Evidence-Based Practice - St Catherines Nursing Home - Essay Example

? Pain Assessment and Management St Catherine's Nursing Home St Catherine is a care home with nursing for the aged, located in Newport city (St Catherine's Nursing Home, 2013). The home, which is owned and managed by Summerhill Care homes Group Limited, has a capacity of thirty residents. The clients of this facility are the elderly patients who require nursing care services. Those with physical disability are also attended to in this care home. Physiotherapy, independent living training and palliative care are the services offered in the care home (Care and Social Services Inspectorate Wales, 2012). The care home is responsible for providing relevant and reviewed plan of care and assessing risks for all residents. Staff members are also responsible for providing medical services to residents and training them on independent living. Staff members of St Catherine’s care home also provide palliative care and physiotherapy to help ill, disabled and injured residents. Provision of cleaning and feeding services to the residents is also the care home staff members’ duty. Resources available for this care home include exercise chairs, Hi-low tables, hand and arm exercise units and wheeling and walking aids, among others. The care home is run by a registered manager, assisted by the director of nursing of the care home and the registered nurse on duty who is responsible for the smooth running of a day’s activities (Care and Social Services Inspectorate Wales, 2012). This proposal provides an analysis about how Evidence-Based Practice in pain assessment and management can be incorporated in the palliative care provided by St Catherine's Nursing Home to improve the quality in palliative care and physiotherapy. The proposal provides sufficient explanations as to why the current pain management approaches used in the care home needs to be more evidence-based. The proposed, evidence-based pain assessment and management practice is expected to eliminate the practical barriers within the care home, as explained later in this proposal. The consultation process, providing details about who should be consulted to implement the proposed evidence-based pain assessment and management is outlined in this proposal. Timelines and explanations of each step of the implementation of evidence based pain assessment and management at St Catherine's Nursing Home are also detailed in this proposal. Why the Current Practice should be more Evidence-Based. All the clients or residents of this care home are elderly. Most elderly people are characterized by pain. Currently, the process of assessment, management and treatment of pain is inadequate at the care home. It should also be noted that elderly people may be reluctant to report pain. Therefore, they are at a risk of ending up without receiving any treatment for their pain. According to Iyer & Appelbaum (2003), the elderly are likely to be undertreated for their pain, especially those in nursing homes. The reasons for this under treatment are patient beliefs and communication problems. For instance, when the elderly patients and the health care providers believe that pain in the old is normal, as part of the aging process, then there are minimal chances that pain will be treated (Iyer & Appelbaum, 2003). Besides, when cognitive deficits and other reasons render an older patient communication deficient, it becomes difficulty for the health care provider to assess the patient’s pain and suffering intensity. Another important misconception that affects the elderly patients is the belief that older people do not feel as much pain as the young because of decreased perception of pain or sensitivity (Iyer & Appelbaum, 2003). Other people believe that when an elderly person does not complain of pain, then that person does not have pain. However, it has been discovered that elderly patients never complain of pain because of various reasons (Iyer & Appelbaum, 2003). First, they do not want to worry their family members and loved ones. Secondly, they may not want to bother or anger home care givers. Third, the old fear that they will lose their independence if they report that they are in pain. Assessment of pain in the elderly patients remains sophisticated than it is in younger patients because the elderly have poor memory, are depressed and sensory impaired (Iyer & Appelbaum, 2003). Making the current practice of pain assessment and management more practice-based will be beneficial to the clients and St Catherine's Nursing Home in various ways. First, it will enable care givers to determine the presence or absence of pain among the residents of St Catherine's Nursing Home adequately. This evidence-based pain assessment and management will solve the current barrier to palliative care and physiotherapy where cases of pain go undetected by nurses, and pain is undertreated, at times. This will be achieved by employing superior pain assessment tools that will enable appropriate assessment of pain. Once assessment of pain has been done, proper management and treatment can be effected easily. This is because nurses will be able to determine the measures that they can take to relieve pain among the elderly patients at St Catherine's Nursing Home. Consequently, the quality of life for the residents in the care home will improve significantly. Rationale for Evidence-Based Pain Assessment and Management in an Aged Care Facility Unrelieved pain is associated with many adverse effects. This becomes even worse if the condition concerns an elderly person. Among the negative impacts of unrelieved pain on a patient is physical and psychological deterioration in health. A patient who is suffering