1.Identify the most obvious similarities and differences between your chosen policy, or procedure or protocol.
2.Discuss using evidence why you believe one of these policies, or procedures, or protocols is more rigorous than the other.
3.Focuss on the differences suggest possible reasons why this might be the case – eg: cultural differences, a new Organisation as opposed to an old one, size of the organisation, relevance of the policy to the organisations client base, resources available to the organisation etc.
Pain management is a very crucial area of healthcare services and is gaining more importance in the relevant field with each passing day. The upsurge in the rate of complex incurable sickness globally is demanding for more alternate pain management procedures to be implemented. This is particularly useful in coping up with the challenges faced in end-of-life palliative care. In this respect, people suffering from diseases such as cancer often have to go through aggressive treatment methods. This sometimes results in unbearable pain in the patients and need to appropriate mitigation strategies. Additionally, people suffering from diabetic neuropathy often secondary rheumatoid arthritis making movement difficult for them.
1.Similarities and differences between chosen procedures
The alternative pain management strategies are used in conjunction with conventional medicines and are known as complimentary medicine. Some of the common procedures of alternative pain management strategies are –aromatherapy, yoga, acupuncture, relaxation and herbal remedies. The overall goal of the application of alternative pain management strategies is to promote overall healing of the mind and body. The method implies a rather holistic aspect is implemented, where much of the emphasis is given to physical and mental well being of the people. Some of the interpersonal attributes such as compassion and care need to be placed in the middle of the strategy. However, both the approaches are person-centred and provide sufficient power and autonomy to the patients in deciding their chosen methods of care.
For the current study, we have chosen alternate pain management, which is based upon a number of procedures. Here, we have focussed upon pharmacological as well as non-pharmacological procedures. The pharmacological pathway is mainly dependent upon the administration of medicines and injections for controlling pain in the patients. On the contrary , The non-pharmacological pathway is mainly focussed upon the holistic care approaches for relieving the acute symptoms in the patients.
The patients suffering from spinal and musculoskeletal problems may be provided with physiotherapy treatment methods. Some of these include spinal and extremity manipulation, functional training, therapeutic exercise. Additionally, patient education and counselling can also help in the management of the symptoms of pain though behavioural manipulation (Argoff, 2014). This is also known as biofeedback where the patients are given more control over their body and relative pain management by manipulating their response or behaviours.
However, for acute pain management some of the effective medications which could be followed are non-steroidal anti-inflammatory drugs, mild and strong opioids. These are generally used for the control of excessive pain in patients suffering from tumours and other similar situations. As argued by Chou et al .(2016), insulin administration two times a day to keep blood glucose levels in control often becomes annoying for the patients.
Therefore, providing them with alternate medical strategies and solutions helps in reducing the health restrictions. Some of the alternate non-pharmacological therapies which can be used for regulating the daily health condition of the patients are light walking and jogging exercises. In this context, conditions such as diabetes are often seen to be associated with aggravated conditions within the patient, which results in swelling of the hands and legs. As commented by Trail-Mahan et al. (2013), light exercises have been seen to increase the levels of serotonin and dopamine in the patients, which act as a mood elevator. However, for the handling and management of pain in palliative or end of life care non-pharmacological interventions alone are not sufficient and need extensive drug therapy over longer periods.
2.Comparison of the procedures
The study further compares the two different approaches to pain management which are pharmacological and non-pharmacological approaches. In order to compare the two intervention methods, we need to study the methods in detail.
Non-pharmacologic pain management
The non-pharmacologic intervention reduces the dependency on analgesics along with reducing the plausible side effects. There are a number of additional benefits of using alternate and non-pharma intervention strategies. Some of these are improving mood, reducing anxiety within the patient population, providing the patient with more autonomy. The choice of therapy is fixed depending upon a number of assessments such as type of the pain, duration of the pain, severity of the pain, the preferences of the patient and their respective family members (Volkow and McLellan, 2016).
Based on these three different approaches have been discussed over here which includes the psychological approaches, physical rehabilitative approaches, surgical approaches. The aim of the incorporation of such methods is to provide the patients with additional stability.
The psychological approaches include providing cognitive behavioural therapy, biofeedback, relaxation and psychotherapy. One of the most used and understated alternative pain management approaches used is biofeedback. The method is used by psychologist to analyse the psyche of patients who feel vulnerable and weak. The sophisticated biofeedback instruments allow the clients to see subtle changes in their physiological activities. The computerised programs allow the patient to understand their reactions to internal and external stressors. The external stressors include pressure at work, whereas the internal stressors include the burden of our own thoughts and perceptions. As asserted by Deyo (2015), such analysis helps the patients in gaining better control over some of their daily set of activities such as breathing, heart rate, muscle tension.
The cognitive behaviour therapy, on the other hand, allows the patient to focus on the larger picture. It is based upon distracting the attention of the patient to more positive stuff such as hobbies, spending time with the loved ones and families. Some of the relaxation techniques which could be applied over here are deep breathing which controls the level of the flight hormone and reduces the sensation of pain in the patients. However as argued by Schug and Goddard (2014), providing the patients with mild anti-depressants could also help in producing a calming effect in case of acute pain. Therefore, cognitive behavioural therapies alone are not sufficient for effective pain management in the patients.
The physical rehabilitative approaches are mainly based upon inculcation of light exercises within the daily routine of the patients. As commented by Schreiber et al. (2014), such methods are effective in pain management in chronic non-cancer pains (CNCP). In this respect, posture training and ergonomics of healthcare units are also taken into consideration for providing the patient with better care and relieving the pain of the patients.
