Research Analysis Chart
Clinical Problem
Because of the inability to determine the emotions of unconscious or sedated patients, the members of the ICU often fail to prevent painful experiences that patients are exposed to during a range of procedures, such as mechanical ventilation, airway suctioning, etc. (Stites, 2013). Therefore, there is a need to design the tools that will help reduce the unpleasantness of similar procedures, at the same time allowing nurses and medical experts to take the necessary measures to facilitate the patient’s safety and recovery.
Resources Assessment
Annotated Bibliography
Alderson, S. M., & McKechnie, S. R. (2013). Unrecognised, undertreated, pain in ICU: Causes, effects, and how to do better. Open Journal of Nursing, 3(1), 108-113. Web.
The authors point to the fact that the issue of pain experienced by unconscious patients in ICU is often underrated. Furthermore, when striving to meet the needs of non-verbal patients, nurses may need to consider using updated tools. The CPOT tool is suggested as the most efficient device in pain management since it allows evaluating pain without the visual signs thereof (Alderson & McKechnie, 2013).
Barr, J., Fraser, G. L., Puntillo, K., Wesley, E., Gelinas, C., Dasta, J. F.,… & Jaeschke, R. (2013). Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit: Executive summary. American Journal of Health-System Pharmacy, 70(1), 53-58. Web.
The authors make it quite clear that the current tools need an urgent update to detect the pain experienced by ICU patients. As a result, the necessity to carry out a thorough examination of the pain management strategies ensues. The nurses are suggested to use preemptive analgesia in order to improve the current service quality (Barr et al., 2013).
Stites, M. (2013). Observational Pain Scales in Critically Ill Adults. Critical Care Nurse, 33(3), 68-79. Web.
The application of the latest tools for improving the patients’ outcomes as a result of ICU-related processes is typically encouraged. However, the lack of clarity about their efficacy is rather disturbing. The results of the quantitative analysis did not show the difference between the four tools (Stites, 2013).
Quintard, H., Pavlakovic, I., Mantz, J., & Ichai, C. (2012). Adjunctive remifentanil infusion in deeply sedated and paralyzed ICU patients during fiberoptic bronchoscopy procedure: a prospective, randomized, controlled study. Annals of Intensive Care, 2(1), 29-35. Web.
The study shows that Remifentanil, one of the most commonly used drugs to prevent pain in the ICU patients, does not necessarily have to be used in large doses. Instead, smaller portions can be administered to the patients so that they could be relieved of pain. It should be noted, though, that the reduction in the dose of the medicine may lead to the patient experiencing mild discomfort (Quintard et al., 2012).
Rijkenberg, S., Stilma, W. Endeman, H., Bosman, R. J., & Oudemans-van Straaten, H. M. (2015). Pain measurement in mechanically ventilated critically ill patients: Behavioral Pain Scale versus Critical-Care Pain Observation Tool. Journal of Critical Care, 40(1), 167-172. Web.
A comparative analysis of the Behavioral Pain Scale (BPS) and Critical-Care Pain Observation Tool (CPOT) has shown that CPOT should be preferred to BPS due to higher precision rates. Particularly, BPS has shown the propensity to responding to the stimuli that cannot be deemed as pain-related. However, it would be wrong to dismiss BPS as an invalid device; instead, the two tools should be regarded as equally important yet applicable in different scenarios (Rijkenberg et al., 2015).
Jeleazcov, C., Ihmsen, H., Saari, T. I., Rohde, D., Mell, J., Fröhlich, K.,… & Schüttler, J. (2016). Patient-controlled analgesia with target-controlled infusion of hydromorphone in postoperative pain therapy. Anesthesiology, 124(1), 56-68. Web.
The authors delve into the concept of ICU pain management. Essential strategies are considered in a quantitative analysis. Furthermore, the authors stress the importance of the TCI tool (Jeleazcov et al., 2016).
Filisetti, C., Gregori, M. D., Allegri, M., Bugada, D., Cobianchi, L., & Riccipetitoni, G. (2016). Pain management in pediatric surgery: New horizons. Journal of Pain & Relief, 5(2), 1-3. Web.
The research overviews the existing methods of pain management in ICU. The authors consider the effects of sedation on the feeling of pain. Also, the significance of nurses’ training is raised (Filisetti et al., 2016).
