Assignment: Barriers to effective pain management

Assignment: Barriers to effective pain management

Assignment: Barriers to effective pain management

Capstone Project Paper: Barriers to Effective Pain Management

            Nurses face various challenges in their clinical practices in their respective units as they take care of their patients. Barriers to effective pain management are among the critical challenges faced by the nurses. The paper will discuss the background to this clinical issue, problem statement, review of literature, execution of the proposed project, the relationship between the intervention and QSEN competency, required resources, evaluation of the project’s effectiveness, and its implication to clinical practices.

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Problem & Purpose Issue

            Ineffective pain management is a major issue facing the healthcare sector in the United States. Approximately 100 million Americans suffer from pain (CDC, 2016b). Also, about two-thirds of office visits in primary care settings are associated with musculoskeletal

pain (Hand, 2016). Consequently, pain management’s annual financial burden in the United States has risen to over half a trillion dollars. Additionally, most medications prescribed for patients with non-cancer-related pain, such as opiate medication, led to an opioid-related overdose in 1 in every 550 users (CDC, 2016b). Moreover, death is reported in 1 in every 32

patients prescribed over 200 morphine milligrams equivalent (MME) (CDC, 2016b). The prescription of fentanyl in pain management is resulting in drug abuse due to its euphoric effects. Most individuals abusing heroin use fentanyl as an alternative. Nonetheless, substituting heroin with fentanyl is dangerous due to its potency, which might lead to respiratory depression or death. Therefore, the practice of pain management in primary care is currently faced with multiple challenges and barriers.

Significance/Background

            Effective pain management is a major issue facing nurses on an orthopedic surgical floor where I take care of post-operative patients after surgery. Nurses on this floor encounter various barriers while trying to manage pain effectively. First, pain management is compromised by patients’ fear of addiction. Opioids are effective in the management of chronic pain among patients who have undergone surgical procedures. Nonetheless, most patients are reluctant to take opiate medications for fear of being addicted to these drugs. Another key challenge facing pain management is patients’ culture and language barrier. Patients from diverse ethnic groups and cultural backgrounds seek care services from the medical facility. For instance, some cultures are against the use of opioids, which are commonly used for pain relief (Givler et al., 2020). Consequently, nurses face a barrier in pain management since they strive to be culturally competent in their clinical practices (Martin & Barkley, 2017). Furthermore, patients are concern about the side effects associated with particular pain management medication. Most patients are against opiate medications claiming they are addictive to the users. Another barrier is struggling with existing chronic pain among some patients. According to Gjesdal et al. (2018), the management of chronic pain requires the healthcare provider to be supportive and listening to a patient to develop mutual trust. Therefore, the management of chronic pain is challenging for most nurses. Finally, pain management is compromised by nurses’ beliefs and attitudes towards pain. Some nurses in the unit consider pain as part of surgical procedures. Thereby, they claim that patients who have undergone operations should persevere pain since its part of their healing process.

The barriers in pain management necessitated a search process to establish an evidence-based pain relief intervention.

Problem Statement

            The author developed a problem statement in terms of a PICOT question, including Population/Patient Problem (P), Intervention (I), Comparison (C), Outcome (O), and Time (T).

• Problem (P)–The problems with pain management in an orthopedic surgical floor is surrounded by several barriers, including patients’ fear of addiction, patients’ culture, patients’ concern about side effects, patients with existing chronic pain, and the nurses’ beliefs and attitudes towards pain.
• Intervention (I)- The proposed intervention involved initiation of opioid medication therapy during pain management.
• Comparison (C)-The preferred alternative involved referring all pain management

patients to a pain specialist.

• Outcomes (O)-Reduce pain experienced by post-operative patients from 10 to below 3.
• Time (T)-Pain is anticipated to reduce within three months following the initiation of opioid medication therapy.

Review of Literature

A literature review was conducted to evaluate the current materials and interventions about pain management in primary care. Several databases, including Cumulative Index of Nursing and Allied Health Literature (CINAHL), Nursing and Allied Health, EMBASE, UptoDate, and Cochrane Library, were utilized during the search.

