Pain Management Case Report: Application of Theory


The provision of care to people suffering from chronic conditions is often associated with the focus on pain management. Such patients tend to endure constant or frequent pain, which hurts their quality of life (Schmidt, 2016). One of the most effective ways to assist these patients is to provide educational services that equip them with self-management tools. The delivery of high-quality educational services to help patients address their pain is one of the priorities especially when it comes to chronic conditions treatment (Allen, Henderson, Mancini, & French, 2017). Nursing practitioners can employ various theoretical frameworks to achieve this goal. Pain management is an important component of care that can be viewed through the lens of Henderson’s and King’s theories. These paradigms imply setting goals and achieving them through effective communication and the provision of patient-centered care. This paper includes a brief description of the theories mentioned above and their application to pain management.

Brief Literature Review and Synthesized Literature Findings

Pain management is one of the areas that has been actively discussed by researchers and practitioners. It has been acknowledged that nurses can help patients suffering from chronic pain through the delivery of educational services (Allen et al., 2017). Medication-based treatment is now regarded as a possible option rather than the major treatment pattern. The prevalence of substance abuse among patients using opioids is one of the factors contributing to the rising popularity of non-medication-based treatment methods. For instance, Allen et al. (2017) stress that meditation and mindfulness have proved to be effective strategies to address pain. The major idea of such strategies is the use of patients’ inner strength and the focus on social ties.

The way care (including educational services) is provided is also undergoing certain changes to make treatment more effective. Goal setting is becoming a widely used practice that enables healthcare professionals to maintain patient motivation and their adherence to the prescribed treatment (McMorran et al., 2016). Technological advances assist healthcare practitioners in reaching wider populations. For instance, Eckard et al. (2016) claim that the use of mobile applications in pain management is associated with positive health outcomes. Patients are more knowledgeable and motivated to use the most effective pain management strategies. Furthermore, cultural aspects are now recognized as an influential component of care. However, nursing practitioners still lack the necessary knowledge and skills to take into account patients’ cultural peculiarities (Bridges & Anastasia, 2016). Based on this quick review, it is possible to assume that there is a need to incorporate the cultural aspects of care into goal-centered care delivery.

The Case Explained from a Theoretical Perspective

Pain management is a complex and lasting process that includes such elements as trust, effective communication, evidence-based tools, as well as motivation and encouragement. Patients often feel distrustful, irritated, and unwilling to collaborate due to their constant exposure to pain (and other conditions). Henderson’s theory can help in addressing the issue due to its focus on several dimensions. According to this theoretical framework, care consists of several elements including physiological, psychological, spiritual, and social (Masters, 2015). Therefore, when addressing pain, nurses should pay attention to such aspects as certain physiological (temperature, blood pressure, and so forth), psychological (being stressed, anxious, depressed, and so on), as well as spiritual and social (beliefs, traditions, family, community, etc.). It is important to add that the social domain is likely to play the leading role in managing pain as other people’s support and understanding can help patients overcome the health issue under analysis. One of the benefits of this theory is that it can help nursing practitioners develop effective communication patterns with patients. However, the intervention aimed at dealing with pain cannot be based on this theory exclusively as nurses are likely to lack the focus.

As has been mentioned above, it can be effective to apply King’s theory of goal attainment when addressing pain since it will assist in remaining focused. The theory implies the establishment of measurable and attainable goals that can serve as motivational strategies and building blocks of trust between healthcare professionals and patients (Urgelles, Pitts, & Gorog, 2016). Importantly, the theory can be utilized as a specific framework for setting goals (Whetsell, Gonzalez, & Moreno-Fergusson, 2015). King describes the primary areas of concern and ways to develop effective and achievable goals. At the same time, although the theory presupposes the focus on patients’ needs and perceptions, little attention is paid to cultural beliefs and associated health behaviors. Therefore, it is essential to combine the two theoretical paradigms when developing a new intervention aimed at helping patients to manage their pain.

Summary of the Case

It has been estimated that one in ten patients in the USA suffers from chronic pain while the cost of treating pain reaches over $630 billion each year (Eckard et al., 2016). It is critical to developing effective strategies and methods to soothe pain and help patients manage it. The attainment of this goal will translate into better health outcomes and satisfaction for patients suffering from various chronic conditions. It is necessary to point out that various populations are prone to this health condition, which makes it difficult to develop a universal remedy to address the problem. Nevertheless, education and support have proved to be effective components of care associated with pain management (Schmidt, 2016). Nurses can and should teach patients to address their health issues and maintain a high quality of life. This learning is often characterized by close communication and collaboration between the patient and the nursing practitioner.

Proposed Solutions from a Theoretical Approach

To address the problem, it is possible to combine the two theoretical frameworks mentioned above and use different tools to implement the proposed solution. The intervention will include two major components, setting achievable goals and then focus on cultural peculiarities. Before the establishment of goals, nursing professionals will make sure they are aware of the primary peculiarities of the patient’s cultural beliefs. Bridges and Anastasia (2016) state that some ethnic groups are distrustful of healthcare professionals and even reluctant to address pain which is regarded as an important symptom and the deserved punishment, at the same time. When communicating with patients, nurses should reveal their knowledge of some health-related beliefs, which can help in creating the necessary rapport.

