Evidence Based Practice Standards

pain is the usual cause for persons to look for treatment. Inadequate pain management can cause delay in healing process. It can also leads to prolonged hospital stay. The acute pain management theory describe how nurse can manage pain with minimal effects from the pharmacological interventions and use of alternative methods of pain management (Good &Moore, 1996) The main factors are in the management of pain are Pharmacological, non-pharmacological, patient participation, education and different interventions. Effective pain management involves the application of non-pharmacological interventions and usage of pain medications. (McEwen & Willis, 2014). The pain management theory deals with management of pain in daily basis. It offers the knowledge about alternate methods in pain

There are many concepts in nursing theory that need further clarification. A concept analysis can provide a thorough explanation of a term in nursing theory that will help healthcare professionals better communicate. The Walker and Avant approach to perform a concept analysis was specifically formulated with nurses in mind (McEwen & Wills, 2014). Walker and Avant proposed a concept analysis be used to further understand the meaning of a term or concept in anticipation that those using the term would have the same understanding (McEwen & Wills, 2014). When a term or concept is in question or needs further questioning in any field of nursing, a concept analysis is indicated (McEwen & Wills, 2014). Walker and Avant’s concept analysis is comprised of eight steps; select a concept, determine the aim of the concept, list all possible uses of concept, defining attributes, model case, alterative case (borderline, related, contrary, invented, and illegitimate), list antecedents and consequences, and lastly list empirical referents (McEwen & Wills, 2014). The defining attributes are deemed most beneficial in obtaining comprehension due to the fact that these attributes show which show up in regularity when relating to the concept (Linda & Judith, 2011). Using the Walker and Avant concept analysis model a formal concept analysis will be performed on the term “pain”. Middle range nursing theory gave the example of pain as one of many concepts used in nursing (McEwen & Wills, 2014).

Itroduction: Evidence-based practice is an approach to medicine that uses scientific evidence to determine the best practice (Beyea & Slattery, 2006). As nurses perform their daily tasks they must continually ask themselves, “What is the evidence for this intervention?”. Nurses are well positioned to question current nursing practices and use evidence to make care more effective. In order to improve patients’ outcomes it is the responsibility of the nurse to transition evidence-based practice into the norm, through application of daily practice (Flynn Makic, Rauen, Watson & Will Poteet, 2014). Continual evaluation of current practice must be performed to ensure the use of evidence-based practice opposed to practice based upon tradition. The implementation of evidence-based practice standardizes healthcare practices and diminishes groundless variations within care. These variations lead to the production of uncertain health outcomes (Stevens, 2013).

Cultural aspects of holistic assessment is relevant in the provision of nursing care as it provides the care team with an overview of cultural needs of the patient as well as providing information in which the patients’ health problems have arisen. Culture is defined as values, beliefs, artifacts, behaviors, attitudes and customs influencing and regulating interactions between members of a social group (Stein-Parbury 2010: 91; Johnstone 2006: 67). It is the nurses responsibility to adhere to the ANMC, competency 2.3, ‘accepts individuals/groups to whom care is provided regardless of race, culture, religion, age, gender, sexual preference, physical or mental state’ (ANMC 2006, p. 4). Kozier & Erb (2012: 360) discuss that cultural sensitivity, appropriateness, competency and safety are all factors that are required to be taken into consideration so that the patient can be provided with the best possible health care. Kozier & Erb (2012: 360) also explain that conflicts in health care have been apparent due to cultural misunderstandings. An example of a cultural misunderstanding is the level of pain. In some cultures, it is normal to dramatically express ones level of pain whereas in other cultures people do

JCAHO (2011) also stated that patients and their families needed to be educated about pain and how the patients’ pain is going to be managed. Every patient perceives and exhibits pain in a different manner and if nurses do not assess the patient thoroughly they can miss it. For instance, Engebretson et al. (2006) acknowledged that, patients manifest pain in different ways and this resulted in nurses performing an inadequate assessment of their patients’ pain. Also, Engebretson et al. recognized that patients often conceal their pain because they do not want to be viewed by staff as complainers or addicts, and if patients decide to speak up the nurses frequently view their patients’ statements from their own cultural, moral and ethical belief system and not their patients which leaves the patients’ pain untreated.

Nurses always want what works best for their patients rather than having to struggle to find what works. The nurse plays a key role in implementing evidence-based practice because it is the nurse who is the advocate and care giver to their patients. Because of evidence-based practice different aspects of nursing care are always changing. It is crucial for nursing practice to evolve because through research other health care professionals have found things that work best and is resulting in less patient deaths and furthering complications in a patient’s illness. Some of the examples that will be discussed here as result of evidence base practice are: better pain assessments in pediatric patients, preventing pressure ulcers, kangaroo care, music therapy to help distract, better hand hygiene, and teaching parents about life saving techniques.

Nursing assessment is a substantial way of gathering physiological, psychological, spiritual, and emotional condition of the patient. It creates a whole picture of an individual and assist the health care providers to formulate a diagnosis. Assessing the comfort of the patient is equally important as taking the blood pressure or temperature. Pain is the fifth (5th) vital sign that is subjective in nature when performing an assessment of a patient. Various studies were conducted in finding the most appropriate evidence-based nursing practice in assessing and managing the pain of a cognitively impaired patient, whether it is acute or chronic or the underlying cause is cancer or post-operative incision. As emphasized by Song, Eaton, Gordon, Hoyle, and Doorenbos (2015), it is vital to ensure that “pain management is based on the best evidence” (p. 456). Perhaps knowing the causes of inability to assess and manage the pain in a cognitively impaired patient would give a clearer understanding of the practice.