Ineffective pain management has affected most individuals in the US than a combination of various chronic conditions, including strokes, cancer, and coronary heart disease. Consequently, the rate of prescribing opioid analgesics to patients with pain has increased significantly in the United States. Unfortunately, most people tend to misuse the prescribed opioids (Hudspeth, 2016). For this reason, primary care providers are experiencing challenges in treating pain. Leaving pain untreated causes unavoidable consequences making it the worst decision despite opioid addiction, abuse, and diversion. Emergency rooms are occupied by approximately one-third of individuals in need of pain management services in primary care settings. It is recommendable for primary care providers to screen patients before starting long-term pain management therapy to minimize the risk of addiction, depression, and aberrant behavior.

According to Hudspeth (2016), the number of patients seeking pain management services in a primary care setting is increasing substantially. Healthcare providers involved in the prescription of opioids are not given special training in pain management. Approximately 50% of patients in need of pain management medications are attended by care providers who lack special training (Hudspeth, 2016). It is challenging for healthcare practitioners to assess chronic pain accurately due to the multifactorial process associated with chronic pain (Mills, Torrance, & Smith, 2016). Additionally, pain assessment is affected by several factors, including psychological, physical, and social (Mills et al., 2016). Thereby, healthcare providers should set pain management goals and conduct depression screening upon the pain management process’s commencement (Mills et al., 2016).

Furthermore, healthcare providers should calculate the risks and benefits of opioid usage such as overdose, dependence, and abuse before therapy initiation (Gupta & Rosenquist, 2016). The decision to initiate opioid therapy in pain management should be based on the outcomes of the analysis (Gupta & Rosenquist, 2016). The opioid therapy should be avoided if the patient is at high risk. Close monitoring is required if opioid therapy is initiated to a high-risk patient as a pain management strategy (Harle et al., 2015). A pain management contract is recommended if a provider decides to prescribe an opioid to a patient. The contract contains the guidelines that the patient should adhere to while taking opioids. The patient is expected to take opioids that have been prescribed by the provider only and in the recommended dosage. The provider should monitor opioid therapy regularly through several strategies, including random screening of urine, frequent office visits, and PDMP review (Gupta & Rosenquist, 2016).

Givler et al. (2020) state that the appropriate use of pain medicine in primary care can be increased by healthcare professionals. Health professionals can educate and guide patients and their families on how to deal with fears associated with opioid medications. The clinicians can explain to the patient that all opioid-related fears can be resolved by using opioid pain medicine properly. Healthcare practitioners should educate patients that using opioids to manage their pain can reduce their physical and psychological stress, improve their quality of life, and prolong their lives. Those at the end of life will also have a more comfortable dying process if their pain is appropriately managed. Satisfaction with pain management is increased by proper patient education.

However, clinicians should opt for an alternative pain management therapy if patients are unwilling to use opioid therapy as pain relievers even after being educated about this medication (Givler et al., 2020). Some of the recommendable pain management alternatives include acupuncture, herbs, cupping, coining, and moxibustion. Nonetheless, the clinician should inform the patients that these options are more effective if they are combined with opioids during pain management. In some cases, the patient prefers the use of a spiritual healer where medicinal herbs are used to manage pain. Health professionals should support the use of traditional remedies in pain management if they are preferred by the patient, provided that they are not harmful to the patient’s health nor delay the healing process. Therefore, a healthcare provider should understand the content of the suggested herb to ensure that it does not contain an active ingredient that might react with the prescribed medications. The collaboration between prescribers and pharmacists is important to ensure that the alternative therapies are safe, particularly when used alongside other prescribed medications (Givler et al., 2020).

Finally, healthcare providers should also strive to address disparities in culturally diverse populations during pain management. Culturally diverse communities seek pain management services in primary care (Givler et al., 2020). Thus, understanding these communities’ culture and language enhances the outcomes of the pain management process (Kolmar & Kamal, 2018). A health practitioner should initiate pain management therapy that is supported by the patient’s culture. An immediate family member or caregiver should be involved during the pain management process in the event of a language barrier to enhance communication.

            The synthesized literature reveals that opioid medications are the best pain management therapies that should be recommended to patients with pain. However, patients and their families should be educated about these drugs to end any fear attributed to them. Additionally, healthcare providers should consider patent’ culture and language when initiating pain management therapy. Patients trust pain management therapy if their culture is considered and respected during the process.

