PainManagement in the Nursing Profession
Inthe context of the proposed research, the researcher sought to findempirical data based on the operated patients as the study populationand find out if indeed, operated patients were vulnerable to healthcomplications due to administration of drugs as pain relievers. Theliterature review defined a few clinical terminologies before delvingdeeper into the research problem. The study also outlined theresearch questions that were deemed appropriate, and explained therationale, as well as the researchable variables. The research usedevidence-based approach to explore the side effects of painmanagement medication, while profiling the alternative approaches inalleviating pain on patients. Differentliteratures presented varying explanations concerning the topic. Forexample, some pointed out that the long-term application of certainpain management drugs results in different side effects, which, attime, might be intense. Thequalitative design was preferred as it applied flexible and sensitiveapproaches to the social context of the issue understudy. It providedan opportunity for recognition of various facts about the problem tothe researcher. While collecting data, there arose both ethical andpractical matters. For example, the compelling moral responsibilityof ensuring that participants (parents of children withhydrocephalus) are warranted appropriate care after the study. If aquantitative design (for example, non-experimental) was utilized inthe research, it would have made the researcher to distinguish andinvestigate correlations consequently, transforming the nature ofthe research. In the placebos’ case, fundamental ethical principleswere infringed, for instance, prescription of medicines to producethe placebo effect without seeking approval from the requiredpersonnel. That is, deception is the main ethical issue that arose inprescription of placebos, which may end up destroying thepatient-physician relationship because patients will lose trust anddoubt the professionalism of their primary caregivers.
PainManagement in the Nursing Profession
Principally,the major aim of conducting a research is to attempt providing asolution to the identified problem that could be beneficial to acertain populace covered in the study. In the context of the nursingprofession, there are many researchable problems that are worthy ofinvestigation and make recommendations that are seen as an attempt ofproviding solutions to the problem. On this note, the researcher isbound to apply proper research methodology, review relevantliteratures, from which conclusion and recommendations shall be made. The paper herewith explores about a possible researchable problem inthe nursing profession, outlines the research questions that areappropriate, and explains the rationale, as well as the researchablevariables. Moreover, the paper will outline the keywords that are tobe used in the literature search. Regarding this, the research willuse evidence-based approach to explore the side effects of painmanagement medication, while profiling the alternative approaches inalleviating pain on patients.
of the Problem
Theresearch problem that is identified concerns pain management in thenursing profession. Concerning this, in the nursing profession,patients that are admitted in the hospital after operation are oftenadministered with pain relievers, which vary depending on variousfactors (Hegartyetal., 2014).Regarding this, pain relievers are broadly categorized asantidepressants,antiseizures, and steroids. Antidepressants are aimed at improvingthe sleep, as well as alleviate pain anti-seizure are useful inmanaging pain that concerns nervous system, while steroids alleviateinflammation and pain (Aschet. al, 2013).However, the continued use of pain relievers among the operationpatients is proposed to have negative effect on them as shall bedemonstrated in the research (Moriarty,McGuire, & Finn, 2011).As such, from the study herewith, it may be possible to unveilwhether or not the use of alternate pain suppression methods is mostthe appropriate technique for alleviating pain from the operationpatients. The issue under investigation is of great significance tothe patients because operation patients are prescribed with largequantities of pain suppressors, which could lead to other healthproblems arising out of the nursing activities. Failure to addressthis issue adequately could have huge negative impacts on operationpatients that might occasion emergence of side effects relatedproblems that may culminate into chronic ailments and healthconditions.
Theproposed questions relate to various issues that revolve around theuse of pain relievers by operated patients. The questions are:
What is the average duration taken by operated patients to recover from their inflammations?
What are the various categories of the pain relievers that are administered on the operated patients until they recover from their wounds?
Are prescribed medications doing more harm than good for the operated patients?
Do operated patients exceed the recommended daily intake of the active ingredients in the pain relievers?
What are the possible alternative pain suppression mechanisms other than through medication?
