Clinical Nursing Practice Problem
Clinical nursing practice problem: non-pharmacological interventions for pain management. Pain is defined as the perceived and hurtful response to actual or potential damage. Pain is a broad concept with many subcategories, including character (chronic, acute), severity (mild, moderate, severe), and location (body part). The term acute pain refers to painful sensations that last less than three months. Typically, acute pain occurs as a response to soft tissue damage (e.g., sprained ankle) and gradually resolves as a patient recovers from the injury. The process of recovery may be both physically and emotionally challenging: patients experience a certain decrease in their quality of life. They cannot go on with life as they would normally do, and this is why many are tempted to rely on pharmacological pain management to make the situation easier to handle.
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As much as prescription drugs may be helpful in relieving pain, they have side effects to be reckoned with. As Lewis, Kohtz, Emmerling, Fisher, and Mcgarvey (2018) report, in the US, over 15,000 people die from an opioid overdose every year. The Centers for Disease Control state that since 1999, the number of opioid prescriptions and overdose deaths have quadrupled. It is argued that in many cases, pain medicine can be avoided or taken very moderately (Lewis et al., 2018). Instead, patients could benefit from nonpharmacologic interventions – physical and psychological strategies aimed at reducing pain. By teaching patients techniques such as breathing for relaxation, health workers would both avert side effects from pain medication and provide patients with self-management strategies.
Clinical Nursing PICOT Question
Will patients with acute pain use breathing techniques as part of non-pharmacological pain treatment as opposed to patients who use none feel relief from pain one week after the intervention?
Define PICOT Elements
- P- (patient population/patients of interest): Patients suffering from acute pain due to a variety of reasons (e.g., gastritis, injury). Exclusion criteria: chronic conditions, end-of-life palliative care patients, cancer patients.
- I- (Intervention): educating patients on breathing techniques to take their mind off painful sensations and alleviate them
- C- (Comparison): Patients suffering from acute pain who do not use breathing techniques
- O- (Measurable outcome): Lower values on the pain scale
- T- (Time frame in months): At one week after the intervention
Evidence Retrieval Process and Summary
This brief literature review draws on recent evidence documented in peer-reviewed journals. The studies discussed in this section were chosen for their relevancy as they address the actual topic and provide both a theoretical framework and practical implications. Jafari, Courtois, Van den Bergh, Vlaeyen, and Van Diest (2017) argue that the majority of existing studies highlight a complex relationship between breathing and pain.
It seems that patients with acute pain benefit more from controlling their respiration. Jafari et al. (2017) presume that breathing techniques have a two-fold effect: a person triggers a physiological response and, at the same time, becomes distracted from pain psychologically. Sharma, Mavai, Bhagat, Murugesh, and Sircar (2017) conducted an experimental study in support of the hypothesis. Participants were exposed to cold water to induce pain reactions, and those of them who used slow deep breathing showed more tolerance to painful sensations.
For all the advantages of nonpharmacological treatment, its implementation is rather challenging. In the light of opioid scrutiny, it seems that nurses still lack education on pain management that does not rely on medication (Lewis et al., 2018). Lewis et al. (2018) show that even though nurses are generally aware of different methods of relieving pain, they report underwhelming or non-existent training. Moreover, because of the high workload, nurses prefer techniques that do not take too much time, such as repositioning as opposed to breathing for relaxation.
Implications of the Evidence
It seems that nonpharmacological interventions show significant efficiency in time management. Despite the overall health workers’ (HWs) awareness regarding the existence of various techniques, only a small share of HWs actually implement them in their daily practice. It appears that one of the main barriers to the practical implementation is nurses’ work overload and, therefore, the lack of time to work with each patient individually. Apparently, the use of nonpharmacological techniques such as breathing for relaxation requires a mutual effort. It is essential that a nurse explain how to breathe in order to relieve pain. At the same time, patients should be attentive learners and execute their self-agency by taking control over their sensations and managing pain independently.
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Jafari, H., Courtois, I., Van den Bergh, O., Vlaeyen, J. W., & Van Diest, I. (2017). Pain and respiration: A systematic review. Pain, 158(6), 995-1006.
Lewis, M. J. M., Kohtz, C., Emmerling, S., Fisher, M., & Mcgarvey, J. (2018). Pain control and nonpharmacologic interventions. Nursing 2018, 48(9), 65-68.
Sharma, P., Mavai, M., Bhagat, O. L., Murugesh, M., & Sircar, S. (2017). Slow Deep Breathing Increases Pain-tolerance and Modulates Cardiac Autonomic Nervous System. Indian Journal of Physiology and Pharmacology, 61(2), 107-113.