Execution of the Proposed Solution

            Executing the proposed solution is a complicated process that requires a wide range of resources. In particular, the implementation process will require finances and human resources. Funds will be used in purchasing opioid medications, which will be utilized in pain management therapy. These medications include Codeine, Fentanyl, Hydrocodone, Hydrocodone/acetaminophen, Hydromorphone, Meperidine, and Methadone. The type of opioid to be prescribed to a particular patient will depend on various factors, including age, other prescribed medications, allergies, and drug reactions. Additionally, money will be used to purchase training materials such as projectors, books, and pens and compensate the trainers.

On the other hand, human resources will include experts on pain management who will be hired to train healthcare providers, in particular nurse practitioners, about the efficacy and safety of opioid medications in pain management. Additionally, the trainers will educate nurses on how to assess the risk involved before prescribing a particular opioid medication to a patient seeking pain management services. Training the practitioners will enhance the success of implementing opioid medications as pain management therapy.

In addition to the resources, the success of implementing the proposed intervention will mainly depend on the culture of the organization. The culture of the targeted healthcare organization involves providing quality care services to all the patients. The organizational management and other key stakeholders support interventions that are likely to improve the quality of patient care (Kress et al., 2015). Therefore, they will embrace the proposed intervention since it aims at relieving patients from pain, thus improving the quality of care provided to post-operative patients on the surgical floor.

The success of the project will also require the support of nurse practitioners working in other departments rather than the surgical unit. Nurses were selected since they spend the most time taking care of patients in their respective units than other healthcare providers (Butler, 2018). Consequently, they are mainly involved in the management of pain among patients experiencing pain in the healthcare organization. Therefore, the success of implementing opioid therapy in pain management will significantly depend on the support other nurses will accord to the proposed project. The project will be successful if other nurses embrace it. On the contrary, a lack of support from other practitioners will result in the failure of the proposed project.

The Relationship between the Proposed Intervention and the QSEN Competency

            The implantation of opioid medication therapy in pain management relates to the QSEN competency of quality improvement. Improving the quality of patient care is the primary goal of the healthcare organization. Healthcare providers strive to provide the highest quality care to their esteemed clients to improve their level of experience and clinical outcomes. The quality of care provided to post-operative patients is compromised by the experienced pain. Thereby, lowering their level of pain from 10 to below three will improve the overall quality of care that is provided to them on the post-operative surgical floor.

Evaluation of the Effectiveness of the Proposed Project

An evaluation process will be required to assess if the implementation of the proposed change was effective or not. The evaluation will be conducted after three months following the implementation of opioid medication therapy. The effectiveness of change will be measured by comparing the number of postoperative patients who were complaining of pain before the implementation of the proposed intervention and those reporting the same complaints after the adoption of the change. The change will be considered to be successful if the number of patients complaining of pain has declined within three months after the implementation of the proposed change. On the contrary, the project will be considered to be ineffective if the cases of pain will not reduce following the implementation of opioid medication therapy. Additionally, the success of the proposed project will be measured based on the patient’s rating of pain. Rating pain as three and below indicates the success of the intervention. On the contrary, the project will be considered to be unsuccessful if the patients will rate their pain to a scale above 3. The evaluation process will be based on data collected by the organization’s management about cases of pain and their ratings. This data will be managed by the members of the project team during the implementation of the proposed project.

Implications of the Proposed Project to the Practice

The proposed change will have a significant impact on the clinical practice. Nurse practitioners should be involved in the prescription of opioids to patients with pain since they spend the most time with them. They should be given special training on pain management to enable them to attend to patients with pain appropriately. Nurse practitioners should calculate the risks and benefits of opioid usage such as overdose, dependence, and abuse before therapy initiation. The decision to initiate opioid therapy in pain management should be based on the outcomes of the analysis. The opioid therapy should be avoided if the patient is at high risk. Close monitoring is required if opioid therapy is initiated to a high-risk patient as a pain management strategy. A pain management contract is recommended if a provider decides to prescribe an opioid to a patient. The contract contains the guidelines that the patient should adhere to while taking opioids.