Themost appropriate research question based on the significance,feasibility, and interest becomes “Are prescribed medications doingmore harm than good for the operated patients?” In this case, theproposed question herewith is feasible because it may encompass theuse of evidence-based approach in exploring the various merits anddemerits of medicinal pain relievers. Regarding this, the question isbroader than others and the ultimate answer is aimed at providingsolutions that would benefit the operated patients from developingother health conditions due to the nursing practice of administeringmedicinal pain relievers. Moreover, the question has highersignificance as it seeks to establish a straightforward problem thatelicits responses on the most appropriate method of relieving pain.
Inthis research, the proposed population encompasses the people whohave undergone surgical operations and hospitalized for more than aweek, while under the administration of pain relievers for asignificant duration. On this case, in a bid to intervene, theresearcher should seek appropriate literature on the use of medicinesin pain relieving before seeking empirical data to prove thehypothesis in line with the suggestion by Grove,Burns and Gray (2014). Indoing this research, the study hypothesis is that the demerits ofmedicinal pain relievers on operated patients outweigh the merits. As such, the researcher will compare the benefits of using medicationas pain relievers against the demerits to make a conclusion. Theoutcome of the research will entail either accepting or rejectinghypothesis before forming the recommendations.
NSAIDs (non-steroidal anti-inflammatory drugs),
LiteratureReview: Pain Management
Innursing, palliative care is the provision of health attention with afocus on preventing or managing the pain of a patient. Inherently,this approach is usually recommended for individuals that arediagnosed with terminal illnesses characterized by immense pain suchas cancer. In clinical practice, one of the most common means ofmanaging ache in patients is the prescription of pain managementdrugs such as painkillers and anti-inflammatory medicines. Inessence, the use of pharmacological agents to manage pain has been inuse in health care for many years however, various literatures haveascertained that the long-term application of certain pain managementdrugs results in different side effects, which, sometimes, might besevere. Fundamentally, this paper reviews diverse literatures thatdiscuss the side effects of pain management drugs, as well assuitable alternatives.
Prevalentresearch shows that drugs are the most common option for managingpain in medical institutions. Examples are non-steroidalanti-inflammatory agents, painkillers such as aspirin, acetaminophen,and antidepressants among others. Although non-steroidalanti-inflammatory drugs (NSAIDs) are effective for relieving pain,inflammation, and fever, they have a variety of side effects that maydiffer in people (Ferriolo& Conlon, 2012).Correspondingly, themost common side effects of these pharmacological agents includestomach upsets, indigestion, and stomach pain in severe cases. Othereffects are gastro intestinal ulcers and renal impairment. Similarly,when painkillers are used for a long time or abused, they elicit anumber of unpleasant side effects in the user. Mild effects arevomiting, nausea, and diarrhea these all result from the interactionof the drugs with the opioid receptors that are found in thedigestive tracts of those individuals. Besides, aspirin has beenfound to elicit nausea, as well as a severe redness of the eyes inindividuals who are below 20 years. Another serious side effect ofthe use of pain management drugs is dependence when people use themedicines for a long time, they experience withdrawal effects such asgastrointestinal discomfort and nausea when they do not use them.
Kauppinen-Räisänenet al. (2012) explain that pain-relieving analgesics comprise thelargest growing OTC products in the markets. With the changinghealthcare market, more people are expected to take charge of theirhealth, which has increased the rate of self-medication. According toTurek and Owczarek (2014), painkillers and anti-inflammatorymedicines belong to a category known as over the counter (OTC) drugs,which comprise pharmacological agents that can be sold to someonewithout a prescription. Consequently, the unregulated purchase anduse of OTCs has facilitated the recent upsurge of the side effects ofpain management drugs. Intrinsically, the aforementioned side effectsoften result from the long-term use of over the counter (OTC)painkillers and OTC non-inflammatory drugs. Fischer, Jones, and Rehm(2014) also note that the use of OTC pain relief medication hasescalated to dangerous levels within Canada. In effect, they stressthe need for pain relieving interventions that will replace thepharmaceutical agents hence, containing the situation.