Different ethnicities from around the world are stereotyped due to the ability to control pain. According to (Calvillo & Flaskerud (1991). Stereotypes include: “Mexican-Americans have a low a pain tolerance”, “Italian Americans are very dramatic about their pain”, “Jewish Americans complain a lot about pain” and “Asian Americans do not express their pain.” Nurses are in the forefront when assessing the patients pain tolerance. However, nurses need to be sensitive to the cultural background of a patient. The transmission of pain can be altered by blocking cells along the nervous system. If the pain receptors in the nervous system are not being stimulated, the body will not feel pain. Moreover, many patients get addicted to pain medications

This study was little different from the previous studies as it was carried out by the student nurses. The students performed a research in collaboration with the faculty and unit to describe the root cause and provide recommendation on improving clinical documentation practices within the health care setting. This included describing the pain reassessment process or plan of care compliance. Six pilot units were selected within the healthcare system with a team or 4-5 students for each unit with a lead faculty for each team. Each faculty was responsible for the work of 3 student teams. 2 teams focused on the pain reassessment and one team on the plan of care documentation. Each student used about 8 hours of clinical hours for this project. The RCA teams met weekly to summarize the current status and develop data tools and recommendations on this project. The project process was completed in 3 phases: background overview, data collection and synthesis and project evaluation including recommendations. The total time to complete the project was approximately 7

Herr, K., Titler, M., Fine, P. G., Sanders, S., Cavanaugh, J. E., Swegle, J., Forcucci, C. (2012) mentioned some of the challenges commonly faced regarding pain management, these include: misconceptions about pain, evaluating pain in those who have cognitive impairments, those with multiple co-morbidities, polypharmacy issues and those who are reluctant to take opioids analgesics. It has been noticed that the problem involves lack of application of Evidenced Based Practice (EBP) for pain by nurses and physicians. The reason for conducting this research is to report on the results of a Translating Research Into Practice (TRIP) intervention, that includes strategies designed to promote adoption of

Nurses usually are the first ones to assess pain and listen to the responses, hence they must assume responsibility for pain management. Nurses not only correspond patient status and concerns to the treating doctor, but also timely implement prescribed therapy. As patient advocates, nurses participate in pain management, health education, and prevention of successive sickle cell crises (Pack-Mabien et al., 2001). The measures of attitudes of nurses and physicians towards SCD patients revealed that the nurses have significantly higher mean Negative Attitude scores and lower Uneasiness scores compared to the physicians (Freiermuth et al., 2014). Further, assessment of nurse attitudes at medical-surgical units and emergency departments revealed high levels of negative attitudes towards SCD patients at both sites (Jenerette et al., 2015). Through several educational efforts, a decline in mean Negative Attitudes subscale scores and increase in mean Positive Attitudes subscale scores was observed in both Physicians and nurses (Freiermuth et al., 2016). These findings suggest that nurses and physicians need additional education about SCD care (Frei-Jones et al., 2009). Additional cultural competency training to health care providers increased practitioners' knowledge about and awareness of dealing with culturally and

Quality pain management is an ongoing, interdisciplinary process that encompasses clinically important outcomes in postoperative patients in both early and long-term recovery, however, quality is compromised because pain it is suggested that pain is vastly under-treated in the postoperative setting (329). Nurses routinely perform comprehensive pain assessments, pain screenings, patient response to treatment, and develop plans of care that include the patient and their families with the ultimate goal of decreasing healing time, avoiding of adverse effects, and increasing satisfaction with the care received (329). While these goals are admirable, they are increasingly difficult to achieve because pain assessment is ambiguous and dependent on

My score for Pain-Ad is 9. Some of the barriers to pain and behavior symptom management nurses experience when caring for dementia population are patient barrier, education barrier and culture barrier. Older adults and dementia patients are at high risk for under treatment of pain that could be due to nurses lacking of adequate education, cost concerns and other obstacles related to the health care system, and patient related barriers, such as reluctance to report pain or take analgesics. Unrelieved pain in the older adult may sometime has significant functional, cognitive, emotional, and societal consequences. Also lack of culture barrier may put these patient at high risk for under or over treatment of pain. For example, people from different

The first step of this model is to create a sense of urgency and to get the nurses motivated to change (Kotter, 1995). By explaining that data from the last quarter demonstrated an increase in rates of worsening pain, will communicate the “why now” of the QIP to the nurses. Additional education about the responsibility and accountability nurses have in accurately assessing, managing and documenting pain will assist in

The most common reason that people seek medical care is pain, and pain is the leading cause of disability (Peterson & Bredow, 2013, p. 51; National Institute of Health, 2010). Pain is such an important topic in healthcare that the United States congress “identified 2000 to 2010 as the Decade of Pain Control and Research” (Brunner L. S., et al., 2010, p. 231). Unfortunatelly, patients are reporting a small increase in satisfaction with the pain management while in the hospital (Bernhofer, 2011). Pain assessment and treatment can be complex since nurses do not have a tool to quantify it. Pain is considered the fifth vital sign, however, we do not have numbers to guide our interventions. Pain is a subjective expirience that cannot be shared easily. Since nurses spend more time with patients in pain than any other healthcare provider, nurses must have a clear understanding of the concept of pain (Brunner, et al., 2010). Concept analysis’ main objective is to clarify ideas, to enhance critical thinking, and to promote communication (Rodgers & Knafl, 2000). This paper will examine the concept of pain using Wilson’s Steps of Concept Analysis (Rodgers & Knafl, 2000).