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examplepaper4006week2.docxPAIN CONTROL IN 3
Pain Control in the Cancer Patient
Students Name
BSN 4006 Policy, Law, Ethics, and Regulations
· Description of the nature and extent of the issue or problem.
· Description of who the issue or problem affects (including both the target population and health care professionals).
· Description of the short- and long-term effects of the problem on the target population and the health care system.
· Discussion points on the theoretical frameworks for understanding the existence of the issue or problem.
· Discussion points on the ethical issues this problem raises in the delivery of health care.
Running head: PAIN CONTROL IN 1
Pain Control in the Cancer Patient
The treatment of pain is so important that the Joint Commission deemed it the fifth vital sign in the year 2000. There have been many issues regarding addiction and pain management once physicians started to treat pain aggressively. However, patients still need to have their pain, treated and the Joint Commission continues to have standards on the treatment of pain. One of the standards is patients have the right to have their pain assessed and managed ("Facts about pain," 2015).
Nature and Extent of Treating Cancer Pain
In the field of cancer care treating cancer pain is as important as treating the cancer itself. Not all patients dealing with cancer have the need for pain medicine, but when cancer pain occurs it needs to be frequently treated with narcotics in ever increasing amounts. There are many issues when treating patients with pain medications. Patients may be reluctant to take the pain medication in case they will need it later, and it will not be effective. They also fear they will become addicted even when the patient has been told that the cancer is incurable. A difficult issue facing the oncology community is the cancer patient whom is a known addict. The ethical duty of the health care provider is to treat adequately the cancer pain. The nurse is required to assess the patient’s pain level. The nurse may have unresolved feelings regarding the addict’s honesty in rating their pain. The nurse may feel that they are contributing to the patient’s addiction or fear the patient is diverting their pain medications. To provide the patient with adequate pain control, the nurse must put aside their reluctance to provide the patient with narcotics.
Who I is Affected by Cancer Pain
The nurse must be aware of the issues of how undertreated cancer pain can affect the quality of the patients’ remaining life. This issue is so important that the World Health Organization (WHO) created standards and guidelines for the treatment of pain. The WHO recommends a three-step approach to the treatment of pain. There are multiple guidelines for the treatment of cancer pain, but most suggest the non-opioid treatments as the first step. Medications such as Advil, and Tylenol are the most common first step in pain treatment. Steps two and three include the use of opioid medications. The goal according to the WHO is the patient to be free of cancer pain (Chapman, 2011). The reality of cancer pain, is that it can be controlled, but not eliminated. An example of this; a patient at Holzer was in the office to see a palliative care physician. The patient was in extreme pain, so bad he was unable to sit or stand, he would cry out in pain. The physician ordered 4 milligrams of Dilaudid with no relief of pain. He was then given 4 more milligrams and still was still suffering. He was going to be admitted to the hospice room for pain control. He was given ever increasing amounts of pain medication. He finally could sit still, but rated his pain at a 10, and the nurses were concerned that he was not accurately rating his pain. The palliative care physician who spent a considerable amount of time with the patient asked him what his pain was when he was first given the Dilaudid, his reply was a 20. The nurses, while well trained, failed to assess his pain adequately. After the patient got his pain under control he went home on a pain pump. His pain was under control but not gone.
Short and Long Term Effects of Cancer Treatment
The WHO noted with the improvements in cancer treatment, that patients will be living longer with their disease. As a consequence of longer life and effective treatments, including surgery, radiation and chemotherapy, pain is a more common side effect of these treatments (Feilding, Sanford, & Davis, 2015).
Cancer-associated pain takes many forms. Pain can be acute because of a biopsy or surgery. Treatments such as chemotherapy can have pain as a side effect. Neuropathic pain is a common side effect of certain chemotherapy medications. Acute pain from a pathological fracture can also occur (Chapman, 2011). Cancer that metastasizes to the bone or spinal cord can cause extreme pain that is difficult to control.
To perform a complete assessment, the nurse must have a thorough knowledge of cancer and the associated pain. At each office visit, the patient’s pain must be assessed as well as how their pain is affecting their quality of life. It is not enough for the nurse to use the standard pain scale. Asking a patient to rate their current pain on a scale from 1-10 does not allow the nurse or physician to see the full range of the depth and breadth of cancer pain.
