Essay

Pain management and assessment standards
At some point in life, individuals are subjected to pain. There are two main types of pain that are chronic and acute pain. Acute pain is subject to subsiding as ones regain a healthy body state. However, chronic pain is persistent and therefore has been classified nonmalignant and cancer-related pain (Hall & Gregory, 2016). These types include the low back pain and peripheral neuropathy. Controlling the pain in a human body is an essential requirement since one is able to perform well when he or she is relieved of pain. Inadequately managed pain has the effect of leading to adverse psychological and physical outcomes for an individual and the involved family as well.Consequently, unrelieved pain has the possibility of activating the pituitary-adrenal axis. The results are adverse since the immune systems are suppressed leading to postsurgical infection and poor healing of wounds.Case-Assignment: Pain Assessment Tool Essay

Some of the common psychological responses include depression and anxiety. According to a research conducted by Kirksey, Meglory & Sefcik, failure to escape from pain might lead into sense hopelessness and helplessness to the affected patient; the outcome is unfavorable since the patient can be predisposed into a more chronic condition (depression) (Kirksey, Meglory & Sefcik, 2015). A great number of patients experiencing inadequate pain management tend not to seek medical care related to other help problems. Poor pain management can lead clinicians into complications with the legal authorities. There are current standards set by the Joint Commission, the association necessitated pain be promptly and addressed and managed (Kirksey, Meglory & Sefcik, 2015).Case-Assignment: Pain Assessment Tool Essay

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Dangerous outcomes of unrelieved pain
Pain is the main cause of stress: pain cause the endocrine system to have reactions which make it release excess hormones, this damages the fat, proteins, carbohydrates and poor use of glucose and other harmful effects (Hall & Gregory, 2016). When the above processes occur, the reaction might combine with inflammatory processes which result in weight loss, fever, shock, increased respiratory, and death. The recovery period of a patient is affected due to prolonged stress response. Other effects include chronic pain in the future, blood pressure, oxygen demand, increased heart rate, and cardiac workload (Hall & Gregory, 2016).Case-Assignment: Pain Assessment Tool Essay

Pain assessment
To provide proper pain management assessment is necessary. Anderson report that lack of pain assessment builds a barrier to proper pain control of pain. Regardless of the availability of many recommendations about pain assessment, some do not apply to acute assessments. Nurses that work on the hospitalized patient suffering from acute pain are advised to select appropriate assessment elements depending on the present medical circumstances. Pain assessment should be practiced using the standard format; mostly every two hours. The parameters for assessing pain must be in compliance with the respective hospital or unit procedures and policies. Pain reassessment is advised that the patient needs are met. The above must be done after every intervention to make an evaluation of the effect and determine whether there is a need for modification. The reassessment must also follow a specified time frame also directed by the hospital’s policy and procedures (Hall & Gregory, 2016). The nurse is entitled to identify the attitudes of the patient, beliefs, knowledge level, as well as previous experiences with pain. The family expectations for regarding control of pain uncover other issues that must be addressed before the surgery.Case-Assignment: Pain Assessment Tool Essay

Patient satisfaction with pain management is not a better way of determining the quality for pain control. The fact that it is difficult to interpret the patient satisfaction findings makes it not a favorable form of patient satisfaction indicator. Commercial patient satisfaction surveys serve as the best ways to monitor patients’ satisfaction with care. Other forms of assessing patient satisfaction include the use of generic health statue surveys, the use of Medical Outcomes Study Short Form-36. The surveys are characterized by questions concerning pain experienced by the participants. Once a review of conduct concerning the pain experienced can be used to measure the quality of pain care.

Some of the pain assessment tools include the visual analog scale and the numeric rating scale (NRS). Other simpler tools are verbal rating scale which helps classify pain in mild, moderate and severe levels. Patients suffering from advanced dementia necessitate interactive observation so as to determine the presence of pain in the patient’s body. Other tools such as PAIN-AD are also used. The joint commission also necessitates the use of pain standard tools. The commission requires hospitals to make use of similar assessment tools in all departments. The prescribed tools provided by the commission are the Wong-Baker FACES scale, NRS and the verbal descriptor scale. The tool to use has to be an agreement amongst the patient and the healthcare worker. The action makes it possible for the patient to familiarize with the assessment tool. There is also a need for the nurse to take note of the patient’s age, cognitive status, and preference before selecting a scale.Case-Assignment: Pain Assessment Tool Essay

Pain reassessment and management
The need for pain reassessment after the patient has undergone an assessment is essential. The main reasons that demand pain reassessment after an intervention cannot be underrated. According to the Joint Commission proposed pain assessment ways discussed above, it is possible to note the emphasis lay concerning the need to recognize pain management. The commission argues that individuals or institutions must not ascertain pain management as the elimination of pain and discomfort; instead, it means aiding and reducing pain management. Wadensten, Fröjd, Swenne, Gordh, & Gunningberg (2011) studied the effectiveness of pain programs in various clinics. Regardless of the nursing interventions, a huge number of patients experience pain that makes them dissatisfied with the manner management programs were managed. Apart from pain intervention and reassessment, there is a need for effective communication between the nurses and the patients. When communication is present, patients tend to develop satisfaction with the pain management.Case-Assignment: Pain Assessment Tool Essay

The intervention aimed at reassessing the state of a patient’s pain after an assessment is inevitable. Nurses must also document their reassessment details in the Electronic Medical System (EMS) referred to an EPIC (Schroeder et al., 2016). By making use of this process, the value of document rate for the nurses should rise from the baseline to 75%. There is a need for nurses to heed in pain reassessment since patients’ pain remains the vital component of their health and satisfaction. Through good use of scheduled pain reassessment time frames, the pain of patients can be appropriately managed and addressed. When pain is properly managed, there is a possibility of the rise of patent satisfaction. The results are higher marks for the designated hospital as of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) and in turn demand for high reimbursement. Also, reassessment makes the length of stay for patients reduce. Patients suffering from pain need to be treated with care since a large number tend to suffer from mobility, which calls for complication. Increased lack of concentration from the nurses makes a recovery inefficient and in the long-term effect is prolonged stay and complications. Chronic issues are also present in patients who do not have their pain reassessed; the effect can be detrimental to the patients’ worth of existence (Lin et al., 2014).Case-Assignment: Pain Assessment Tool Essay  Pain reconsideration remains a vital aspect of pain administration. Patients must be considered in every aspect of the clinical healthcare; a patient remains a valuable aspect of the nursing practice. With the appropriate pain reassessment, the quality of healthcare will be improved. When the process is put in writing a chance for improvement is created. Patients are obliged to ensure that the pain of each patient is reassessed after a specified time and with specialized interventions.

To sum up, a discussion of the Joint Commission management standards in regard to pain management and reassessment makes it possible for nurses and other healthcare providers to provide reliable services to patients. With the various tools and highlighted above enable the health workers to discern concrete and reliable information concerning the quality of patient satisfaction. The need to reassess the patients’ condition s makes avails room for making decisions regarding the perception of the patient about the quality of services. Patients feel satisfied when nurses or other healthcare providers engage them in the sharing of the information process. Use of the suggested tools also is a valuable approach towards attending the patients. Hospitals need to have a consistent way of assessing pain among its patients. The above is achieving through the employment of the Joint Commission suggested tools. Case-Assignment: Pain Assessment Tool