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Nr 500 wiki theory pptx

Nr 500 wiki theory pptx






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    Nr 500 wiki theory pptx Nr 500 wiki theory pptx Presentation Transcript

    • + Pain: A Balance Between Analgesia & Side Effects Kristen Sanders, Jason Simick, & Sarah Smyth Johns Hopkins University School of Nursing
    • + Objectives  Describe the identified problem and its significance  Discuss the purpose and relevance of the selected middle range theory, a balance between analgesia and side effects  Analyze this middle range theory using Fawcett's criteria  Understand the theory guided solution proposed for the problem and its implications for practice  Identify potential problems with implementing the theory guided solution and ways to circumvent those obstacles
    • + Background  Pain:     A balance between analgesia and side effects Middle range physiological theory Proposes multimodal therapy in conjunction with attentive nursing care and patient participation for the treatment of acute pain Applicable to inpatient settings and patients experiencing acute post-operative pain or trauma Purpose of theory is to provide a holistic method for acute pain management that provides better relief while minimizing the unpleasant side effects of opioid analgesic medication
    • + Case Presentation  This presentation will be focusing the theory of a balance between analgesia and side effects on abdominal surgical patients experiencing acute postoperative pain in an inpatient hospital setting
    • + Problem-Pain in Abdominal Surgical Patients  Acute post-operative pain has significant impact on a patient's physical and emotional health    Unpleasant and distressing Unmanaged post-operative pain can lead to slower wound healing, longer recovery time, and an increase in complications and morbidity Undermanaged post-operative pain continues to be an important problem in health care today     Of 80% of postoperative patients experiencing pain, 71% report moderate to severe pain As many as 50% of postoperative patients report their pain as poorly controlled Patients may feel that pain is a necessary and normal part of the postoperative period or be afraid of being labeled as a "drug seeker" resulting in underreporting of pain Many barriers to providing adequate pain relief including as needed (PRN) medication scheduling, under-utilizing appropriate pain medications, uncontrolled side effects of opioid analgesics, underreporting of pain by patients, lack of pain assessment by providers, and technology issues
    • + Nursing Relevance  Nurses have a responsibility to relieve suffering of their patients  Code of ethics for nurses calls on nurses to treat every patient with dignity and respect, meet the comprehensive needs of the patient, and perform assessments and interventions to relieve pain and suffering  Nurses must treat pain as a fifth vital sign - they play an integral role in assessing pain, helping to coordinate a treatment plan, and implementing appropriate interventions  Nurses must adequately assess and treat pain in order to increase patient satisfaction, decrease recovery time and length of hospital stay, reduce health care costs, and meet Joint Commission on Accreditation of Healthcare Organizations (JCAHO) standards
    • + Description of Theory  Theory for patients experiencing both moderate and severe pain from trauma and/or surgical procedures in a hospital setting.  Focuses on creating a balance between analgesia and side effects.  Theory for adult patients only (does not include children or the elderly).  Assumptions of theory:      Doctors and nurses work together effectively when managing pain in the acute setting. Certain methods of pain management are necessary including epidural and systemic opioids, in addition to anesthetics. Medications will be given to curb side effects of pain medications when needed. Patients are able to learn about pain control and to verbalize their symptoms, while also establishing goals for their pain management. Nurses have an up to date understanding of pain control.
    • + Description of Theory  Three    Main Propositions Multiple methods should be used to control pain (nonpharmacologic & pharmacologic). Nurses should not only assess and intervene in relation to their patients’ pain, but also should reassess and alter their interventions when necessary (i.e. adding additional therapy, increasing dosing, etc.). The patient should be taught about pain management and should set goals for their pain control.
    • + Evaluation – Fawcett’s Criteria  Significance      Highly significant - it is the initial integrative prescriptive middle range theory for acute pain management Theory provides nurses with the means to make a difference in the pain level of their patients in order to promote healing, relieve suffering, and prevent potential long term complications Provides a more comprehensive and parsimonious overview than current pain management guidelines and is supposed to be a guide for both nursing practice and research Theory was created with idea that its clinical principles and research propositions would be used to promote further research and the dissemination of pain relief information to nurses Particularly useful in randomized controlled trials and for postoperative surgical floors
    • + Evaluation – Fawcett’s Criteria  Consistency & Clarity     Theory has internal consistency - context and content of the theory are in agreement Theory is meant to be used in the context of acute postoperative pain and trauma which is congruent with the propositions multimodal therapy, attentive care, and patient participation Theory has semantic clarity and semantic consistency - very specific and clear definitions of concepts and consistent use of the same terms and definitions throughout the explanation of the theory High degree of parsimony - theory is stated simply and concisely with minimal concepts and propositions while still providing enough detail to have a high degree of clarity