Additionally, nurse practitioners should educate and guide patients and their families on how to deal with fears associated with opioid medications. The clinicians can resolve all opioid-related fears by emphasizing the benefits associated with the use of opioids as pain management medication. However, clinicians should opt for an alternative pain management therapy if patients are unwilling to use opioid therapy as pain relievers even after being educated about the benefits of this medication. Some of the recommendable pain management alternatives include acupuncture, herbs, cupping, coining, and moxibustion.

Finally, nurse practitioners should embrace the cultural diversity of patients seeking pain management services from healthcare organizations. Patients feel appreciated if the healthcare provider embraces and respects their cultural beliefs, values, and traditions during care delivery.

Conclusion

            Nurses face several barriers during pain management in their respective units within a healthcare organization. In particular, pain management barriers faced by nurse practitioners on the post-operative floor include patients’ fear of addiction, patients’ culture, patients’ concern about side effects, patients with existing chronic pain, and the nurses’ beliefs and attitudes towards pain. Current pain management interventions have not been successful in addressing this clinical issue. Therefore, an appropriate intervention is required to address the issue of pain management in a healthcare organization. It is proposed that the use of opioid medication therapy is effective in managing pain among post-operative patients compared to referring those patients to pain specialists. The effectiveness of the proposed intervention will be measured by comparing the cases of pain before the implementation of the project and three months after adopting the change. The change will be considered to be successful if the number of patients complaining of pain has declined within three months after the implementation of the proposed change. On the contrary, the project will be considered to be ineffective if the cases of pain will not reduce following the implementation of opioid medication therapy. Nurse practitioners from various departments will be involved during the implementation of the proposed change since they spend the most time with patients with pain in their respective care units within the healthcare organization. Finally, the implementation process will require finances and human resources. Funds will be used in purchasing opioid medications, which will be utilized in pain management therapy. Additionally, money will be used to purchase training materials such as projectors, books, and pens and compensate the trainers. On the other hand, human resources will include experts on pain management who will be hired to train healthcare providers, in particular nurse practitioners, about the efficacy and safety of opioid medications in pain management.

References

Butler, R. (2018). Estimating Time Physicians and Other Health Care Workers Spend with Patients in an Intensive Care Unit Using a Sensor Network. Clinical Research Study. https://vinci.cs.uiowa.edu/compepi/wp-content/papercite-data/pdf/butler18.pdf

Centers for Disease Control and Prevention. (2016b). Increases in drug and opioid overdoses deaths–United States, 2000-2014. Retrieved from http://www.cdc.gov/mmwr/preview/ mmwrhtml/mm6450a3.htm

Givler, A., Bhatt, H., & Maani-Fogelman, P, A. (2020). The Importance of Cultural Competence in Pain and Palliative Care. Statpearls. https://www.ncbi.nlm.nih.gov/books/NBK493154/

Gjesdal, K., Dysvik, E., & Furnes, B. (2018). Living with chronic pain: Patients’ experiences with healthcare services in Norway. Nurs Open; 5(4): 517–526. Doi: 10.1002/nop2.160

Gupta, A., & Rosenquist, R. (2016). Use of opioids in the management of chronic noncancer pain. Retrieved from www.uptodate.com

Hand, A. (2016). Quality improvement project to enhance provider awareness and use of the coping strategies questionnaire (CSQ) to assess patients’ level of coping with chronic pain (Doctoral dissertation). Retrieved from http://scholarworks.umass. edu/nursing_dnp_ capstone/

Harle, C. A., Bauer, S. E., Hoang, H. Q., Cook, R. L., Hurley, R., & Fillingim, R. B. (2015). Decision support for chronic pain care: How do primary care physicians decide when to prescribe opioids? a qualitative study. BMC Family Practice, 16, 48.

Hudspeth, R. S. (2016). Standards of care for opioid prescribing: What every APRN prescriber and investigator need to know. Journal of Nursing Regulation, 7(1), 15-20.

Kress, H. G., Aldington, D., Alon, E., Coaccioli, S., Collett, B., Coluzzi, F., … Sichère, P. (2015). A holistic approach to chronic pain management that involves all stakeholders: Change is needed. Current Medical Research & Opinion, 31(9), 1743–1754. 10.1185/03007995.2015.1072088

Kolmar, A, & Kamal, A, H. (2018). Developing a Path to Improve Cultural Competency in Islam Among Palliative Care Professionals. J Pain Symptom Manage;55(3): e1-e3.

