Pain Management in Palliative Care: A Critical Review

Role of the Nurse

You need to demonstrate that you can systematically search for, locate and select relevant professional research/evidence relating to your topic; demonstrate the skills of critical appraisal by critically appraising the research/evidence you have located and chosen by using a critical review framework. You need to also, determine how the research/evidence you have located can be related to, and incorporated into, practice, including a discussion of potential barriers to doing so. Finally, exhibit overall, the skills of presenting work of a high academic standard, including academic referencing, and respecting the core principles of professional nursing

Your Methodology section should have at least four subheadings; Inclusion. criteria, Exclusion criteria, data collection methods and data analysis method. Inclusion: what you want to include Exclusion: what you want to exclude e.g papers published in Spanish etc.

how do you plan to collect data and from where?

Do a textual analysis; read through relevant literature and identify significant information in them. You can use a table to show the studies, authors, year of publication and summary of findings. Findings: Organise your findings in light of similarities and differences. Discussions: discuss your findings in relation to other literature other than your papers.

Limitations: 2-3 limitations

Conclusions: Summary of your research and strongly connect this to nursing practice.

References; must be consistent and well-written.

You need to demonstrate that you can systematically search for, locate and select relevant professional research/evidence relating to your topic; demonstrate the skills of critical appraisal by critically appraising the research/evidence you have located and chosen by using a critical review framework. You need to also, determine how the research/evidence you have located can be related to, and incorporated into, practice, including a discussion of potential barriers to doing so. Finally, exhibit overall, the skills of presenting work of a high academic standard, including academic referencing, and respecting the core principles of professional nursing

You should submit your assignment through the Unit Assessment.You will receive an electronic receipt to confirm submission of your work.

LO3: Assemble evidence-based care interventions with patients utilising collaborative teamwork.

LO4: Share their research findings and evidence with the wider healthcare team accounting for present and future challenges to service delivery.

Palliative care is not just about supporting patients at the last month of their life,  but its about building upon the quality of life for the patients, their families and those that are close to them and that are with the patients treatment every step of the way. Palliative care is not just focused on the patient’s disease, but applies a holistic approach by meeting their physical, practical, functional, social, emotional and spiritual needs of the patient. Supporting and informing patient and those that are close to them about the treatment plans by allowing them to state their wishes and goals.

Rationale

Palliative care can be based in primary care such as hospice, hospital setting and in community. I will be focusing on the role of nurses in pain management in palliative care and the different ways to control the pain, which can be administration of medication and the application of non-medication. Gwyther, (2011) I will be mentioning about the ethical principles of nursing which are autonomy, beneficence, non-maleficence and justice.

The nurses play a big role in managing pain in palliative care, is by supporting the holistic needs of the patients and also involving the careers and families including them in the patients assessments and treatment which can be physical, emotional and spiritual health of the patients. Hagan, (2017) states about ability to improve the symptoms, which can be physical and emotional. This shows that managing pain and symptoms is showing compassionate listening and counselling skills, as this can promote the highest quality of care for the patient and families. Brown. (2013), nurses are responsible for managing pain of their patients through proper administration of medications is anti-inflammatories, anti- seizure and opioids which can ease the pain.

There are other ways in application of non- medications, as this could be based on heat, cold, position change, massages and communication to other member of the pain management team. Morrow, (2020) states about the incorporate pain assessment tool as the fifth vital sign, as nurses asks this question to the patient to rate the pain from the scale of 1-10 scale, as some patients are not always able to rate the pain. Leonhardt, (2020) understanding the patient’s pain is by the onset, frequency, location, radiation and trigger as this can helps the nurses and doctors to carry out procedures and medication which can benefit the pain.

WHO, (2018), states palliative care improves the quality of life of the patients and their families who are facing problems with life threatening illness and each year WHO has estimated around 40 million people are in need of palliative care, and there is 78% people are living in low and middle income countries. NICE, (2016) states there are 2/3 of patients with cancer and other progressive conditions needs to have strong opioids to manage their pain. Each year there are 300,000 people that are diagnosed with cancer in the UK and it is estimated that there is 900,000 living with other chronic illnesses. Public health England, (2018) stated that 4.9% of the people have died in the hospital, 21.8% in care homes and in the community and 5.7% in the hospices and this indicates to all age groups.

Ethical Issues of Pain Management

There are ethical issues of pain management in palliative care, as this may result in patients misusing medications and opioid addiction, after being used for a while and if stopped then the patient will be experiencing the withdrawal symptoms. kitzmiller, (2018) has stated the principle based ethical analysis as the principle of beneficence is help the patient to be pain free and to do good to the patients in best interest. In palliative patients are the medical team will discuss with patient about their treatments and their goals and wishes. Ghasemi, (2015) the medical team need to assess the risk and side effect in pain management can withholding or withdrawal of treatment in patients’ best interest. Paulus, (2020) states non-maleficence is not cause any intentional harm to the patient and balancing the risk and benefits of the treatment plans of the patients. In palliative care, the medical team will discuss about treatment plans that is appropriate to the patient’s condition, as they can offer resuscitation status.

Lavoie, (2011), states the principle of autonomy is the ethical right to make patients own decision and carry them through and the health care professional and the hospitals are to respect the patient’s decision and actions without unnecessary interferences. In palliative care, patients address their wishes about their treatment and other needs which needs to be respected. RCN, (2016) states the principle of justice is fairness as the patients have the right to have best quality of care, according to the legal justice and law of the country. In palliative care the medical team offer treatment options to the patients in their best interest and that they are respected with the decision such as patients may decline their treatments and they may only need to be medication to help with pain.

For Nurses to provide pain management for palliative care, a variety of policies and guidelines are published to help guide nurses as well as health professionals. A guideline was published by NICE for helping nurses provide palliative care for management- “Palliative care care for adults: strong opioids for pain relief.” This guidline has been updated and changed the NICE guideline CG140, which was published on May 2012. The main attention for this guideline is to advice health professionals on the best care to provide patients with advanced or progressive disease through communication when giving opioids (NICE, 2016).

Furthermore, the guidline also advices patients in managing pain being able to self-manage their medication. This can be done through nurses and health professionals providing education on using opioids and managing the constipation and nausea after taking opioids. (NICE, 2016 1.1.17).

The Center to Advance Palliative Care believes that providing palliative care requires expertise and professionalism with individuals with serious illnesses. Palliative care focuses on patient’s relief on pain and stress of the illness. The main aim of the policy is to enhance quality of life for not patients, but their families as well. Having experience nurses and health professionals working together provides the patient with extra support and can pro long the treatment.

Conclusion

In conclusion, this assignment has been focusing on the board aspect of pain management in palliative care. The role of nurse has been mentioned and the ways to manage pain with the administration of medication and without the administration of medication. There is statistic that has been used to shown. The ethical principles have been mentioned and that has been link to the palliative care. Some policies have been mentioned and guidelines that is still being followed.

Literature review is defined as a systematic identification, analysing, evaluating, summarizing, and interpreting the data which is existing in current literatures and on areas of the study (Valdes, 2019).  Literature based research is important in nursing as the clinical practise are based on the current evidence-based practice as it promotes the development of the nursing profession (Hill, 2017).