Acute Pain Management Theory Dr. Good and Dr. Moore: Acute Pain Management Theory Dr. Good and Dr. Moore Background: Background Middle range theory Developed to fill a knowledge gap Guide practice Introduction to Theorist: Introduction to Theorist Dr. Marion Good Doctorate degree Faculty member at Case Western Reserve University Currently involved in a research project NCase Introduction : Introduction Dr. Shirley Moore Doctorate degree Faculty at Case Western Reserve University Abundance of research and training projects http://fpb.case.edu/Faculty/Moore.shtm Pain Management Theory: Pain Management Theory Pain is one of the most common reasons individuals seek treatment Includes several factors Pharmacological, non-pharmacological, patient engagement, education and alternative methods Barriers to ignored pain Affects the healing process, lengthen hospital stays, create barriers and additional complications Reason for theory selection Deal with acute pain daily Interest in alternative methods How this theory would apply to the emergency department setting Overview of Theory: Overview of Theory Knowledge deficit Relaxation and music Clinical guidelines from the Agency for Health Care Policy and Research http://www.ahrq.gov/clinic/ptsafety/chap37a.htm Outcomes and Concepts: Outcomes and Concepts Desired outcomes Achieve a balance between possible side effects and analgesia Relief of Pain Concepts Interventions The problem Desired outcome Theory Selection: Theory Selection My current clinical practice The use of alternative methods in the ED setting Accurate pain assessments Every patient perceives pain differently BIG QUESTION…: BIG QUESTION… What equals pain management? How can alternative methods be used in the ED? PowerPoint Presentation: Variables Nurse must identify proper and appropriate interventions Ineffective pain management Balance between medications and alternative methods Giving medications is simply not enough Acute Pain Management: Acute Pain Management Constant assessment and re-assessment Knowledgeable on medications Established nurse-patient relationship Nurse and physician must work as a team Patient teaching Goal setting Patient Education: Patient Education Pain Pain scale Alternative methods Side effects Patient participation Patient must be willing to be involved in their care Assessment Tools: Assessment Tools PowerPoint Presentation: TO RELIEVE OR ELIMINATE PAIN ! Critique of the Theory: Critique of the Theory Reason for critique Criteria developed by Fawcett Analysis and evaluation of the theory Analysis: Analysis Scope Mid-range Definite concepts Concepts are interventions, the problem which is pain and define the outcome which is relief of pain Good scope: pain management can be broken off a larger scope Descriptive theory Can spark additional research into pain management Analysis: Analysis Context Meets the metaparadigm Knowledge of pain and how it affects the body Derived from the discipline of medicine Guidelines are the basis for a middle range theory Analysis: Analysis Content Concepts Propositions Acute pain identification and relief Use the concepts in order to achieve Evaluation: Evaluation Significance Identification of pain and its treatment Most common reason people seek treatment Provide appropriate care Identify pain in the patient and how it affects the healing process Limits its significance Only encompasses adults Evaluation: Evaluation Internal consistency Concepts are easily identified and defined Theory proposition is reasonable Same terms are used throughout Provides congruency Parsimony Content is clear and concise Identify the reason for development Evaluation: Evaluation Testability Concept of pain is measureable Empirical testing Provides a base for additional testing Need all concepts present Theory is being tested Use in children and those with chronic pain issues Evaluation: Evaluation Empirical Adequacy Research has shown that alternative methods help reduce pain Involves patients Gets them involved in their care Sparked additional research Evaluation: Evaluation Pragmatic Adequacy Education involved Pain Alternative methods PowerPoint Presentation: Feasible to implement into practice Pain is not a broad subject Theory does have its limits! Does not address children, elders or patients with special problems such as opioid tolerance Contributions to Nursing/Healthcare: Contributions to Nursing/Healthcare Allows identification of alternatives to pain management Implementation of alternative methods Relaxation and music Contributions: Contributions Dr. Good is expanding to include different disciplines How the use of alternative methods affect patients heart rates, respiratory rates, sleep, recovery rate and complications Contributions: Contributions Intensifies the nurse-patient relationship Studies show: The use of alternative methods with medications significantly reduces pain in patients Patients allowed to pick their own music Using educational tapes for education MUSIC: MUSIC Teach Me to Whisper 7:03 Liquid Mind Liquid Mind VI: Spirit New Age Relaxation: Relaxation Alternative Methods: Alternative Methods Viable intervention for pain control Being explored by different disciplines Music Therapists Draws patients attention away Decreases pain levels Improve patients outcomes Alternative methods have minimal side effects Reduce post-operative complications Theory-Practice Link: Theory-Practice Link Use in the ED remains unclear Limiting factors Time limitations Environment Proper pain management begins immediately PAIN ASSESSMENT! Theory-Practice Link: Theory-Practice Link Medications are not enough Pain protocols in place Can be applied to any patient experiencing pain Additional research being conducted Acute Pain Management: Acute Pain Management Alternatives methods must be taught to patients Not an exact science Each patient will respond differently In the ED….: In the ED…. Patients could be taught relaxation techniques prior to procedures Headphones Education of the staff What is available? Lack of knowledge Acute Pain Management: Acute Pain Management Theory could expand to include the ED How this theory can be used in my clinical setting Additional education Strong knowledge development Open minded Pain Management Future: Pain Management Future Can this change the way health care treats pain and improves patient outcomes??