Notably,there are alternatives to the pharmacological relief of pain.Ferriolo and Conlon (2012) point out that techniques such asacupuncture and massage therapy have been shown to be effective atrelieving back pain. Additionally, spinal manipulation is alsomoderately effective at managing both chronic and mild back pain. Inthis regard, Ferriolo and Conlon (2012) recommend them asalternatives to the more common OTC painkillers and OTCnon-inflammatory agents. Nevertheless, they explain that thecost-effectiveness of these methods has not been defined yet hence,these options are not usually regarded as first-line measures.
Fundamentally,physical and behavioral therapy are good substitutes for painmanagement drugs as they do not induce dependence or other sideeffects, yet they are effective for relieving pain in individuals.Carter and Stratton (2011) explain that physical exercise has beenproved particularly helpful in the management of lower back pains. Inthis regard, they recommend physical therapy as a suitablealternative to the use of pharmaceutical agents in pain relief.
Conclusively,many research materials document the side effects of the long-termuse of pain management drugs. Nevertheless, most of them seeminglyfocus on the effects of painkillers and non-inflammatory agents, asthey are readily available over the counter in any part of the world.Examples of the side effects of prolonged pain managementpharmaceutical use include diarrhea, nausea, and reddening of theeyes among others. These effects are usually caused by theinteractions of the drugs with the opioid receptors in the body ofthe user for instance, when the aspirin reacts with the opioidreceptors of the gut, they lead to stomach pain or discomfort.Interestingly, other researchers have acknowledged the potentialdangers of excessive use of drugs in pain management. Consequently,they have proposed physical therapy as a suitable alternative.Examples of the proposed replacements for pain management drugsinclude massages, acupuncture, spinal adjustments, and physicalexercise. Intrinsically, these methods have been shown to work in therelief of lower back pain.
Thepaper used a generic qualitative approach to investigate how peoplemake sense and explain their experiences of health and illness.However, to a novice qualitative researcher, working with thetechnique may be challenging due to the broad and diverse qualitativemethods. Nonetheless, the authors point out that making an informeddecision about a study’s design, adopting the underlyingprinciples, similarities and differences of the primary qualitativemethods, as well as their use to the topic under investigation, isessential (Smith, Bekker & Cheater, 2011). According to theresearchers, there are many terms used in the description ofqualitative research. For instance, it can be either ‘generic’ or‘descriptive.` However, a consistent ‘generic research’ will beutilized to represent qualitative techniques not based on aparticular theoretical perspective. The study sought to explain theissues faced by a researcher when designing a qualitative study byfocusing on the experience of parents living with hydrocephaluschildren.
Inthis type of research, there arise both ethical and practicalmatters. It happens when respondents desire to continue with thestudy intervention once the research is complete. There is acompelling moral responsibility of ensuring that participants(parents of children with hydrocephalus) are offered appropriate careafter the study. Nevertheless, the controversy may appear overwhether and when participants in a productive study can have accessto the research or the intervention. At one end of the spectrum,there is a belief that it would be beneficial if continuous access tothe research intervention is allowed particularly when it ends upassisting the participants or proves efficient and safe regardless ofthe burden and cost (Houghton, Casey & Murphy, 2010). At theother end, there is the notion that constant access to the studyintervention should not be provided so long as it was sufficientlydisclosed during the selection of the respondents.
Therealso appears to be a conflict whether or not the study interventionwill be relevant. The scope ranges from the perspective that theresponse is essential for a proposed application only if stakeholdersembrace opinions that use a much-reduced standard of proof (Houghton,Casey & Murphy, 2010). Moreover, it is hard to authenticate theview that respondents’ mere impression of benefit entitles them tolong-term access to the research intervention. More so, the researchfailed to illustrate the practicability of the intervention despiteintegrating results with findings from previous studies or provideconcrete proof that the proposed intervention was the best.
