The highest number of cancer patients experience pain at different points in their illness. Pain may occur directly based on the fundamental oncologic condition, and it might also originate from the therapy anticipated for disease modification. The skill and knowledge required to handle cancer pain has changed to the point in which efficient pain management is regarded by a number as an underlying human right. In this regard, failure to offer effective pain management is regarded to be unethical and poor medicine. Initially, pain management in cancer had been hindered by a number of factors which include lack of enough knowledge regarding several tools accessible to relief pain symptoms and complexity in assessment. However, things have changed with advancement of technology and availability of more information regarding cancer assessment and management (Bharnagar & Gupta, 2015). This paper focuses on employment of anticipated changes in pain management in the ecology department in my health care facility.
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Current Practice to be changed
The current nursing practice that need to be changed in our healthcare facility is pain management practice employed today among the cancer patient. The nurses employ regulated opioid dosage technique to regulate pain among cancer patients based on the severity of the pain. However, this practice is becoming less effective especially among patients who develop its resistance. As a result, a considerable number of patients are experiencing serious uncontrollable pain. In this regard, the healthcare should consider reviewing this practice. The practice needs to be changed.
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Why the Current Practice Need to be changed
The nurses working in the oncology department of our healthcare facility have been struggling with pain management for a long time. The nurses have been trying to manage different oncology pains using opioid medications based on the severity of the pain. In this case, opioid level of treatment was varied by either reducing or increasing the opioid dosage among cancer patients, based on whether the pain is mild, moderate or severe. This technique is being used to handle even surgical related pain in case the tumor is removed through surgery. However, this technique has been found to be less effective in pain management. About 25% of the patient cannot respond to opioid related pain management intervention. They therefore suffer greatly during their treatment, an aspect that is highly related to high percentage of early death for patients who are resistant to opioid, as compared to other cancer patients. Moreover, most patients are currently developing anxiety due to believe that the excess use of opioid may result to addiction. This has added to the ongoing challenge the nurses are experiencing in pain management in the department. The new challenges include patient’s refusal to take medication for the fear of addiction and later, having no choice due to continues intolerable pain they end up taking it but remain restless due to the fear of addiction. The department also experience insomnia, and cases of constipation for most patients. This condition was related with side effects of using opioid as pain management drug. The senior nurses in the department now believe that a better pain management strategy is required to improve patient care outcome in the department. It is also evident based on the situation that a more effective and improved pain management technique is needed in the department to enhance care and reduce the level of opioid resistance among the cancer patients in the department.
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Key Stakeholders in the Current Nursing Practice
The key stakeholders in this change include the nurses working in oncology department, patients suffering from cancer, nursing leadership in the department and the entire organizational leadership which is responsible for the overall performance of the healthcare organization. Others include nursing working in informatics department and the hospital administration.
The Main Role of the Key Stakeholders
The patients have a very great role in assisting to establish the effectiveness of a nursing care practice. The assessment normally done to measure the level of pain is highly done through oral interview and observation. True confession and sincere expression from the patient plays a great role in establishing the effectiveness of the nursing practices or the care given to the patients. In this case, they can highly act as agents of change. The expression of dissatisfaction and sincere confession of increase in pain despite of the measure taken acted as the major reason as to why the nursing leadership in the organization considered reviewing the current pain management practice.
Nurses are the other major stakeholders. They are directly involved in caring for the patients and thus, they can easily determine the effectiveness of the intervention provided to the patient. Nurses also play a great role in reporting patients’ dissatisfaction with the current intervention measure to the relevant authority. Nurses also need to put an effort to establish a better intervention measure for this condition. After realizing the problems cancer patients’ experience, nurses in charge should consider developing a research to establish how they can improve the nursing care outcome for cancer patients’ pain management.
The organization leaders play a major role in implementation of change. They can highly enhance change by developing policies, and creating other motivating measures to enhance change in an organization. Leaders will also play a great part in providing for the needed resources to enhance change. Moreover, they are the decision makers and thus, no change can be implemented without their authorization.
Nursing in Informatics Department
Nursing in the informatics department are responsible of providing information to the nursing team and the nursing leaders. In this regard, they will play a major role in using the available technology. This department will assist in conducting an intensive research to establish the available evidence based techniques that can be employed to enhance pain management among cancer patient or general information on evidence based practice on pain management in different situation. This information will be used by nurses in the oncology department and the nursing leaders as well as oncologists in defining the best evidence based practice that can be employed.