The surgical approaches are provided in utmost cases where both the pharmacological and the non-pharmacological methods fail to provide sufficient support to the patients. In the context of tumour removal, the growing undifferentiated mass of tissue may be building constant pressure against the nerves. This results in the development of acute pain within the patients and could be only cured with the help of surgical interventions. However, as argued by Gelinas et al.(2013), the intervention of the least invasive surgical approaches have helped in the reduction of anxiety in the patients regarding the pros and the consequences. Some of the sophisticated methods such as laparoscopy and sonication have been found to be effective in removing tumours and eradicating tumour related pain (Jensen and Turk, 2014). The surgeries are often followed by parallel administration of opioids for after surgical pain management.
Pharmacological pain management
The pharmacological pain management can be divided into several types based on the type of pain and the particular kind of drugs used for controlling the pain. The discussion has been based upon the commonly used drugs and the general procedures followed for determining the drug doses. The drug could be divided into several classes such as non-opioid analgesics, opioid analgesics and co-analgesics. The non-steroidal analgesics include acetaminophen non-steroidal anti-inflammatory drugs. Some of the core medicines which belong to this group are aspirin and salicylic acid derivatives. These have been known to reduce the sensation of pain in the pain in the patient temporality and are applied locally.
The opioid here are a class of drug derived from opium poppy and are prescribed for the management of pain in the patients (Chou et al. 2016). This class of drugs have been seen to produce a variety of symptoms in the patients such as mild confusion or drowsiness to hallucinations in the extreme cases. Therefore, the opioids are often balanced with light physical exercises and active daily routines, which reduce the tendency of dependency on medicine alone. As asserted by Volkow and McLellan (2016), high incidents of opioid neurotoxicity have called for alternative alternate solutions or strategies.
In this respect, some of the non-opioid medications have been found to be effective in controlling and reducing pain in acute and chronic conditions such as pain due to cancer, arthritis, postoperative pain. Some of the examples of non-opioid medications are paraminophenols, salicylates (aspirin, diflunisal), propionic acid derivatives (ibuprofen, naproxen, flurbiprofen). The acetophinomen acts via a central mechanism and produces effects within minutes to hours. However, as argued by Gelinas et al. (2013), both the opioids and the non-oipoid acts through different mechanisms. Therefore, a combinatorial effect is required along with light physical exercises and intervention approaches which produced much longer and viable effects. This is because dependency over the medicinal approaches alone can result in pseudoaddiction within the patients (Franklin, 2014).
A number of evidence can be stated over here for effective pain management within the patient population. Here, discussions with reference to both pharmacological and non-pharmacological methods have been done. In this respect, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has proposed standards, alternate measures and initiatives to improve pain management. The JCAHO guidelines stated that providing combinatorial pain management approaches to the patient helps in the quantification of the effects of a given therapy on the health of the patient (Simpson et al. 2014). The JCAHO standards have stressed upon appropriate pain management facilities for ambulatory care services, home care, hospitals and long-term care organizations. The need for the pharma and the non-pharma clinical approaches of pain management have been further justified through a set of guidelines:
- Recognise the right of patient to appropriate management and assessment of pain
- Screening the nature and intensity of pain in all patients
- Orientation of newly appointed staffs for effective pain management through pharmacological and non-pharmacological assessment methods including data keeping and active documentation.
- The patients and their respective families need to be educated regarding the pain control methods through cognitive and behavioural approaches
3.Differences between procedures
There lie a number of differences between the procedures for pharmacological and non-pharmacological intervention methods. The pharmacological methods are based upon direct administration routes in the form of tablets and blood administration through syringe. They result in fast and temporary relief to the patients in case of acute pain. However, there are limitations as constant syringe push might result in the development of pressure ulcers in the patients (Martorella et al. 2014). Additionally, constant dependence on medications produces effect such as pseudoaddiction in the patients. The pharmacological methods of treatment produce pain relief through mild sedative effects.
On the contrary, the non-pharmacological methods of disease control results in development of more agility in the patients along with bringing about a positive change in the health and pain perception of the patients. The non-pharma methods do not have plausible side effects and could be continued over long term along with prescribed pain management drugs.
The differences within the use and applicability of the procedures could be attributed to a number of factors such as cultural differences. As commented by Schreiber et al. (2014), the cultural beliefs possessed within a population often affect their health behaviours and approaches. In this respect, some of the indigenous Australians may prefer to use alternative medication approaches rather than rigorous drug therapies; which have potential side effect over the long term. In addition, change in the organizational approaches and policies often affect their manners of service delivery. In this respect some may follow a conventional mode of pain management with more emphasis upon physical methods such as exercises. Similarly, the size of the client base and the organizational resources are some other important factors. As commented by Gelinas et al (2013), resource limitation may impact upon the positive outcomes to be achieved by the healthcare unit.
The current assignment focuses on the aspect of pain management and emphasizes upon two distinct methods of pain control in acute and non-acute care. These are pharmacological and non-pharmacological intervention methods which are used together within the current medical context to relive the aggrieved conditions in the patient. The pharma based methods are mainly dependent upon the administration of medicines for controlling pain. These have often been found to be associated with a number of side effects. The alternative methods and approaches, on the other hand, provides a more holistic way out for long term pain management in acute conditions such as arthritis and other lethal conditions such as cancer. However, in some of the situations such as pain due to post operative concerns and tumours immediate surgical drug therapy is needed.
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