The article by Bernhofer is devoted to the issue of pain management, which the author characterizes as elusive. The reason being, the perception of pain severity and the necessary amount of medication are strongly subject to assorted biases on the patients’ and the practitioners’ behalf. The author calls for an ethical approach towards pain management and outlines the main principles of it.
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Principles of ethical pain management
The principality of ethical pain management can be summarized as follows. First, the course of pain management should be determined by the patients’ preferences (the autonomy principle). Second, the treatment decisions should be beneficial for the patient (beneficence). Third, the nurse practitioner should opt for the practices to most efficiently reduce the harm caused by the disease and the treatment procedures (non-maleficence). Finally, all patients regardless of their age, gender, ethnicity, and socio-economic status should be provided with the highest quality care according to their condition (justice) (Bernhofer, 2012, p. 1-2).
The ethical model, care quality, and patient outcomes
The application of these principles is intrinsically connected with quality patient care and positive outcomes. Indeed, one of the positions the Code of Ethics states is that the nurse “practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person” (American Nurses Association, 2015a, p. 269). This statement pertains directly to what Bernhofer regards as justice and autonomy. She states that these principles facilitate patient involvement in decision-making concerning their course of treatment – which has been proved to relate with better perceived pain management (Bernhofer, 2012, p. 1). Moreover, according to the Scope and Standards of Practice, one of the core competencies of an RN is outcome identification, which subsumes the ability to identify the hazards and benefits of each particular treatment (American Nurses Association, 2015b, p. 35). The principles of beneficence and non-maleficence, therefore, pertain directly to the quality of the delivered health care.
The ethical model in practice
Many practitioners express their concerns over the patients’ pain management behavior, lest the patients should turn out to be drug addicts seeking opioids. A considerable body of literature exists on this particular issue, although I personally have never dealt with it. My practice, however, can include acute post-operative patients requiring pain management medication. The side effects of some treatments in elderly patients can be debilitating (e.g., nausea) or they can be allergic to that type of medication.
The initial response to such a situation would be to curb all the side effects of the analgesia with other medications. However, because the ethical model subsumes beneficence and non-maleficence, prescribing several medications only to reduce the effects of an allergy (especially in senior clients) would be undesirable. An option to follow the justice and quality principle would be to seek other means of pain management. For instance, if a patient cannot stand intravenous analgesia, the practitioner could opt for perineural catheterization or regional analgesia instead. The former option also meets the autonomy principle as the patient can do it themselves post-discharge.
The principles of the ethical model of pain management are perfectly compliant with the positions outlined in the Code of Ethics and the directives of the Scope and Standards of Practice. Applied to practice, these principles facilitate ethical decision-making when managing pain and result in better patient outcomes.
American Nurses Association. (2015a). Code of ethics for nurses with interpretive statements. Silver Spring, MD: American Nurses Association.
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American Nurses Association. (2015b). Nursing: Scope and Standards of Practice (3rd ed.). Silver Spring, MD: American Nurses Association.
Bernhofer, E. (2012). Ethics: Ethics and Pain Management in Hospitalized Patients. Online Journal of Issues in Nursing, 17(1), 1. Web.