Discuss about the Assessment of Pain for Community of Aboriginal.
1. Mr. Smith is from the community of Aboriginal and Torres Strait Islander people. As pain assessment is difficult in these people. Pain assessment in Mr. Smith is influenced by his culture. Because people of community from which Mr. Smith belongs, feel embraced to express their pain and are hesitant to give trouble to healthcare professional about their painful condition. Nurse should develop trust relationship with Mr. Smith as he is not willing to open up with painful condition. With this trust relationship nurse can assess pain of Mr. Smith very effectively. Nurse should understand family, culture and community of Mr. Smith to assess his pain. Nurse should make Mr. Smith understand importance of pain management medicine (Queensland Health, 2015).
2. Assessment, caring and management of Mr. Smith was completely holistic. Social and cultural aspects of the Mr. Smith were kept in mind while assessing pain of Mr. Smith, however nursing practice was completely non-judgmental. Social and cultural aspects were considered in case of Mr. Smith because community of Aboriginal and Torres Strait Islander people from where he belongs, have different view on nursing and medical care.
Following are the code of ethics related to the non-judgmental nursing care in Mr. Smith situation.
Nurses value informed decision-making.
Nurses value ethical management of information.
Nurses value a socially, economically and ecologically sustainable environment promoting health and wellbeing
Following are the code of professional conduct related to the non-judgmental nursing care in Mr. Smith situation.
Nurses respect the dignity, culture, ethnicity, values and beliefs of Mr. Smith and treatment, and of their colleagues.
Nurses maintain and build on the Aboriginal and Torres Strait Islander people community’s trust and confidence in the nursing profession.
Following are the EN Competency Standards related to the non-judgmental nursing care in Mr. Smith situation.
Practices nursing in a way that ensures the rights of the people are upheld.
Provides skilled and timely care to people receiving care and others while promoting their independence and involvement in care decision–making (Nursing and Midwifery Board of Australia, 2016).
3. Pain assessment questions (Breivik et al., 2008):
What makes pain worse?
What makes pain improved?
What is earlier medicine for pain?
Whether these medicines were effective?
What is way of expression of pain?
Since how long pain is there?
What is the frequency of pain?
Is there change in intensity of pain at different time points?
How much duration pain lasts?
Mental and emotional status (Mabbett, 1996):
What is today’s date?
What is month and year?
Where is your birth place?
What is your name?
What is your school name?
What meal you took yesterday?
What you did last Sunday?
What is state capital?
Social and cultural issues (Cammock et al., 2014):
With whom can disuses care and management?
Would like to take someone’s help in decision making?
Whose help required?
Do you follow any spiritual practices or prayers?
Is there requirement of any spiritual articles?
4. Advance health directive is a document Mr. Smith can fill. This document mentions Mr. Smith’s requests and instructions for future health management practices for any health condition. This document comes into picture, when Mr. Smith unable to make any type of decisions about his health (Docker, 1996).
Mr. Smith should give Enduring power of attorney to someone to facilitate the disposal of his property, dealing with his financial matters, signing documents on his behalf and purchasing on behalf of him. Mr. Smith should be informed that Enduring power of attorney would not interfere in his personal care (Mitchell et al., 2014).
Mr. Smith can donate his organs either when he is alive or after his unfortunate death. These organs can be transplanted in the person and this can save the life of recipient’s life. Mr. Smith should know that organ donation is not a forceful act and it is completely depends on his will (Berntzen & Bjork, 2014).
5. Complementary therapies for pain in palliative care includes music therapy, relaxation, massages, aromatherapy massage and foot reflexology. Music therapy aid distraction of Mr. Smith form the pain and uses vibro-acoustic stimulation. Music therapy includes relaxation of muscles and calming down Mr. Smith. Massage therapy lessen wear and tear of muscle and muscle strain. Massage therapy also reduces anxiety in Mr. Smith. Aromatherapy massage has added advantage of incorporating mind-body element and utilizing aroma odor to produce soothing effect on mind and relaxation. Foot reflexology is a component of massage therapy which is mainly focused on the foot of Mr. Smith. Acupuncture also proved to be beneficial in the pain management Mr. Smith (Crawford et al., 2014).
