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Nursing Practice In Relation To Complex Pain Management

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Nurses make decisions in their profession that should take into account laws as well as ethical standards. Therefore, to make the necessary decision as a nurse, you should have a clear understanding on how the law, ethics and nursing practice works.  This essay addresses the nursing practice relating to complex pain management, pharmacology issues, and the patient-nurse relationship. It provides a compelling case study of Tom, a “55-year-old Aboriginal male with lung cancer and multiple metastases.” The Tom’s case study will be used throughout the essay to point out how legal as well as ethical factors affect the nursing practice. It will also look at how nurses should consider both aspects of legal &ethical issues when making decisions in the nursing practice 


Understanding Pain and Pain Management in Nursing

Pain is commonly experienced as well as widely expressed in the nursing field.  It occurs in up to 80% of patients having “advanced cancer” like the case of Tom as well as almost 60% of patients dying of other illnesses (Anderson and Devitt 2004).  With the availability of analgesics, there’s no pharmacological reason as to why cancer patients need to continue enduring pain. However, with the growth in the palliative care unit, pain managementt approach has been practiced in many hospitals so as to relieve both pain and anxiety in patients.  In the case study presented, significance to provide safe palliate care especially to the Aboriginal Australians is three core principles that should be practiced. First, there should be engagement with the Aboriginal groups as well as personal when planning, providing as well as monitoring palliates care. This will ascertain that the cultural requirements of the Aboriginals are addressed as well as the preferences of a patient or his families are looked upon. Some of the ways that can be used to engage Aboriginal societies include; referring to an Aboriginal Liaison health worker.  In the case study, the nurse, Sarah engages Nancy, an Aboriginal liaison officer on the issue of Tom. She asks for support as well as advice from the Liaison officer on how to go about caring for her patient plus his family.  Later on, they acknowledge the need for a traditional healer when Jimmy (Tom’s son) decides to call his uncle, where they plan for a teleconference meeting. Another core principle when communication with Aboriginal Indigenous Australians is to converse with the patient, relatives, and friends, Aboriginal health worker as well as communities in a manner that value the safety of their culture (Grace et al.2011). These communications may require the nurse to complete a detailed clinical assessment of the patient, shun from using medical terminologies as well as allocate more time for meaningful discussions among other requirements. All these requirements we have mentioned above are evident in the case study where Tom with his family as well as a nurse and the aboriginal health officer are discussing the assessment of Tom’s condition. Lastly, information should be provided to allow safe palliative care for the non-indigenous Australians. Through this, every healthcare worker including nurses should have cultural safety training. Also, workplace relationships, as well as a partnership with the indigenous liaison workers should be building so as to boost the practical understanding of the staff when it comes to providing safe care.

According to Liaw et al. (2011) Pain management entails different types of experiences throughout the life cycle of a person. These experiences can either be acute or chronic from the chronic worsening or pain a symptom of a patient receiving palliative care. Pain can either be psychological, emotional, physiological or spiritual. In the nursing practice, it should be noted that every patient has right to receive effective pain management. Pain assessment as well as management is essential for alleviating excruciating pain.  In managing pain, nurses use pharmacological or non-pharmacological techniques to ease the pain the patient is going through. Management of pain by older people might be a complicated process because of the alteration in diminished pain sensation as well as consciousness, which might make it hard for the patient to converse with his family members about the extent of pain as well as the adequacy of managing it. Wynne et al. holds that, a drug history is necessary for treating pain, especially for the older patients since they might be on different medications. This is because it’s necessary to avoid drug interactions as a registered nurse. Besides, pain management techniques aren’t invasive although invasive techniques such as the use of locally made anesthetics might be applied in some instances (Pereira 2017).  


Palliative Care and Pain Management

A study published in the “England journal Medicine” showed that palliative care aids in managing symptoms and ease pain. It is also vital for cancer treatment especially for individuals with metastatic lung cancer. The same study showed that people who had palliative care that was offered immediately after being diagnosed with cancer suffered little depression were hard to get the end of life care, and most important of all, lived longer. Metastatic cancer implies that the cancer was caught late and it has spread to other parts of the body such as the heart, the brain, and the bone thus making cancer inoperable as well as incurable. However, there are some medications that have been found to prolong the lifespan if the patient for months and some for a few years. Unfortunately most of these, treatments have adverse side effects since they entail radiation treatment daily and do not even provide relief for the late stage lung cancer. Another study published in the medical journal focused on patients with lung cancer as well as difficulties breathing. In the case study used in this essay, the nurse noticed that his patient has difficulties in breathing and that his condition had worsened from the last time he came to the hospital. In the second study mentioned above, 50% of the patients were given breathlessness support devices while the other patients were not (Vos et al. 2009). The support services entailed respiratory medicine, occupational therapy, and palliative care. Seven months later, it was realized that the patients who received the support devices had less trouble breathing plus were much likely to be alive. Such devices helped those patients breathe easily. However, they only improved the survival period for patients with COPD and not those with cancer. Another study that analyzed 14  people of palliative care found that those who had at least one palliative care spends almost four days fewer in the ICU 