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Oncologists will also play a great role in contributing in the selection of the best evidence based solution that can be employed to different patients based on the actual cause of their pain. Although most cancer patients experience pain there are different types of pain and thus, some may need a different intervention measures from others. Oncologist will assist in justifying some of the intervention measures obtained from the research and providing their views on their application to different patients.
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Pain management among cancer patient is recognized as a challenging task across the globe. Different literatures have recommended different techniques that can be used to control pain among cancer patients evidently. These techniques include both non-pharmaceutical and pharmaceutical techniques (Naga, 2015). The most employed pharmaceutical technique in cancer patient pain management is WHO analgesic ladder which is said to reduce the level of medical resistance to 10-15% (Bharnagar & Gupta, 2015). This involves administering pain management drugs in three steps or order. The administration involve nonopioids in the first stage, where paracetamol or/and aspirin are used. The second step involve employing mild opioids for instance codeine where necessary and finally, the use of strong opioids that include morphine for severe pain. The literature also recommended the use of other drugs to manage the anxiety for instance adjuvants, and laxatives to reduce the level of constipation (Ripamonti et al., 2011). The research recommended that the reduction of opioid dosage to handle the side effects worsens the situation. In this regard, it is recommended that the dosage should continue as the patient receive other drugs to suppress the side effects symptoms.
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There is a wide range of non-pharmaceutical techniques employed to control pain among cancer patients these techniques. Among the most sited techniques included radio therapy which reduced the pain for a month by 27%. Others include physical therapy which included walking, bath and bed supports, and position instructions, massage, ice or heat use, nerve stimulation using transcutaneous electrical, reflexology, ultrasonic stimulation, acupressure or acupuncture (Singh & Chaturvedi, 2015). Others included spiritual care, cognitive behavioral training, active coping training, creating outlets for instance music, and distraction training (Hokka et al, 2014). The research also established that effective assessment and continuous evaluation of the level of pain among patients can highly enhance the level of pain management (Choi et al., 2014)
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Recommended Best Practice
There are a number of proposed pain management techniques among cancer patients. However, the most productive technique is the use of holistic pain management techniques. This involves the use of both pharmaceutical and non-pharmaceutical techniques to manage the pain. The pharmaceutical technique should strictly follow the recommended WHO analgesic ladder. The non-pharmaceutical measures should be employed based on individual condition. However, the use of spiritual care, nerve stimulation using transcutaneous electrical, reflexology, ultrasonic stimulation, acupressure or acupuncture should be tried among different cancer patients. The nurse should always use what works best for the patient.
Appropriate Practice Change Model
The best model to employ in this case is ACE Star Model of Knowledge Transformation. This model is selected because it provides a simple, but comprehensive technique to translate evidence into practice. The model is employed to obtain all necessary and accessible information regarding a topic in a summary form. Then decisions on point of care are needed which will assist in selecting the best practice. The model contains five major steps which include discovery that involves primary research regarding the topic (Stevens, 2013). The second step is evidence summary of the topic. This involves synthesis of the entire available knowledge. The third stage is translation into action which normally involve integrating expertise and evidence base to extend recommendations. The forth step involve practice integration to obtain the best evidence. The final stage is evaluation where the effectiveness of the new integrated evidence based practice are measured. In this case, the nurses will be involved in intensive research and form a comprehensive integrative review which will provide them with all possible available pain management measures. These measures will be integrated in the current pain management care system based on the expert decision. Their effectiveness will be measured by evaluating the patients’ response to the measures in terms of level of pain and resistance (Stevens, 2013).
Possible Barrier to the Proposed Change
The main possible barrier for the implementation of the proposed change is the need for extra training among nurses on how to employ non-pharmacological measures for pain management among cancer patients. Nurses may require training in using some of the equipment used for this purpose. They may also require some knowledge in physical therapy among other things. This may be expensive to the healthcare or it may require free time for nurses to be trained which could be challenging. The hospital may also require to change its environment to accommodate new measures such as the use of music in the wards or the accommodation of chaplaincy in the hospital for spiritual nurturing an aspect that would require the top management approval and assistance.
Possible Ethical Implication
Nurses are ethically required to be more concerned about their patients’ well-being. Basically, pain is regarded to be unethical and thus, nurses should be able to relief pain among their patients at all time. Opioids is one of the drugs used to manage pain among cancer patients and it is still accommodated in the current change. The ethical issue may rise where the patient believes opioid is a drug which may cause an addiction. In this case, a nurse may require to employ other measures or to go against the patient’s will. This puts nurses into a great dilemma. However, the new changes do not introduce anything that would compromise the ethical principles of nurses and thus, it will be very effectively integrated in the system.
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