Mr. Smith should be refereed to specialized doctors in gastroenterology, nephrology and psychiatry. As Mr. Smith is going through many problems related to gastrointestinal system. He is unable to empty his bowl so that doctor can give suitable medication or suggest any other suitable method to empty his bowl. Also he is having stomatitis so that doctor can prescribe some medicine or suggest some external application to lessen severity of ulcer. Mr. Smith also should be referred to nutrition expert as he is not willing to eat food. In such scenario, nutrition expert can suggest suitable food for condition and to maintain optimum level of nutrient level and to prevent dehydration. As Mr. Smith is suffering through incontinent of urine at night, he should be referred to doctor specialized in nephrology. As he is facing problem in sleep, he should be referred to psychiatrists (Mehrotra et al., 2011).
7. Family members of Mr. Smith should clearly make aware of the exact condition of the him. With the help of nursing staff, family members of him should be advised to take care of him, so that they can realize and understand exact condition of him. So that they can be mentally prepared to accept whatever may be going to happen with Mr. Smith. As Mr. Smith is willing to meet his children, family members should do all the actions to make him happy and he should feel comfortable. Most importantly, family members should not feel guilty for the condition of Mr. Smith because his lifestyle and behavior are mainly responsible for his current condition (Hebert et al., 2011).
8. In anorexia there is the increase in the angiopoetin-like protein 6 (ANGPTL6). In anorexia there is the deficiency of protein due to continuous starvation and this leads to the multiple organ failure like heart, gastrointestinal tract, reproductive organs, kidney and brain. Due to this Mr.Smith is feeling dehydration. Management for anorexia involves feeding with suitable meal, psychological therapy to change his mind for eating and medication like fluoxetine.
In ascites, due to portal hypertension, there is the abnormal sequestration of the fluid in the splanchnic bed. This leads to the reduced circulating blood. As a result sodium and water retention occurs due to sympathetic system activation and rennin release. Consequently, there is the accumulation of fluid around abdominal cavity. This reflects in Mr. Smith as he has abdominal distension. Sodium restriction and diuretic therapy are advised for the patient with ascites.
Dyspnoea occurs due to the interaction between different systems like respiratory system, cardiovascular system, neural system, and oxygen carrying system. In case of respiratory system abnormality in the alveoli gas exchange and central control of ventilation leads to dyspnoea. In Mr. Smith, dyspnoea reflects in his breathlessness and continuous requirement of oxygen. Management of dyspnoea includes oxygen therapy, beta agonist, opioids and sometimes anxiolytics.
Hiccups occurred due to the abnormality (involuntary contraction) in the hemidiaphragm. Due to contraction of diaphragm and subsequent closure of vocal cord, it produces sound like ‘hic’. Frequency of hiccups alters in inverse proportion with arterial carbon dioxide tension. Hiccups are clearly evident in Mr. Smith. Management of hiccups includes chlorpromazine, metoclopramide, muscle relaxants and sedatives (Hammer & McPhee 2014).
9. Mr. Smith is having breathlessness and he is having Ventolin nebulisation to prevent bronchospasm. By seeing at the data it is evident that most of the organs of the Mr. Smith are affected or deteriorated. It reflects for the ascitis, pruritus, severe mouth ulcer, bowl not opened since several days, uncontrolled urination, severe pain, agitated and confused state. In case of deterioration of multiple organs, it would be difficult to treat the patient. Because treatment for organ may affect the functioning of other organ. As in the case of ascites, diuretic is a recommended therapy. However, in case of Mr. Smith he is already facing problem of incontinent urination. Also he didn’t opened bowl for several days and there is the accumulation waste in the body. Due to ulcer in the mouth and Mr. Smith’s disinterest in eating, he is not taking proper food and he is lacking nutrients. All these conditions reflects, Mr. is at the end stage of life (Springhouse, 2006).
Palliative care: Palliative care is specific healthcare system specialized for the patients with chronic illness. This system doesn’t focuses on the complete cure of the patient, however it aims at relieving patient from symptoms of the illness and medical and physical stress due to the disease condition. Main goal of the palliative care is to improve quality and wellbeing both patient and family members. Team of palliative care includes doctor, nurses, physiotherapists, occupational therapists and social workers (London et al., 2005).