HowQuantitative Design Would Have Affected the Research
Unlikethe qualitative design, quantitative one mostly concentrates onsubstantiating relationships between dependent and independentvariables (Polit & Beck, 2011). The study only targets to explainthe experiences of parents with hydrocephalus children. In case aquantitative design (for example, non-experimental) was used, itwould have forced the researcher to differentiate and explorecorrelations hence, changing the nature of the research. Inaddition, there would be no control groups and variable manipulationsince the quantitative technique concentrates entirely onobservations.
Methodsof Data Collection
Anideal data collection method is one that is clear, reliable,unbiased, and valid. It must be able to produce evidence to answerthe research questions and the test hypothesis. The appropriateinformation collection technique for the scenario is primary datacollection method, that is, questionnaires and interviews. Secondarydata collection methods that can be used include analysis ofstatistical abstracts, care plans, and patient medication reportsamong others. (Chaleunvong,2013). To obtain responses from the participants, questionnairescan be distributed among them. After distributing the questionnaires,the respondents should be given ample time to fill themappropriately. Interviews are another way of collecting data. Usinginterviews to gather data provides an opportunity to the respondentsto speak out what they have in mind verbally other than in writing.Open and closed-ended questionnaires are an important instrument ofcollecting data. The closed-ended questionnaires will require theparticipants to reply with answers like I agree or disagree whilefor the open-ended questionnaires, spaces are provided for therespondents to inscribe their views. Face to face interview can proveto be an important tool in data collection.
Theactual target consisted of 10000 respondents. The population will besubjected to random sampling to give each respondent an opportunityto participate in the research process. Stratified random samplingtechnique can be used to select categories from a list of thetargeted population. This entailed isolating the sample populationinto smaller groups and then picking a participant from eachsubcategory (Weiss& Weiss, 2012).A total of 100 respondents will be selected and issued withquestionnaires to fill and express their opinions in issues regardingease of accessing healthcare, friendliness of the staff, and patientwait time. A sample size is a representation of the target populationthat the researcher focuses on in the study. The sample size wasselected based on the researcher’s view that there was a need tooffer important information required in the study. The sample size isdetermined using the equation below:
n=(Nh/N)*n)/nh(Weiss& Weiss, 2012)
Wherenh= sample size for the stratum, Nh= population size for the stratum h,
N= total population size, and n = total sample size.
Howto Ensure a High Standard of Reliability and Validity
Tocheck on the validity of the data collection tools, specificquestions that were incorporated in the questionnaire are aimed atcapturing specific information about the respondents. Thesequestionnaires were sent to the respondents to fill and were thensubmitted for proper evaluations(Gagnon,2010). Apre-test was also done on the questionnaires, which guided theinterviewers during the interview. A selected sample of therespondents and the data collected was evaluated. The pilot study wasconducted to pretest the approaches and the data collection toolsused.
Toensure high standards of reliability of the data tools, the designedquestionnaires were given to some selected sample of respondents andthen the information gathered was gauged to measure theirreliability. The same approach was applied to the interview guidethat was used to interrogate the selected sample respondents andevaluation of the data collected followed. The collection of data inbulk ensures that the collected information is an accuraterepresentation of the actual situation under study. The data canfurther be amended, coded, and categorized to present the results ofthe data analysis in a systematic and proper way.
Questionsfor Gathering Information
Part1. Closed-ended questions
Howstrongly do you agree or disagree with the following statements
1= strongly agree 2 = agree 3 = not sure
4= disagree 5 = strongly disagree
I find the doctors to be good when explaining the aims for taking medical tests
There are certain areas regarding the healthcare, which I receive that need to be improved
Part2. Open ended questions
Do you have ease of access to the medical specialist that you need?
Where you receive medical care, do people wait for so long to be served?
Does your doctor treat you in an approachable and polite manner?