Poor pain assessment is not the only barrier to poor cancer pain control. Poor pain control of cancer pain is not just a local issue or even a national issue, but it is an international issue. A Korean study that involved 201 cancer patients examined patient reported pain barriers. One of the most frequently reported barrier was the patient’s attitude toward taking pain medications. The patients surveyed were concerned about addiction, tolerance, side effects, and harmful effects of taking opioids. The study noted that patients with depression are more likely to report pain control barriers than those without depression. Patients with depression were also 25% more likely to report severe pain (Kwon et al., 2012). The study evaluated patients’ attitudes towards the treatment of cancer pain. One interesting point was the patients’ view of the inevitability of pain from cancer or fatalism. This same fatalism is also common in the Appalachian area of the country as described in a study through the University of Kentucky (Royse & Dignan, 2011). This shows how universal attitudes towards cancer and pain are.
Theorectical Frameworks for Understanding Cancer Pain
Nurses are often not adequately trained to assess and document pain other than rating pain from the one to ten scale. A study was completed in which two different methods were employed in educating nurses on pain assessment management techniques. The study focused on content delivery (Phillips, Helenika, Hickman, Lam, & Shaw, 2014). The study involved scenarios that evolved from chart reviews. The study had noted that data was gathered in an ethical manner. The study indicated that online learning has the potential to improve the nurses’ ability to assess the patient’s pain. The program that was used in teaching was not as important as was the frequency of the education. The more frequent the education, the better the nurse did in assessing and reporting the patient’s pain. Nurses who worked in the field less than five years did better with the education than nurses who were working in palliative care for more than five years. In general, after the educational program, the nurses’ knowledge of pain assessment improved, as did their confidence in assessing pain. The nurses’ documentation that would allow for clinicians to make better decisions did not improve.
The study concluded that online learning interventions can and do improve the ability of nurses to improve pain assessment skills. This had a positive impact on the patients’ reporting of pain. It noted that the nurse is an important part of the process to assist the patient with receiving adequate pain control. They also discussed a blended learning approach for nurses who are challenged by online learning formats (Phillips et al., 2014).
ethical issues this problem raises in the delivery of health care.
Ethical Issues that can Come up from Cancer Pain Control
Nurses are on the frontline of cancer pain control. They must be able to put their own prejudice and biases aside to allow the patient to have the best quality of life for however the long patient has. This can be months to years with modern medical and radiological treatment. Nurses all too often ask a patient to rate their pain from one to ten, and if the number is low, the nurse may not go any further in a pain assessment. When the number is high, around nine or ten, the nurse may not believe the patient, but must question the patient further. Just as in the case of the hospice patient who felt his pain before the large doses of Dilaudid was a 20, because 10 did not describe his pain level. Even if the adequate control of pain was not mandated by the Joint Commission, the nurse has a duty to prevent needless suffering of the patients in their care. A well-trained nurse working with cancer patients needs to understand and come to terms that adequate control of the patients’ pain may cut their life short, but will improve the quality of the life they have remaining.
Patients’ worldwide are reluctant to take large amounts of pain medication that may be needed to provide comfort. However, nurses worldwide need to help the patient understand the importance of adequate pain control.
References
Reference style for a book:
Carlyle, T., & Niemeyer, C. (1996). On heroes, hero-worship, and the heroic in
history. Lincoln, NE: University of Nebraska Press.
Reference style for a print journal:
Ellinger, A. D., & Bostrom, R. P. (1999). Managerial coaching behaviors in
learning organizations. Journal of Management Development, 19(9), 752
770.
Here are some examples of Electronic references
Bartlett, S. (2010, March 3). Schools helpless against nursing shortage. Press-
Republican.Retrievedfromhttp://pressrepublican.com/0100_news/x1726192928.
com
Kuehn, B. M. (2008). Groups target nursing school bottleneck to address medical workforce deficit. JAMA: The Journal of the American Medical Association, 300, 887-888. doi:10.1001/jama.300.8.887
TO CHANGE THE HEADER ON THE SECOND PAGE CLICK “Different First Page”
AFTER YOU CLICK INSIDE THE HEADER.
Bartlett, S. (2010, March 3). Schools helpless against nursing shortage. Press-Republican. format of
all Retrieved from http://pressrepublican.com/0100_news/x1726192928.com references.
Huston, C. J. (2010). Professional issues in nursing: Challenges and opportunities. Philadelphia, PA: Wolters Kluwer/Lippincott Williams and Wilkins. indent for
each Kuehn, B. M. (2007). No end in sight to nursing shortage: Bottleneck at nursing schools a key reference.
factor. JAMA: The Journal of the American Medical Association, 298, 1623-1625.
Kuehn, B. M. (2008). Groups target nursing school bottleneck to address medical workforce and DVD deficit. JAMA: The Journal of the American Medical Association, 300, 887-888. doi:10.1001/jama.300.8.887
