Non-Pharmacologic Nursing Interventions for Pain Based on Patient's Personal Experience with Pain
In the nursing profession we consider pain as the fifth vital sign. It is the most common reason that patients seek medical attention. As nurses we are limited to the resources available to us for the treatment of pain, that are non-pharmacologic. The purpose of this paper is to explore some of those options, and to assess whether or not it could be implemented into the nursing routine. In the hospitals today nurses are expected to do more with less everyday so giving a patient a pain pill is a lot easier and faster than a back rub, or distraction techniques. It is also important for the nurse to assess the type of pain that the patient Is having, sometimes non pharmacologic is the best therapy for the patient to experience optimum results. There is also a lot of research available on non-pharmacologic intervention in conjunction with pharmacologic interventions, which yield the desired pain relief for the patient.
Key Words: Pain management, pain assessment, interventions for pain, non-pharmacologic interventions.
The human body experiences pain as a response to tissue damage, and alerts your body that it needs to escape from this tissue damaging stimulus. Pain is subjective, meaning that every person experiences and expresses pain differently. There are many factors that influence a patients response to pain. Personal experience with pain in the past, cultural, emotional and environmental factors all play a role. Pain greatly affects the outcomes of a hospitalized patient. This paper will focus on pain interventions that can be implemented by the nursing staff in the perioperative period. It will explore the options available to the patient and nursing staff. Nurses have a great responsibility in the perioperative period to make sure that a patient is comfortable. Even with all the new development in pain management, almost all of the patients suffer from pain in the post op period due to lack of knowledge and interest from their healthcare team (Yaban, 2019). Adequate pain control is vital for patient satisfaction, healing, and fast recovery time (Santhna, Norhamdan, & Damrudi, 2015).
Background of the Problem
Research shows that pain post operatively is still a major concern in the surgical patient population. Post-operative pain can have many different sources. Such as positioning in the operating room, and the tissue damage that occurs during surgery. It is crucial that nurses are able to identify and treat the surgical pain because it can have negative effects on the patients recovery (Rizalar, & Ayfer, 2016). Pain can cause both a physical and an emotional response that can affect the quality of life of the patient. When a patient experiences severe pain they cannot do deep breathing exercises, coughing, mobilization and sleeping which is needed to promote healing. Ineffective pain management may disturb the healing process and cause complications in the respiratory and circulatory systems as well as issues with excretion. As a result it can increase the readmission rates, length of hospital stay, and the overall cost of care.
Significance of the Issue in the Nursing Field
This topic is important for nurses research because there is a lack of education on post-operative interventions for pain management. Nurses need to become familiar with the idea that there are other options for pain management out there. The first intervention that nurses implement is analgesics. Even though a simple change in position or distraction can benefit the patient more. Patients also need to be educated on pain, and the options that are available to them. Research into nurses’ attitudes towards pain have determined that nurses think that the patients pain is less than what is reported (Fatma, & Serife, 2017) Nurses also lack knowledge and experience for managing pain, which in turn effects the success of treatment (Rizalar, & Ozbas, 2016). It may not be possible to have a pain free surgical experience but it is important to treat the pain so that the patient is comfortable. Nurses need to create independent markers associated with pain occurrence. Unsal, Karakurt, & Bahceli, (2019) suggest that the patient experience and expression of pain is affected by the sex of the patient and the type of operation they had , but also is affected by who is accompanying the patient.
Patient education needs to begin in the preoperative period. Studies have shown that patients pain levels can be reduced by providing them with information on the options that will be available to them post-operative for pain (Fatma, & Serife, 2017). Some patients may expect to be completely pain free after their procedure. So educating them on what to expect after the procedure will improve the patient satisfaction rate. It is important to educate the patient that being completely pain free for the first couple days port-op is very rare. Informing them that we do want them to be comfortable and will provide them with the tools to make themselves comfortable at home. Good pain control is essential in the post op period because it relaxes the patient, increases their quality of life, decreases their time in the hospital and decreases the rate of complications (Fatma, & Serife, 2017). There is some research available on scripting and pain management. Bellury, Mullinax, Mozingo, Dantzler, & McGee,(2018) found that the use of scripting had a statistically significant result in the pain scores. Patients reported that pain control was significantly greater. So just by voicing to the patient that you do care about their perception of pain and that you will try to get them comfortable post operatively is very beneficial to the entire outcome of the surgery. Fatma, & Serife, (2017) concluded that nurses need more education and service training on pain management, and that patients pain control expectations should be identified and that care needs to be provided based on those expectations.
Examples of Non-Pharmacologic Interventions
There are many non-pharmacologic interventions that nurses can implement, some examples are: (Yaban, 2019)
Menthol application to the skin: can provide some external analgesia.
- Vibration: a type of electric massage that can reduce pain.
- Aromatherapy: use of essential oils by inhalation, massage, or steam. Bahr, Allred, Martinez, Rodriguez, and Winterton (2018) concluded that patients who received an Aroma Touch Hand Technique massage with essential oils had experienced a 50 percent reduction in their pain scores. Hekmatpou, Pourandish, Farahani, & Parvizrad, (2017) determined that the use of wild orange essential oil reduced pain and anxiety in patients with limb fractures.
