Background
One of the prevailing issues faced by clients in the nursing profession is pain during the care delivery process. It is apparent that the primary role of nursing professionals is to enhance the wellness status of patients by alleviating physical and psychological pain, but the current models of practice have failed to include the relevant measures that must be applied to ensure that the caregiving process does not introduce more pain to patients and their families. The emergency room is particularly one of the worst areas affected by the lack of models to enhance pain management during the caregiving process. Nurses are expected to apply an evidence-based approach to pain management, but there is currently limited evidence on the best ways to assess and limit pain during the care delivery process. There is a need for the relevant guidelines for the assessment and management of pain during the actual care process to be developed to ensure that patients start feeling better immediately after admission to the health care facilities, especially if they are sent to the emergency room.
PICOT Question
In the emergency room, does enhancing pain assessment and management procedures increase the ability to eliminate the actual pain incurred during the caregiving process?
Literature Review
According to Stang, Hartling, Fera, Johnson, and Ali (2014), current evidence reveals that the emergency department is associated with low performance in pain management. This is a result of the lack of adequate and accurate pain assessment tools and a lack of competence in pain management among the associated health care providers. The researchers proposed that the best approach toward enhancing the quality of pain management is to assess the treatment processes with a close focus on the actual pain associated with different procedures.
This should be followed by an assessment of the performance of the respective caregivers with a close focus on the measures applied to limit the pain incurred by the patients during the service delivery process. This is an evidence-based approach toward alleviating the current situation, where patients endure more pain when they arrive in the emergency room, especially if they are in conditions where they cannot communicate effectively for self-reporting about the pain. The lack of guidelines for measuring procedural pain should be solved by bridging the gap through the development of a care delivery system that is performance-based, with pain management efficiency as one of the merits of performance for the nurses.
According to Bollard (2016), pain management is one of the major issues that hospitals have been facing, especially in the pediatric and emergency departments. There seems to be a lack of proper guidelines to help nurses and other physicians to enhance their abilities to assess and manage pain. A close focus on the emergency department reveals that most of the patients come to the hospitals in chronic pain, which has to be managed to enhance their status of wellness. While most of the nurses are equipped with knowledge on how to deal with pain in different cases in the ER, it is apparent that the majority of the caregivers are not acquainted with the methods of assessing the pain caused to the patients during the caregiving process. There is an obvious lack of tools to assess and measure the pain and Bollard (2016) advocates for the health care system to leverage technology in the development of the appropriate measures to evaluate pain in the caregiving process.
While looking into the need for imaging for chest pain in the emergency room, Wolinsky (2016) revealed that there is a need for nurses and other caregivers in the emergency room to start providing patients with an evidence-based and individual-based approach in the treatment process. Some guidelines must be followed when dealing with patients in the ER, especially if they portray specific types of pain. Nurses are influenced by the traditional models to provide the same approaches for similar types of pains, but Wolinsky (2016) argues that an individual based pain management model should be availed. Most patients in the ER face the risk of developing more complications because of the general pain assessment and management approaches used by the nursing professions. There is a need for the assessments to be individual-based, and for the nurses to respond appropriately without considering the requirements of the ineffective traditional models of pain management.
According to Falch et al. (2014), pain is one of the symptoms used in the diagnosis process in the emergency room. Doctors need to know the exact parts of the body that are in pain to help in the diagnosis process. This implies that pain management continues to be ignored in the pre-diagnostic period. Nurses and doctors allow the patients to experience more pain once they get to the emergency room to facilitate the collection of sufficient data to understand the illnesses. While it is arguable that it is ethical to withhold pain medication in the pre-diagnostic process, it is apparent that the diagnosis process might also involve an increment in the amount of physical pain experienced by the patients. Additionally, the diagnosis process might also take too much time; thus, leading to the development of more pain for the patient. The researchers in this study proposed the administration of strong pain medications once the patient gets to the emergency room and assessing the pain regularly to adjust the medications accordingly. This approach aims at ensuring patients do not undergo more pain in the caregiving process.