from persistent pain that has been untreated or undertreated has low concentration on physical day-to-day activities. Given that the residents of St Catherine's Nursing Home are all elderly, they are most likely to underreport or fail to report their pain. Therefore, pain among the elderly should be assessed and treated promptly. As mentioned earlier, in this proposal, there are various reasons for this occurrence. For instance, elderly people feel that when they disclose that they are in pain, they burden their loved ones with worry. They also feel that the action of reporting pain to the care givers angers them. Separately, elderly patients may decide to sleep or engage in some physical activities to distract their attention from pain. Unfortunately, this is misinterpreted by the care givers that when an elderly person is quiet, asleep or engaged in a physical activity, then the person is not in pain. Other elderly patients fear that if they report that they are in pain, they will lose their independence. Others have a belief that immediately they report that they are in pain, they will be put under drugs such as analgesics, and will become addicted, instead. Other misconceptions about pain are held by some nurses. For instance, most nurses believe that elderly people do not feel much pain because their sensitivity has declined. Others belief that pain among the elderly is a normal phenomenon since it is a characteristic of the aging process. Therefore, these nurses perceive the reporting of pain by elderly patients as exaggeration. When all these factors are considered, it is evident that there are significant barriers that hinder the assessment and management of pain. This means that pain among the elderly either remains underreported, unreported, undertreated or untreated. This condition poses major health problems, which should be solved, if the health of patients is to e restored and maintained. As for the case of St Catherine's Nursing Home, the proposed evidence-based pain assessment and management will solve numerous, current problems in health care problems. It will also improve the health status of the residents and improve the quality of health care, as well. First, the proposed, evidence-based pain assessment and management will ensure that there is careful assessment and regular review of pain in the aged care facility always. This will be achieved through the implementation of a detailed initial evaluation of pain among elderly residents by nurses (Care Search, 2013). Also, the proposed, evidence-based pain management will allow for regular reassessment of severity of pain among elderly patients of the care home. This means that proper recording, assessment and management of pain will be implemented within St Catherine's Nursing Home, with the aid of the proposed, evidence-based pain management. In turn, favourable, patient outcomes will be achieved. Secondly, the proposed, evidence-based pain assessment and management of pain in St Catherine's Nursing Home will address pain beliefs and misconceptions adequately (Care Search, 2013). With an evidence-based pain management tool or guideline, nurses will be required to assess for the presence or absence of pain in every resident presented at St Catherine's Nursing Home. Those residents at the aged care facility who will be found to be pain, will have their pain managed or treated by the relevant staff members of St Catherine's Nursing Home. In cases, where staff members may be unable to treat their clients, they may refer them to other health care facilities for treatment. Pain will be dealt with for what it is as assessed or reported by the client, and not according to the nurse’s beliefs. Third, an evidence-based pain management program is required at St Catherine's Nursing Home to address pain among those who cannot communicate effectively because of physical problems, reduced conscious state. Since the residents of this aged care facility are mainly thee elderly, some of them may not be able to communicate or report their pain, not because of their beliefs and misconceptions but because their conditions cannot allow them to communicate. For instance, physical conditions of the elderly may alter their communication. Others may be in a reduced conscious state, barring them from communicating their pain. The proposed, evidence-based pain assessment and management will employ the use of pain behaviours to curb this problem (Care Search, 2013). This will ensure positive outcomes in the provision of nursing care at St Catherine's Nursing Home. The adoption of evidence-based pain assessment and management at St Catherine's Nursing Home will eliminate cases of inadequately managed pain. Inadequately managed pain can lead to serious, negative psychological and physical effects to an individual (Wells, Pasero, & McCaffery, 2013). Continuous pain is known to hamper the immune system and subjects the patient to a further threat of suffering diseases (Wells, Pasero, & McCaffery, 2013). It can lead to cardiac problems and reduce patient mobility. This might increase the cost of care for the patient. With the evidence-based pain assessment and management guidelines, mobility of the residents will be ensures within St Catherine's Nursing Home. Furthermore, their health will be sustained because pain will be assessed and treated promptly to relieve them. It will also increase the quality of their care home life. It is the responsibility of nurses and other health care practitioners to identify or assess pain and manage it or treat it appropriately. It is wrong for nurses to presume that the persons who are under their care have no pain, without using appropriate methods and tools to determine the