- Exercise: increases blood circulation, prevents muscle tension.
- Positioning: staying in one position for a long time can cause pain, repositioning the patient will help relieve pressure in the painful areas and increase blood circulation.
- Music therapy: is used to provide relaxation and helps to distract the patient. Santhna, Norhamdan, & Damrudi, (2015) found that music therapy reduced post-operative pain after a TKR. Pain scores in the experimental group were less that of the control group.
- Reflexology: a type of massage to the hands, feet and head that correspond to various parts of the internal organs and body. Khorsand et al., (2015) found that reflexology can reduce pain and analgesic consumption in patients post appendectomy.
- Hypnosis: a complex method that allows a patient to focus on a specific thing.
- Prayer: Used for the patients request to be relieved of pain and forgiveness of sins.
- Hot application: is an effective pain intervention that leads to vasodilation, and reducing blood viscosity.
- Cold application: helps to decrease edema by vasoconstriction.
- Imagination: helps the individual to change perceptions, thus reducing pain.
- Massage: proper massage can block nerve impulses and relax the muscles. Joy, Arora, & Tamang, (2014) determined that foot massage is successful at reducing pain levels in patients after abdominal surgery
- Relaxation: techniques that can provide relief from mental and physical stress, thus acting on the muscle spasms that are caused by surgery.
According to Cavalheiro, Ferreira, de Souza, & Ferreira, (2019) nurses are performing non pharmacologic interventions for pain relief but are not charting them. Therefore nurses need more education and support to from coworkers in their daily work life. It is stressed that nurses chart the patients pain level with every vital sign, and it is also stressed that there be some sort of documentation for an intervention if the patient is having pain. However if the patients pain level is mild and we repositioned the patient, that might not be something that the nurse would feel like charting because the patients pain level was mild.
Non Pharmacological Interventions in Conjunction with Pharmacological
Rizalar and Ozbas (2016) determined that the use of pain killers alone did not provide the optimum effect of pain relief. It was also determined that the frequency of non-pharmacologic interventions by nurses was low. Those patients that received combined modality therapy had lower pain scores than the patients that were given pain killers alone. The mechanism of action of non-pharmacological interventions are not clear but they are non-invasive and don’t pose a significant risk.
All of the above interventions that were mentioned, pose a great deal of anxiety to nursing because nurses are not trained to perform such interventions. Therefore it is important that we recognize what our limits are. Nurses should be trained in non-pharmacologic interventions that could be performed. Interventions like aroma therapy, therapeutic touch, and massage (Yaban, 2019). Research shows that implementing such interventions can greatly increase the patient outcome post operatively.
Nursing theory relevant to pain management
Jean Watson’s Theory of Caring focuses on providing care for the patient by attending to the needs of the patient. Jean Watson explained nursing as a “concern in promoting health, preventing illness, caring for the sick and restoring health” (Jean Watson’s Philosophy, 2012).
Through pain assessment, education and intervention nurses may promote health, prevent illness and restore health. Managing pain and attending to patient needs are included in these aspects. The nursing process is a framework of Jean Watson’s theory. Through assessment, planning, intervention and evaluation, the nurse provides quality care to the patient. In proper pain management, the nurse assesses the patient’s need, plans in order to provide care that safe and effective, intervenes according to the need and evaluates the effectiveness of the intervention.
One of the ten carative factors of Jean Watson’s Theory includes forming a trusting relationship with the patient, through communication and care. When patients see that their nurse is assessing their pain and comfort level. They realize that they are cared for. The nurse makes time for the patient, and the patient trusts the nurse with their care. Another carative factor includes teaching and learning, this happens during the post-op period when the nurse is educating the patient on non-pharmacologic interventions that the patient can implement at home. Such as ice/heat application, rest, ways to avoid straining the incisions and operative area so that the patient can heal. This is also the time where nurses assist patients with their human needs and provide a supportive environment for the patient (Jean Watson’s Philosophy of Nursing, 2012). Jean Watson’s Theory of Caring includes many factors that are part the assessment and treatment of pain in the post-operative period.
Non-pharmacologic pain interventions are fundamental for nurses to have a knowledge base on. As pain management is considered a very important role in nursing care and healthcare overall. Especially post-operative pain, because it has the potential to affect the patients healing process and quality of life long term. Adequate pain management can reduce complications and shorten the length of hospital stay for the patient. Therefore is crucial that nurses have the necessary knowledge, attitudes and behaviors toward pain management ( Yaban, 2019). It is important that nurses become educated on non-pharmacologic pain interventions because they have no side effects like analgesics would. These interventions also help decrease the stress and anxiety of surgery, which can improve healing. Research suggests that nurses applied analgesic therapy most often, and do not apply non pharmacologic pain interventions.
Limitations and Implications to Further Research
Further research needs to be done on specific nursing interventions that can help with pain relief. The limitations to this paper are that the sample sizes of the articles are small and further research is needed to see of the results can be replicated. There also needs to be more research on interventions that will help with post-operative pain specifically.
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