Alasiry, S., & Löfvenmark, C. (2013). Nurses’ perceptions of pain assessment and pain management for patients with myocardial infarction in a coronary care unit. Middle East Journal of Nursing, 7(5), 9-22.
The study sheds light on the problems related to pain management in ICU. The adoption of sedatives along with consistent acquisition of new knowledge is suggested (Alasiry & Löfvenmark, 2013).
Literature Review
The phenomenon of experiencing pain in the ICU by patients when being subjected to the standard procedures is unfortunately common (Rijkenberg et al., 2015). The problem becomes even more obvious once the fact that the ICU patients need to be sedated and, therefore, cannot respond properly is mentioned (Quintard et al., 2012). Therefore, there is an obvious need for improving the quality of care in the contemporary ICU setting so that nurses could manage and meet the needs of the patients accordingly.
As Rijkenberg’s quantitative (randomized control) study shows (Rijkenberg et al., 2015), the situation is aggravated by the fact that there are numerous sources of pain that a patient can be exposed to in the ICU environment. The sample included 13 people. Therefore, to detect the issues that cause the patients’ discomfort and trigger unpleasant experiences, one needs to apply very sensitive and advanced tools that allow identifying the slightest changes in people’s reactions toward specific stimuli (Youssef et al., 2015). Furthermore, there is a need in evaluating the source of the reaction (i.e., labeling it as a psychogenic or physiological one) so that the appropriate course of actions could be identified. Consequently, the devices that should be used to measure the intensity of the patients’ responses need to be very accurate (Rose & Haslam, 2013).
The fact that the target audience can be described as non-verbal makes the task of reducing the pain and managing the unpleasant experiences even more challenging. Indeed, without the appropriate response from the target audience, the nurses will be deprived of an essential source of information (Mai, Duong, & Hellström, 2016). Thus, the nursing experts may fail in their decision-making process when choosing the appropriate pain management framework. At this point, the significance of using an accurate pain assessment device needs to be mentioned (Stites, 2013). In their quantitative research, the authors studied the psychometric properties of the tools suggesting systematic assessment as a solution.
A number of pain rating scales exist, yet few of them permit an accurate evaluation of the patients’ experiences. The problem is rooted deeply in the lack of opportunities for identifying the source of the response (i.e., psychological or the physiological one). As a rule, the systems based on emotional intelligence principles are used in order to measure the pain rates in patients. For example, the adoption of the Visual Analogue Scale implies that both acute and chronic pain levels can be measured when carrying out the ICU-related activities (Alderson & McKechnie, 2013).
However, when considering the factors that shape the intensity of pain that patients experience during the ICU-related procedures, one must also consider the level of the nurses’ proficiency and expertise. There is no need to stress that the ability of the nurse to locate the source of the problem and choose the appropriate tool for managing it by using a well-thought-out decision-making framework is crucial (Labeau et al., 2015). Thus, the staff of the ICU facilities must be provided with the appropriate training so that they could acquire the corresponding skills and the knowledge necessary to deliver the services of the finest quality (Soh et al., 2014). The primary challenge of the task is that the ICU personnel must be trained to be able to apply a set of rigid frameworks and at the same time address individual problems using flexible strategies. Thus, the tools used by the nursing staff must be pliable (Barr et al., 2013).
Therefore, one should give credit to the CPOT framework as the ultimate tool for managing the pain-related experiences that patients face in the context of the ICU environment. The approach allows increasing the competencies of the employees significantly, therefore, creating premises for a patient-centered approach. Thus, the nurses will be capable of locating the problems at the earliest stages of their development and managing them appropriately (Rijkenberg et al., 2015). Since the training material is arranged so that the nurses could acquire the relevant skills in the shortest amount of time possible, it needs to be incorporated into the ICU environment (Mohamed & Ramadan, 2015).