According to Patrick, Rosenthal, Lezzi, and Brand (2015), studies have recurrently revealed that the administration of pain management measures in the emergency room is still a major challenge in health care facilities. It is particularly worrying that in most facilities, pain management measures are applied more than half an hour after the patient is admitted. This reveals that patients endure more pain during the caregiving process before the administration of pain management medications. There are gaps in the measurement of the pain incurred during the caregiving process before the provision of the pain medications, and researchers are concerned that there is a need for new policies to be devised to compel caregivers, especially the nurses, to recommend for the administration of pain management medications immediately after a patient is admitted to the hospital.
The researcher identified that the waiting time for patients in the emergency room for pain management procedures has been increasing, yet nurses and doctors start collecting test samples and evaluating the patients immediately after admission. It is logical to assume that during the waiting time, the patients endure more pain than they had on admission because some of the tests involve physical handling, which can lead to more pain. The diagnosing procedures in the emergency room might also be quite rigorous if the patients are in critical condition, which results in more pain as the nurses and doctors try to work as fast as possible. There is a clear need for the development of policies that focus on better approaches to pain management in the ER.
According to the reviewed literature, it is apparent that current studies are focusing on the development of the most feasible models to apply in the emergency department to ensure that nurses and doctors enhance their focus on eliminating the pain incurred by patients during the care delivery process. There are gaps in the development of evidence to support the required guidelines, but one of the underlying issues is the lack of assessment and management of pain immediately after the patients have been admitted to the emergency rooms (Al Qadire & Al Khalaileh, 2014).
Additionally, there is a clear indication that the preference for lack of management of pain in the pre-diagnostic process is an approach aimed at increasing physical agony for the patients (Gelina, Arbour, Michaud, Robar, & Cote, 2013). Most patients in the emergency rooms are in extreme pain, and it is the role of nurses and other physicians to ensure that the pain is alleviated immediately. This implies that current policies advocating for a waiting period before the administration of pain management medications should be reviewed (Pretorius, Searle, & Marshall, 2015). While pain is a useful symptom for the diagnosis process, there are other better ways of diagnosis that do not increase the risks on the wellness status of patients in the ER. It is quite apparent that the issue of pain management should gain more interest from policymakers in the health care system.
References
Al Qadire, M., & Al Khalaileh, M. (2014). Jordanian nurse’s knowledge and attitude regarding pain management. Pain Management Nursing, 15(1), 220-228.
Bollard, E. R. (2016). The management of chronic pain: What do we know, what do we do, and how should we redesign our comprehensive assessment and treatment in order to provide for more patient-centered care? The Medical Clinics of North America, 100(1), xvii.
Falch, C., Vicente, D., Haberle, H., Kirschniak, A., Muller, S., Nissan, A., & Brucher, B. L. D. M. (2014). Treatment of acute abdominal pain in the emergency room: A systematic review of the literature. European Journal of Pain, 18(7), 902-913.
Gelinas, C., Arbour, C., Michaud, C., Robar, L., & Cote, J. (2013). Patients and ICU nurses’ perspectives of non‐pharmacological interventions for pain management. Nursing in Critical Care, 18(6), 307-318.
Patrick, P. A., Rosenthal, B. M., Iezzi, C. A., & Brand, D. A. (2015). Timely pain management in the emergency department. The Journal of Emergency Medicine, 48(3), 267-273.
Pretorius, A., Searle, J., & Marshall, B. (2015). Barriers and enablers to emergency department nurses’ management of patients’ pain. Pain Management Nursing, 16(3), 372-379.
Stang, A. S., Hartling, L., Fera, C., Johnson, D., & Ali, S. (2014). Quality indicators for the assessment and management of pain in the emergency department: A systematic review. Pain Research and Management, 19(6), e179-e190.
Wolinsky, D. G. (2016). Imaging for chest pain in the emergency room: Finding the right gate not the right gatekeeper. Springer, 1(2), 1.