Commonly Used Analgesic for Managing Pain in Lung Cancer Patients

Morphine is a potent opioid used to ease cancer pain. A particular receptor mediates its effects within the CNS and peripherally. McGrath (2010) argues that morphine’s key action is on the smooth muscles, but in the presence of inflammation, a silent receptor gets activated. Opioids are administered intravenously, sublingually, orally, as well as intravenously with respect to its indication as well as routes for administration. Both sustained as well as immediate release preparations have the same analgesic effects.  Also, both opioids and laxatives need to be prescribed at the same time so as to alleviate the start of opioid-induced constipation. Morphine is administered orally, and it requires either regular or modified release. The previous analgesic treatment should determine the starting dosage. In the case study, the nurse talks about getting his patient some drugs to ease the pain as well as problem breathing (McGrath 2010). When the aboriginal liaison officer inquiries the patient about his pain as well as trouble breathing, the patient responds by saying that he does not want to be put on morphine because he does not want to be drowsy. He responds by saying that his aunt was given morphine that made her drowsy and died the following day 


Patient Nurse Relationship

According to Pink and Allbon (2008) non-aboriginal medical professionals are adopting a holistic strategy of providing advice as well as care for their patients. What they need to do is practice humility through respecting local traditions as well as being cautious not to impose their values. They should know that health entails physical, emotional, spiritual as well as intellectual wellbeing. Besides, they should work hand in hand with other multi-disciplinarians and put in health representatives from the community. They should be sensitive to cultural care. For instance, less eye contact might be okay, but patients may be good with long silences as well they might not answer direct questions. In the self-contained societies, what may happen to a person might affect his family but the entire community. Aboriginal people may be conversing in the second language so that they might need a translator as well might be uncomfortable questioning an individual who is seen to have much knowledge plus power. As a matter of fact, there are excellent publications authored by the aboriginal scientists as well as Aboriginal medical professionals (Pereira 2017). Such people are properly positioned to know the core issues in the Aboriginal health as well as have greater knowledge plus practical recommendations. 



Anderson, I. and Devitt, J., 2004. Providing culturally appropriate palliative care to Aboriginal and Torres Strait Islander peoples: Discussion Paper. Australian Government Department of Health and Aging, editor. Wodonga: The National Palliative Care Program.

Chapman, Y., Francis, K. and Birks, M., 2014. Understanding the community. Rural Nursing: The Australian Context, p.34.

Grace, J., Krom, I., Maling, C., Butler, T. and Midford, R., 2011. Review of Indigenous offender health.

Lee, V., 2014. Public Health Association of Australia submission to the Australian Human Rights Commission: National Children’s Commissioner examination of intentional self-harm and suicidal behaviour in children

Liaw, S.T., Lau, P., Pyett, P., Furler, J., Burchill, M., Rowley, K. and Kelaher, M., 2011. Successful chronic disease care for Aboriginal Australians requires cultural competence. Australian and New Zealand journal of public health, 35(3), pp.238-248.

Marmot, M., 2005. Social determinants of health inequalities. The Lancet, 365(9464), pp.1099-1104.

McGrath, P., 2010. The living model: an Australian model for Aboriginal palliative care service delivery with international implications. Journal of Palliative Care, 26(1), p.59.

Pereira-Salgado, A., Mader, P. and Boyd, L.M., 2017. Advance care planning, culture and religion: an environmental scan of Australian-based online resources. Australian Health Review.

Pink, B. and Allbon, P., 2008. The health and welfare of Australia's Aboriginal and Torres Strait Islander peoples. Canberra: Commonwealth of Australia. 

Taylor, K. and Guerin, P., 2010. Health care and Indigenous Australians: cultural safety in practice. Macmillan Education AU.

Vos, T., Barker, B., Begg, S., Stanley, L. and Lopez, A.D., 2009. Burden of disease and injury in Aboriginal and Torres Strait Islander Peoples: the Indigenous health gap. international Journal of Epidemiology, 38(2), pp.470-477.

Wynne-Jones, M., Hillin, A., Byers, D., Stanley, D., Edwige, V. and Brideson, T., Australian Indigenous HealthInfoNet.

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