Martin, E, M, & Barkley, T, W. (2017). Improving Cultural Competence in End-of-Life Pain Management. Home Health Now;35(2):96-104.

Mills, S., Torrance, M., & Smith, B. H. (2016). Identification and management of chronic pain in primary care: A review. Psychiatry in Primary Care, 18(22), 1-9

ORDER A CUSTOMIZED, PLAGIARISM-FREE Assignment: Barriers to effective pain management HERE

This is a Capstone project paper the topic is Barriers to effective pain management.

Your paper should be set up in APA format, must include a table of contents page. Your paper must include all of the following section headings numbered below:

1.Introduction- describe to the reader what you will be doing
2.Problem & Purpose Issue- provide an explanatory statement as to what is the issue. What are you looking to accomplish. This is a small paragraph not one sentence.
3.Significance/background- why is this an important issue specifically to where your are looking to make the change (this will lead the direction of the literature search)
4.Literature Review- The evidence to support the change you are proposing. Conduct a literature review related to the problem. Find 5-7 peer reviewed, current journal articles. Web site sources will not be counted in the 5-7 requirement but can be used as additional resources. Explain what the literature suggests and synthesis the results as they relate to the proposed solution and problem. What is suggested as best practice based on studies? (references that you look at. This is mostly what others have said so should be mostly citations) Review journal articles to see how to write this section and look at sample paper.
5.Method/Solution- What do you think you would do to change or impact the problem? and How will you make this change happen? The plans to making the solution happen.
6.QSEN- How does it relate to the QSEN competencies (only need to connect to one even if you see many). Make the connection clear {I look to see if you pick the one that appears the most relevant}
7.Evaluation- How will you be able to show that the change was effective? Must be measurable. Consider data that the organization already collects, but remember to include who will manage the data, analyze the results and how will the results show effectiveness?
8.Implications to practice- what will the change mean for practice. Some concluding remarks.

References- Provide a reference list of articles you have used in the paper in APA format. You should not reference something if it was only read and material not taken meaning if there is not an in text citation it does not belong in the reference page. (References should not be more than 5 years old)

Project topic should relate to one of the QSEN competencies listed below

Patient Centered Care.
Teamwork and Collaboration.
Evidence-Based Practice.
Quality Improvement.
Safety.
Informatics.
and fit into one of the categories listed: education, practice, research or policy

In your paper you must Describe the problem. Describe the significance for the problem and the relationship to nursing as related to an identified (QSEN) competency. Provide a clear problem statement . Explain why this is an important issue/ concern, the background of the issue.
Conduct a literature review related to the problem. Find 5-7 peer reviewed, current journal articles. Web site sources will not be counted in the 5-7 requirement but can be used as additional resources. Explain what the literature suggests and synthesis the results as they relate to the proposed solution and problem. What is suggested as best practice based on studies?
Method for executing the solution; what resources would you need to carry out this proposal? Does the culture of the organization or community of interest support/or detract from accomplishment of this? This should be an interdisciplinary proposed project (variations in nursing specialty is still within the discipline of nursing so you are highly encouraged to consider others that would be important to the success of the project). Explain why these professionals were selected. Describe the necessary resources which may include monetary needs, manpower, equipment, etc.
Synthesize the nursing implications from the literature to the specific concern or issue and include implications to practice that the solution offers. Implications should be related to the area you chose from the 4 listed below.

Practice: What did you determine was the best or preferred nursing practice for this concern? Provide rationale and evidence.
Policy: What is the current policy related to the problem and what is the concerns that are not being addressed. What evidence or rationales suggest a change is needed?
Education: What are the current guidelines for educating staff about patient care or nursing practice related to this concern or issue, providing rationales and evidence?
Research: What are priorities for further study, from a nursing clinical or professional perspective?

FYI : I work in the hospital on a surgical orthopedic floor taking care of post op patients after surgery. Some barriers nurses encounter on my floor while trying to manage pain effectively are patients’ fear of addiction, patients’ culture, patients’ concern about side effects, patients with existing chronic pain, and the nurses’ beliefs and attitudes towards pain. Some Possible solutions to these barriers are creating a pain management team, arrange the nurse educators to do Inservice to educate staff on pain management for patients with chronic pain.