presence or absence of pain. Therefore, nurses should ensure that pain is addressed and managed promptly (Wells, Pasero, & McCaffery, 2013). If nurses fail to perform this important duty bestowed to them by law, legal action may result from poor management of pain. Therefore, clinicians should assess pain and manage it promptly. The evidence-based, pain assessment and management guideline for St Catherine's Nursing Home will aid nurses in ensuring that pain is promptly addressed and managed. Implementation of the evidence-based pain assessment and management in this aged care facility will enhance patient satisfaction. When people visit any health facility, they expect that all their health concerns will be addressed. The same case applies for the elderly too. As much as their principal concern may be to receive nursing care, identification and relief or treatment of pain is vital. It enhances patient satisfaction. Therefore, the adoption of evidence-based pain assessment and management will contribute significantly to satisfaction among the residents. Residents whose pain has been relieved or properly managed will be able to enjoy the other services offered at St Catherine's Nursing Home. Evidence-based pain management at St Catherine's Nursing Home will reduce cases of depression among the aged care facility’s residents. Unrelieved pain is the main cause of depression among elderly residents of care homes or nursing homes. This is because the elderly think deeply about their unresolved condition. In turn, depression affects relationships between a client and nurses and other clients, as well. It should be noted that lack of assessment of pain is a barrier to pain control (Wells, Pasero, & McCaffery, 2013). The adoption of evidence-based pain assessment and management at St Catherine's Nursing Home will reduce or eliminate depression among clients and improve relationships because pain would have been managed properly. This will also increase comfort. Evidence-based pain assessment and management at the aged care facility will improve psychological and physiological and physical function among residents. According to Wood (2008), proper documentation of pain is the key to success in the provision of health care services to the elderly in a care home. This is because it will allow routine assessment of pain presence or absence. Also, evidence-based assessment and management of pain facilitates the assessment of signs and symptoms of pain (Mosby, 2011). After the sigs and symptoms have been assessed, the intensity will be measured and the right remedy will be determined. Nurses will have a chance of determining what will relief the pain best. St Catherine's Nursing Home requires an evidence-based pain management strategy that is friendly to the residents. This is because the residents, being elderly, need to be encouraged to report their pain. Reporting of pain is essential in its assessment and management (Joint Commission Resources Inc., 2003). This evidence-based pain assessment and management strategy is a suitable assessment strategy for St Catherine's Nursing Home because it will give the residents an opportunity and permission to report pain (Tolson, Booth, & Schofield, 2011). Finally, the proposed, evidence-based pain assessment and management for St Catherine's Nursing Home is ideal for the aged care facility because it provides education to the patient or client. Once pain has been identified and assessed, the nurses take time in explaining the treatment plan that will be used to relief the client’s pain. The client will also get to know the prescribed medications. It is important to know the side effects of medications, if there are any. The proposed, evidence-based pain assessment and management strategy offers the client a chance to know the potential side effects of medication. This promotes the patient’s responsibility. This means clients will be accountable for the medications that they take, and that they should comply freely, once they agree. Further, it promotes physical and psychological health (Buttaro, 2013). The Consultation Process Before the implementation of the proposed, evidence-based pain assessment and management strategy, the care home’s registered manager, the director of nursing of the care home and all the registered nurses will be consulted. The registered manager for the care home will be given a copy of the drafted guidelines of the proposed, evidence-based pain assessment and management strategy. Upon reading the provisions of the proposal, the manager will decide whether the proposal can be implemented. The director of nursing will also be given a copy of the document, which provides details of the provisions of the proposed, evidence-based pain assessment and management strategy for the care home. Both the registered manager of the care home and the director of nursing will be given a copy of the proposal at the beginning of next month. They are required to take a period of two weeks and then provide their response about the applicability of the proposed, evidence based provisions i the document. If they agree that that the proposal should be implemented at St Catherine’s Nursing Home, then copies will be circulated to every nurse within the nursing home, two days later. The writer of the proposal will then devise a training strategy for the nurses to educate them on the requirements of the proposed, evidence-based pain assessment and management strategy. The tutor, in this case will be the writer of the proposal or any other staff member, chosen by the writer. After the nurses have been trained have trained, implementation will be effected, step by step. The Planning Process After the registered manager of the home care