Because of the frequent pain-related experiences that ICU patients have when undergoing the standard procedures, there is a need for nurses to design the framework that will help address the problem. Specifically, it is strongly recommended that the nurses should improve their skills with the help of consistent training, a regular acquisition of the relevant knowledge, etc. (Epp, 2012). Furthermore, it is advised that nursing experts should be offered a complete guide on the steps that must be taken in the course of the ICU procedures. Particularly, the aspects related to reducing the pain in the course of mechanical ventilation need to be touched upon in the course of the training process. As soon as the nursing staff realizes the needs to adopt patient-centered strategies so that the experiences of the customers could be less painful, a rapid improvement in the ICU service quality can be expected.
References
Alasiry, S., & Löfvenmark, C. (2013). Nurses’ perceptions of pain assessment and pain management for patients with myocardial infarction in a coronary care unit. Middle East Journal of Nursing, 7(5), 9-22.
Alderson, S. M., & McKechnie, S. R. (2013). Unrecognised, undertreated, pain in ICU: Causes, effects, and how to do better. Open Journal of Nursing, 3(1), 108-113. Web.
Barr, J., Fraser, G. L., Puntillo, K., Wesley, E., Gelinas, C., Dasta, J. F.,… & Jaeschke, R. (2013). Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit: Executive summary. American Journal of Health-System Pharmacy, 70(1), 53-58. Web.
Epp, K. (2012). Burnout in critical care nurses: A literature review. Dynamics: Journal of the Canadian Association of Critical Care Nurses, 23(4), 25-31.
Filisetti, C., Gregori, M. D., Allegri, M., Bugada, D., Cobianchi, L., & Riccipetitoni, G. (2016). Pain management in pediatric surgery: New horizons. Journal of Pain & Relief, 5(2), 1-3. Web.
Jeleazcov, C., Ihmsen, H., Saari, T. I., Rohde, D., Mell, J., Fröhlich, K.,… & Schüttler, J. (2016). Patient-controlled analgesia with target-controlled infusion of hydromorphone in postoperative pain therapy. Anesthesiology, 124(1), 56-68. Web.
Labeau, S. O., Bleiman, M., Rello, J., Vandijck, D. M., Claes, B., & Blot, S. I. (2015). Knowledge and management of endotracheal tube cuffs. International Journal of Nursing Studies, 52(1), 495-499. Web.
Mai, T., Duong, T. A., & Hellström, A. H. (2016). Permitted visits to the ICU or not – children and parents’ experiences. Health, 8(1), 1089-1097. Web.
Mohamed, E. A. S., & Ramadan, H. M. (2015). Impact of in-Service Training Program for Nurses on Nursing Management for Children with Pneumonia Under Mechanical Ventilation at Ahmad Gasim Hospital, Khartoum, Sudan 2013. American Journal of Clinical Neurology and Neurosurgery, 1(2), 60-67.
Quintard, H., Pavlakovic, I., Mantz, J., & Ichai, C. (2012). Adjunctive remifentanil infusion in deeply sedated and paralyzed ICU patients during fiberoptic bronchoscopy procedure: a prospective, randomized, controlled study. Annals of Intensive Care, 2(1), 29-35. Web.
Rijkenberg, S., Stilma, W. Endeman, H., Bosman, R. J., & Oudemans-van Straaten, H. M. (2015). Pain measurement in mechanically ventilated critically ill patients: Behavioral Pain Scale versus Critical-Care Pain Observation Tool. Journal of Critical Care, 40(1), 167-172. Web.
Rose, L., & Haslam, L. (2013). Behavioral pain assessment tool for critically ill adults unable to self-report pain. American Journal of Critical Care, 22(3), 246-256. Web.
Soh, K. L., Soh, K. G., Ibrahim, N. A., Ahmad, N. Z., Japar, S., & Raman, R. A. (2014). Recalling ICU experiences: Patients’ perspectives. Middle-East Journal of Scientific Research 19 (Innovation Challenges in Multidiciplinary Research & Practice), 1(1), 106-111.
Stites, M. (2013). Observational Pain Scales in Critically Ill Adults. Critical Care Nurse, 33(3), 68-79. Web.
Youssef, H. A. M., Mansour, M. A.M., Al-Zahrani, S. S. M., Ayasreh, I. R. A., & Abd El- Karim, R. A. K. (2015). Prioritizing palliative care: Assess undergraduate nursing curriculum, knowledge and attitude among nurses caring end-of-life patients. European Journal of Academic Essays 2(2), 90-101.