The main objective of palliative care is to mitigate the affliction of the patients along with their families by the inclusive evaluation and treatment of the physical, spiritual, and psychosocial symptoms that have been experienced by the patients (Sholjakova et al., 2018). Pain is considered as one among the most dread symptoms of an advanced, rapidly growing disease and dying. It is the most common but not necessarily experienced in case of both non-malignant and advanced malignant conditions. A patient-centred approach involving systematic and thorough assessment, management and regular review can provide pain relief for most patients (Tredgett, 2019). The palliative care focuses on providing the comfort as well as the prevention from the suffering of the patient’s extreme health issues. However, the treatment of the pain pertain an integral part of the palliative care. An adequate pain management helps in attaining an improved quality of life for the patients as well as their families (Sholjakova et al., 2018).
The target audience of this booklet is third year undergraduate students and new graduate nurses. It will help them in understanding various underpinning concepts of the pain management.
1. Pain management
2. Significance of pain management
3. Principles in Palliative care
4. Approaches to pain control palliative care
5. Pain management strategies
6. Effective pain management in terminally ill people
7. How National palliative care standards help in the pain management?
Pain and its types of pain
Pain is the unpleasant sensory and disturbing experience that is related with either actual or potential tissue injury (Smith et al., 2018).
Pain is something that will affect any individual adversely in a direct way or in an indirect way and have the potential to reduce the process of healing if the person is already dealing with some other disorder. It has often been seen that untreated extreme pain results in comorbid situation where along with the disorder and the associated pain there comes some mental disorder too (Tompkins, Hobelmann & Compton, 2017). However, this situation could be managed if proper pain management is done. Adequate pain management under palliative care potentially results into the preclusion of some additional health complexities, the facilitation of healing, and also enhances an individual's quality of life. Pain management focuses on all of the aspects of pain such as the cause of pain and potential treatment that can help in treating that pain and potential causes of that pain (Tompkins, Hobelmann & Compton, 2017). This is done by focusing on the subtle surgical measures, some pharmacological as well as non-pharmacological therapies etc. Pain management is an umbrella term that entails various methods in it. These methods are framed in such a way that it could potentially prevent, reduce, or stop the sensations of pain. It could be by using psychosomatic methods; medications, or physical methods Mwanza, Gwisai & Munemo, 2019).
The importance of Pain management lies in its roles and the major roles that pain management in palliative care plays are:
Pain management strategies are the ways in which one can treat the pain and it could be pharmacologic and non-pharmacologic as well (Worley, 2016).
The non- pharmacologic ways of pain management entails some nursing interventions with the objective of providing relief from pain to the patient. The first step involves is the assessment of pain which is done by using the pain assessment scale. This scale is used in identifying the pain intensity, assessment and recording that pain. This tells about some of the important features of the pain as documented by Maciel et al. (2019) such as:
The non-pharmacological ways of pain management includes:
When pain management is achieved with the help of medications then this type of strategy is known as pharmacologic strategies of pain management. In case of extreme pain that cannot be treated by simply distracting the person or any other non-pharmacologic ways, pharmacologic ways is used as the drugs and medicines administered for pain works efficiently. This will work exactly in a way that will help in resolving the pain if it is administered in a way the clinician has prescribed regularly or alternatively at right time (Guerriero et al., 2016). It should not be hold back by thinking to consume it until the pain gets worse. The care plan in case of pharmacologic methods for pain management might not just involve a single drug but can also be prescribed in combination of some other pain medicine also. Examples of some pharmacologic agents are:
Note: All these drugs are administered on some principles according to the type of drug and severity of the patient.
However, these methods must be focused on addressing the patient’s concerns as it has been concerned as one of the most important attribute of pain management (Hemmingson et al., 2018).
Effective pain management strategies in case of terminally ill people require:
The National Palliative Care Standards could be helpful in the pain management as it can articulate and promote a vision for the compassionate and appropriate specialist palliative care. The Standards could also be helpful in the recognition of the significance of patient-centered along with focusing on age-appropriate care. This can also help in the organization the pain of the patient competently. Specifically, the standards help in understanding the importance of focusing on to the preferences and the requirements of particular attention of the people who are at risk. This entails some values that come under the National Palliative Care Standards (Schroeder & Lorenz, 2018). They are:
Guerriero, F., Bolier, R., Van Cleave, J. H., & Reid, M. C. (2016). Pharmacological approaches for the management of persistent pain in older adults: What nurses need to know. Journal of Gerontological Nursing, 42(12), 49–57. https://doi.org/10.3928/00989134-20161110-09
Hemmingsson, E. S., Gustafsson, M., Isaksson, U., Karlsson, S., Gustafson, Y., Sandman, P. O., & Lövheim, H. (2018). Prevalence of pain and pharmacological pain treatment among old people in nursing homes in 2007 and 2013. European Journal of Clinical Pharmacology, 74(4), 483–488. https://doi.org/10.1007/s00228-017-2384-2
Maciel, H., Costa, M. F., Costa, A., Marcatto, J. O., Manzo, B. F., & Bueno, M. (2019). Pharmacological and nonpharmacological measures of pain management and treatment among neonates. Revista Brasileira De Terapia Intensiva, 31(1), 21–26.
Mwanza, E., Gwisai, R. D., & Munemo, C. (2019). Knowledge on Nonpharmacological Methods of Pain Management among Nurses at Bindura Hospital, Zimbabwe. Pain Research and Treatment, 2019, 2703579. https://doi.org/10.1155/2019/2703579
Schroeder, K., & Lorenz, K. (2018). Nursing and the Future of Palliative Care. Asia-Pacific Journal of Oncology Nursing, 5(1), 4–8. https://doi.org/10.4103/apjon.apjon_43_17
Sholjakova, M., Durnev, V., Kartalov, A., & Kuzmanovska, B. (2018). Pain relief as an integral part of the palliative care. Open access Macedonian Journal of Medical Sciences, 6(4), 739–741. https://doi.org/10.3889/oamjms.2018.163
Smith, C. A., Levett, K. M. , Collins, C. T., Armour, M., Dahlen, H. G., & Suganuma, M. (2018). Relaxation techniques for pain management in labour. Cochrane Database of Systematic Reviews, 3. doi: 10.1002/14651858.CD009514.pub2.
Tompkins, D. A., Hobelmann, J. G., & Compton, P. (2017). Providing chronic pain management in the "Fifth Vital Sign" Era: Historical and treatment perspectives on a modern-day medical dilemma. Drug and Alcohol Dependence, 173 Suppl 1(Suppl 1), S11–S21. https://doi.org/10.1016/j.drugalcdep.2016.12.002
Tredgett, K M. (2019). Pain control in palliative care. Physical Problems, 48(1), 2-8. https://doi.org/10.1016/j.mpmed.2019.10.003
Umberger, W. (2018). Complementary and integrative approaches to pain and patient preference. Pain Management Nursing, 20(1), https://doi.org/10.1016/j.pmn.2018.11.059
Wendling, L., Glick, W., & Tighe, P. (2017). Goals and Objectives to Optimize the Value of an Acute Pain Service in Perioperative Pain Management. Techniques in Orthopaedics (Rockville, Md.), 32(4), 200–208. https://doi.org/10.1097/BTO.0000000000000245
Worley, Susan L. (2016). New directions in the treatment of chronic pain: national pain strategy will guide prevention, management, and research.” P & T: A Peer-Reviewed Journal for Formulary Management, 41(2), 107-14.
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