and the director of nursing confirm their approval, the idea of evidence-based pain assessment will be sold to the nurses and other staff. A copy of the document will be issued to every nurse and staff. Then they will e allowed to read its contents for one week. At the lapse of one week, all nurses will be trained. The elements of the training will include the methods that can be applied by staff to determine the presence or absence of pain on residents. The training will be subdivided into seven sessions, according to the provisions of the pain assessment and management proposal. Each session is expected to take two days. The first session will educate members about pain assessment. The requirement of the proposal of pain assessment and management is that it is mandatory for every resident who is admitted at St Catherine's Nursing Home be assessed. Assessment will be aimed at determining whether the client is in pain. This will involve resident/client/patient history gathering, whereby they will obtain detailed history and access the most reliable evidence available by getting in touch with the patient to decide upon the alternative that suits the patient. (Gray, 2001) Nurses will be trained on methods of accurate pain assessment such as visual analogue scales, verbal rating scales and numerical rating scales (Wood, 2008). The second session will be about how to determine whether pain is physical, psychological or spiritual. The third session will touch on how nurses and staff should respond to both self-report clients and those that cannot report their pain. The next session will be about what nurses need to do in order to incl8ude clients in the treatment plan. The fifth session involves behaviour changes identification by nurses and staff. Finally, the sixth and last stage will touch on evaluation of the care plan in pain management for the resident. This should be done regularly to ensure that comfort is restored at the earliest convenience. Change Management The proposed, evidence-based pain assessment and management strategy will be a new idea at St Catherine's Nursing Home. Therefore, it is expected to face resistance from some members who want to continue carrying out their activities the old way. The first step that will be taken to enhance change management is to have the registered manager of the home care and the director of nursing market the proposed strategy. They will hold sessions and chats with nurses and staff members, telling them the importance and benefits of the proposed, evidence-based pain assessment and management strategy. Also, the tutor who will be in charge of training will have to ensure that contents of the proposal are understood fully to avoid differences. People tend to resist ideas that they do not understand because they feel it will be difficult for them to put such theory into practice. Therefore, the tutor should instil confidence in the nurses and staff members, through adequate training. Professional, Team and Leadership Development The professional team that will lead the implementation of the evidence-based pain assessment and management strategy will include the home-care manager, director of nursing, training facilitator, supervisor and nurses and staff members. To ensure success and smooth administration of the strategy, the care home manager will be responsible for issuance of policies or amendments. The director of nursing will oversee the implementation of these policies into practice. Supervisors will supervise the nursing staff to ensure that their practices are in line with the provisions of the evidence-based pain assessment and management strategy. The nursing staff will act as change objects by applying the provisions when attending to clients. The tutor or training facilitator will be responsible for frequent training and updating of the policies in consultation with the home-care manager. Nurses should include patients in the practical application of this proposal by allowing them make choices of what fits them best. They should also provide all the relevant and crucial information to the residents of St Catherine's Nursing Home. References Buttaro, T. M. (2013). Primary Care: A Collaborative Practice. St. Louis: Elsevier Press. Care andSocial Services Inspectorate Wales. (2012, July 13). Inspection Report: St Catherines Nursing Home. Retrieved from http://www.carehome.co.uk/carehome.cfm/searchazref/20005033CATA CareSearch. (2013). Assessment Tools. Retrieved from http://www.caresearch.com.au/caresearch/tabid/748/Default.aspx Gray, J. A. (2001). Evidence-Based Healthcare. Edinburgh: Churchill Livingstone Press. Iyer, P. W., & Appelbaum, S. (2003). Medical-Legal Aspects of Pain and Suffering. Tucson: Lawyers & Judges Publishing Company. Joint Commission Resources Inc. (2003). Approaches to Pain Management: An Essential Guide for Clinical Leaders. Oakbrook Terrace: Joint Commission Resources Press. Mosby. (2011, November 30). Evidence-Based Practice: MAnaging Acute Pain. Retrieved from http://confidenceconnected.com/connect/article/evidence-based_practice_managing_acute_pain/ St Catherine's Nursing Home. (2013). St Catherine's Nursing Home. Retrieved from http://www.carehome.co.uk/carehome.cfm/searchazref/20005033CATA Tolson, D., Booth, J., & Schofield, I. (2011). Evidence Informed Nursing with Older People. Chichester: Wiley-Blackwell Press. Wells, N., Pasero, C., & McCaffery, M. (2013). Improving the Quality of Care Through Pain Assessment and Management. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK2658/ Wood, S. (2008, September 18). Assessment of Pain. Retrieved from http://www.nursingtimes.net/nursing-practice/clinical-zones/pain-management/assessment-of-pain/1861174.article Read More