Ethicsare sets of moral values that direct and control individuals’behavior in professional undertakings. Research studies are governedby laid down guidelines that allow the researchers to work in thebest interests of all stakeholders (Cutcliffe & Ward, 2014). Theprescribing placebos case involved a woman called Ms. Wood. This caseraises issues concerning the ethicality of prescribing placebos.Prescribing placebos involves administering “fake medicine” to apatient without revealing the information to them. Ms. Wood isoverweight and has been suffering from chronic hypertension. As aresult, she has also been experiencing fatigue and depression. Thedoctor attending to her is an intern who works for a couple of daysper week in the clinic. Ms. Wood complains of severe fatigue andabdominal discomfort. Dr. Marshall and Dr. Gibson advise Ms. Wood toseek the help of a qualified psychiatrist, but she refuses to see thespecialist fearing she might lose her life insurance. Instead ofagreeing to see a psychiatrist, Ms. Wood begs Dr. Gibson to prescribemedication to her to boost her overall energy. However, since therewas no established cause of this condition, Dr. Marshall who is theattending doctor revealed that he had been administering vitamin B-12to her, but Ms. Wood was not informed.
TheMain Ethical Issues Involved
Inthe above case, fundamental ethical principles were infringed. Thetwo physicians deceived Ms. Wood by prescribing medicines to producethe placebo effect without seeking her approval. Dr. Marshall advisedthe patient to exercise regularly in a bid to boost her energy, cutweight, and relieve stress. Dr. Marshall went ahead and gave hervitamin B-12 injection. Vitamin B-12 is administered to patientswhose diagnostic tests show deficiency of this element. The mainside-effects associated with the injection of vitamin B-12 includediarrhea and fatigue. Vitamin B-12 also lowers the amount ofpotassium in the body, which increases the risk for hypertension.Since the patient was already diagnosed with chronic hypertension,administering vitamin B-12 to her might have caused detrimentaleffects on her health.
Althoughprescribing placebos produces positive outcome on the patient’shealth, particular ethical matters must be observed. The main ethicalconcern that arises in the prescription of placebo medication iswhether physicians have autonomy to administer placebos withoutseeking the patients’ approval (Miller, 2012). Placebos might causeundesirable side-effects thereby putting the patient’s health injeopardy. Deception is the main ethical issue that arose inprescription of placebos (Brown, 2013). Prescribing placebos withoutinforming the patient damages the patient-doctor relationship. Thisis characterized by lack of trust, which reduces the patient’soutcome. In the above case, Dr. Marshall deceived Ms. Wood since hehad been giving her vitamin B-12 injections without her consent. IfMs. Wood found out that she had been getting vitamin B-12 medication,it would have tarnished her relationship with the doctor. She wouldhave even opted to cancel visits to the clinic. This would havedeteriorated her wellbeing. In a bid to minimize the ethical problem,Dr. Marshall should have informed Ms. Wood that it was necessary toadminister vitamin B-12 to boost her energy. Dr. Marshall should haveadvised her to exercise and take vitamin B-12 supplements. This wouldhave minimized the ethical problem.
Toformulate a research, it is imperative to identify the eminentproblem that should be resolved through proper research andliterature review. To do this, the researcher should identifynumerous questions revolving around the research problem beforenarrowing down to the most feasible and significant ones. As such,there should be adequate rationale that defends the research questionto be resolved while establishing the measurable variables thatshould be incorporated in the study.
Ethicsshould always be upheld, especially in the nursing profession tomaintain a proper working relationship. Administering medication topatients without seeking their consent is seen as deception.Deception can tarnish the patient-physician relationship sincepatients will lose trust and doubt the professionalism of theirprimary care givers. This in turn can be detrimental to the patients’outcome. Accordingly, it is appropriate in the exploration ofcomplicated issues to acquire insights and deeper understandingconcerning the patients experiencing the phenomena (Pringle, Hendry &McLafferty, 2011). However, selecting a practical research approachcan be challenging. Therefore, it would be fitting for a noviceresearcher to weigh the designs based on merits and demerits andafter that make a choice.
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