11. Drowsiness - In this stage patient always feel sleepy and lethargic.
Becoming unresponsive - Patient become unresponsive to the external world.
Disorientation - Patient becomes confused about routine aspects like time and date, recognisation of family members.
Loss appetite - Patient lost interest in eating and subsequently loss of appetite. This is due both impaired physiology due to diseases state and depression due to disease.
Bowl and bladder dysfunction - Bowl and bladder of patient cannot work according normal physiology.
Changes in sensitivity of skin - Skin becoming more sensitive or senseless due to multiple ailments.
Dyspnoea - Patient become breathless. (Springhouse, 2006)
12. General support to the well being of the patient. It includes physical, mental, social and cultural care of the patient. Rehabilitation to the acute episodes of the pain to feel comfortable to Mr. Smith. Try to keep complications in control. Try to minimize anxiety, depression and fear due to the illness. Make understand family members real condition of Mr. Smith and advise them to give warmth and comfort to Mr. Smith at the end of life. To make Mr. Smith and family members emotionally and psychologically stable. Try to fulfill every wish of Mr. Smith. Provide nutrients and oxygen to Mr. Smith as much as possible. Continuously monitor vital signs of the Mr. Smith (Springhouse, 2006).
Breivik, H., Borchgrevink, P. C., Allen, S. M., & Rosseland, L. A. (2008). Assessment of pain.
British Journal of Anaesthesia, 101(1), 17-24.
Berntzen, H., & Bjork, I.T. (2014). Experiences of donor families after consenting to organ donation: a qualitative study. Intensive and Critical Care Nursing, 30(5), 266-74.
Cammock, R.D., Derrett, S., & Sopoaga, F. (2014). An assessment of an outcome of injury questionnaire using a Pacific model of health and wellbeing. New Zealand Medical Journal, 127(1388), 32-40.
Crawford, C., Lee, C., Freilich, D., & Active Self-Care Therapies for Pain (PACT) Working Group. (2014). Effectiveness of active self-care complementary and integrative medicine therapies: options for the management of chronic pain symptoms. Pain Medicine, 15(1), S86-95.
Docker, C. (1996). Advance Directives/Living Wills in: McLean S.A.M., Contemporary Issues in Law, Medicine and Ethics. Dartmouth.
Hammer, G., & McPhee, S.J. (2014). Pathophysiology of Disease: An Introduction to Clinical Medicine Flash Cards. McGraw-Hill Education.
Mabbett, P. D. (1996). Delmar’s Instant Nursing Assessment: Mental Health. Albany, NY: Delmar Publishers.
Hebert, K., Moore, H., & Rooney, J. (2011). The Nurse Advocate in End-of-Life Care. Ochsner Journal, 11(4), 325–329.
London, M.R., McSkimming, S., Drew, N., Quinn, C., & Carney, B. (2005). Evaluation of a Comprehensive, Adaptable, Life- Affirming, Longitudinal (CALL) Palliative Care Project. Journal of Palliative Medicine, 8(6), 1214–1225.
Mehrotra, A., Forrest, C.B., & Lin, C.Y. (2011). Dropping the baton: Specialty referrals in the United States. Milbank Quarterly, 89(1), 39–68.
Mitchell, L.K., Pachana, N.A., Wilson, J., Vearncombe, K., et al. (2014). Promoting the use of enduring powers of attorney in older adults: a literature review. Australasian Journal on Ageing, 33(1), 2-7.
Nursing and Midwifery Board of Australia (2016). Retrieved form
https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Codes-Guidelines.aspx on 3rd September 2016.
Queensland Health. (2015). Sad News, Sorry Business: Guidelines for caring for Aboriginal and Torres Strait Islander people through death and dying. Retrieved from https://www.health.qld.gov.au/atsihealth/documents/sorry_business.pdf on 3rd September 2016.
Springhouse. (2006). End-of-life Care: A Nurse's Guide to Compassionate Care. Lippincott Williams & Wilkins.