    • + Evaluation – Fawcett’s Criteria  Adequacy  Empirical – claims made by theory must be consistent with empirical evidence  Theory is supported by a multitude of empirical evidence   All three components (multimodal therapy, attentive nursing care, and patient participation) of the theory have specific empirical research to support their effectiveness including credible organizations’ guidelines and meta-analyses Pragmatic – degree of usefulness of theory in real world  Theory is already being implemented in clinical practice by a majority of hospitals  Use of multimodal therapy, attentive nursing care, and patient participation has proved useful and effective in real world settings
    • + Evaluation – Fawcett’s Criteria  Feasibility  In acute care settings nurses are on the forefront of patient care and are uniquely positioned for the effective implementation of this theory  Three propositions of patient participation, multimodal interventions, and attentive care are directly linked to the daily practice of effective nursing   This in turn allows practical feasibility for the implementation of this theory These three propositions required for the feasible implementation of the theory of the balance between analgesia and side effects are now standard behaviors that are expected of nurses in the acute care setting
    • + Rationale for Using Theory  Many aspects of the theory relate to this problem and population:      Addresses adults experiencing surgical pain in an acute care setting. Pertains to adults experiencing pain that is moderate or severe. Seeks to educate patients about pain control. Suggests assessing and reassessing patients’ pain in order to alter the plan of care when needed. Suggests giving medications to curb side effects of pain medication when necessary.
    • + Solution to Original Problem  Establish a positive and proactive relationship with patient to identify and manage pain involving the entire healthcare team.  Doctors and nurses must work together to effectively manage pain for patients and have appropriate therapeutic pharmacologic and non-pharmacologic plans in place and be prepared to adapt them for the patient  A relationship should be built with the patient establishing through education, the expectations of pain control and the plans for pain management  Early communication between the patient, nurses, and physicians should be facilitated to establish a proactive versus reactive plan
    • + Solution to Original Problem  Establishing both pharmacologic and non-pharmacologic treatment plans for managing acute post-op pain  As recommended, multiple approaches should be utilized and a plan should be developed specifically for the patient  Pharmacologic pain management plan must include management of side effects of pain control medication to include nausea, constipation, sleeplessness and potential withdrawal  Non-pharmacologic interventions must be adapted to specific effectiveness for each patient to include relaxation, music, positioning, hot and cold therapy, companionship, and distraction  Evaluation of effectiveness must remain fluid and dynamic with constant adaptation to the specific needs of each patient.
    • + Solution to Original Problem  Summary of solution given the propositions of the theory  Given large percentage of patients reporting pain (71%) and proportion reporting poor pain control (50%) patients must be involved in the pain control plan  Assessment and adaptation must be continuous to maintain effectiveness, pain is personal, specific, and unique to each patient, and the plan for its management must be as well  Pain management plan must include multiple methods for pain control, both pharmacologic and non-pharmacologic, to maintain highest level of effectiveness for each patient and most effective management of side-effects
    • + Managing Potential Complications  Poor communication regarding pain control plan  Patients may have unrealistic expectations or uncertain of expectations at all   Nurses must foster an environment of open communication and patient education regarding pain control. Expectations should be established early and continually re-visited as assessments are conducted to determine effectiveness of pain control plan. Nurses and physicians not coordinating efforts  Multi-disciplinary communication must be maintained to ensure all members of the health care team are following the same plan and adjusting it when not effective
    • + Managing Potential Complications  Effectiveness of pain control not reassessed   Pain control must be reassessed and adjusted as necessary to meet the patient’s needs Non-pharmacologic interventions not implemented  To balance analgesic side effects non-pharmacologic interventions are effective in minimizing pharmacologic dependence for pain control. These basic but sometimes time consuming interventions must remain part of the focus and not forgotten for the overall plan to be successful
    • + References  American Nurses Associations. (2001). Code of ethics for nurses with interpretive statements. Retrieved from http://www.nursingworld.org/MainMenuCategories/EthicsStandards/C odeofEthicsforNurses/Code-of-Ethics.pdf  Fawcett, J. (2005). Criteria for evaluation of theory. Nursing Science Quarterly, 18(2), 131-35. doi:10.1177/0894318405274823  Peterson, S. J., & Bredow, T. S. (2009). Middle range theories application to nursing research. Philadelphia, PA: Lippincott Williams & Wilkins.  Viscusi, E. R., & Schechter, L. N. (2006). Patient-controlled analgesia: Finding a balance between cost and comfort. American Journal of HealthSystem Pharmacy, 63(1), S3-13. Retrieved from http://ehis.ebscohost.com.ezproxy.welch.jhmi.edu/ehost/pdfviewer/pd fviewer?sid=5c2843cb-29f4-497d-89b107d5368ba9b6%40sessionmgr115&vid=4&hid=104