I was approaching the patient with an intention that I would assess the patient's condition, and if necessary, following assessment I would provide her some analgesic medication. The staff nurse told me not to give any more pain medication, "she had had enough."
It was very evident that there was difference of opinion between me and the staff nurse. From my academic learning, I knew that pain assessment is an important parameter of nursing care, and accurate assessment patient's pain status is important. Current evidence suggests that pain assessment and rating of pain would guide adequacy of pain medication.
In such cases of differences of opinion, there is a fair chance that nurses' assessment would be guided by personal beliefs. Literature suggests that in many cases clinical decisions are taken by the healthcare professional based on traditional practice which may not have any evidence. This is specially applicable in case of pain management in the clinical setting by the nurses. There is also evidence that nurses are guided by their own beliefs on pain assessment, and in many cases the experienced nurses underestimate the intensity of pain. Pain is regarded as a subjective sensation, and hence there is a high tendency that painful conditions are stigmatised in that high intensity pain is regarded as a ploy to get more pain medication, while nurses feel that the intensity of pain is not worth intervening (Clark et al., 2006).
With the background that I will graduate into a registered nurse, it was an opportunity for me to reflect on the situation to examine whether I have enough competencies to deal with such situations. It was an ideal situation where research could be utilised to improve practice so the outcome of care is better leading to better patient satisfaction. I immediately took the opportunity to discuss the scenario with the staff nurse and convinced her that I would look into evidence from studies to decide what we needed to do. There was internet connection available in the unit, and in the available database, I ran a search for relevant literature on the key words "nursing" and "pain management" (Rustoen et al., 2009). Since meta-analyses provide maximal analyses of research, conclusion and discussion of some if these literatures provided the guideline. The basics of the guidelines were that whenever in doubt regarding the adequacy of pain medication, the pain medicine consultation should be used and adequate dosage of analgesic medications should be decided, while the patient remains under strict monitoring and surveillance for any signs of respiratory depression.
I remember, I also told in that discussion that the hospital policy guidelines also indicate this. When I found evidence, I immediately showed the findings from the literature to all staff present there, and highlighted that this would improve the patient outcome (ANMC, 2006), since pain symptoms delays discharge and increases hospital stay. I was a little hesitant in saying this since I was just a student and my experiences were just nominal. However, the strength of the evidence was so compelling that ultimately these findings could be used to change and improve practice. Another concern was that I did not know this patient's history totally, and therefore, there was a fair chance