Henderson’s framework can serve as the guide during the first stage of the intervention. The nurse will pay attention to the dimensions described to identify patients’ peculiarities and needs. Pain management is often associated with psychological and spiritual aspects, so these elements will require the most attention (Allen et al., 2017). Henderson’s theory provides insights into possible ways to develop effective communication patterns with patients and encourage them to learn and acquire self-management skills. Therefore, the benefits of the use of this theory are manifold as nurses manage to identify the most valuable peculiarities of their patients and encourage them to collaborate with healthcare professionals. This collaboration is essential for the establishment of goals.

The next step in the implementation process is setting attainable and measurable goals that should be based on (or at least modified by) the cultural peculiarities of the patient. Nurses should discuss possible strategies to manage pain, as well as the benefits of soothing pain and adverse effects of untreated pain. Again, this discussion should be guided by the focus on the cultural peculiarities of the patient. The nurse has to provide arguments to support the prescribed treatment by addressing patients’ possible prejudice or bias. King’s model can help in addressing all these areas. When the goals are set, it is possible to discuss various details related to the suggested treatment.

The implementation of this treatment will imply the use of mobile and Internet technology. Eckard et al. (2016) explored the benefits of such tools. The elements of the intervention described by Eckard et al. (2016) will become the basis for the new intervention. Patients will receive notifications and reminders about the procedures to undertake, as well as goals to be attained or those that have been achieved. As for the Internet component of the intervention, social media will be used as the major platform for the communication between healthcare professionals and patients. Blogs and such social networks as Facebook or Twitter will become the sources of knowledge and channels for knowledge sharing. The use of technology may narrow down the population that can benefit from the intervention as younger people are more active users of technology. However, Eckard et al. (2016) note that adults and older adults are becoming more active users of social networks and other Internet-based communication channels.

The implementation of this intervention will require the provision of training to nursing professionals. These practitioners will learn about the peculiarities of different ethnic groups’ health-related beliefs and traditions. The focus will be on the groups that prevail in a particular region. Apart from learning about people’s views on pain management, nurses will be trained to persuade patients and motivate them to use effective ways to treat their chronic pain. Some training may be necessary for the area of technology use. Nursing professionals may need certain guidelines when writing blogs, being active on social networks, and so forth. Finally, the hospital’s IT professionals may need to develop or choose an existing mobile software that can be used.

At the same time, it is important to note that this project is associated with a certain investment. The administration of the healthcare facility will have to consider allocating more funds to provide monetary rewards to the staff participating in the project. The intervention implies additional effort nurses have to make, which may need financial motivation or other types of benefits. The possibility to work from home, more flexible schedules or shorter shifts can be other options to motivate the hospital’s nursing personnel. All these benefits are possible due to the involvement of technology since nurses can communicate with their patients through social networks in any setting (other than the hospital).

Research Instrument to Evaluate the Proposed Solution

Qualitative research design can be used to evaluate the effectiveness of the program. It is possible to implement a case study as the focus will be on a particular population, those suffering from chronic pain. It is essential to examine the perspectives of both nurses and patients. Focus group discussions can be the tools to achieve this goal. As for nursing professionals, they will share their views on the strengths and weaknesses of their training program, the effectiveness of the care they provide, as well as possible improvements. It can be necessary to address such aspects as workload, availability of resources, and nurses’ burnout or negative attitudes if any. This information can help in evaluating the cost-effectiveness of the intervention and make certain improvements. The discussions involving patients can address such areas as the benefits of the services related to pain management they receive, the availability of resources, their overall well-being, and so on.

The Evaluation of the Research Instrument

The qualitative research design is chosen as it is necessary to evaluate the way people would feel about the new treatment rather than estimate the number of people who benefit from the participation in the project. The positive influence of psychological support, educational services, non-pharmacological methods, and the use of technology have already been touched upon. However, it is essential to explore the way people see such interventions, as well as their strengths and weaknesses. These insights will help in improving services related to pain management.

As far as the use of focus group discussions, it is noteworthy that this instrument has some weaknesses as the participants may feel reluctant to share their views openly due to the involvement of their peers. Nevertheless, this data collection method is instrumental in collecting more information and reaching more people as compared to interviews. Moreover, it is possible to mitigate the weaknesses of the tool through the development of the appropriate atmosphere and asking the right questions.

Conclusion

To sum up, pain management is one of the major areas of concern as it is associated with the wellbeing of millions of people suffering from chronic conditions and the possible increase in the substance abuse rate. The proposed intervention is based on Henderson’s and King’s theoretical frameworks. On the one hand, the new treatment will involve the identification of patients’ needs and peculiarities through the use of Henderson’s dimensions. On the other hand, the intervention will imply setting attainable goals based on the information obtained. Specific attention will be paid to the cultural aspect as pain management is often a vulnerable area since ethnic groups have different views on the matter.

To evaluate the proposed intervention, it is possible to carry out a case study. Nurses and patients who will participate in the research will take part in focus group discussions. The areas that will be covered will include patient’ outcomes, their wellbeing, the quality of services provided, availability of resources, nurses’ perspectives on the intervention, their workload, and so forth. These research instruments will help researchers identify the areas for improvement and possible ways to make the intervention more effective. The previous research shows that such intervention is likely to be beneficial for patients suffering from chronic pain. However, it is essential to make sure that the new approach is effective and applicable in many settings.

References

Allen, T., Henderson, T., Mancini, V., & French, K. (2017). Mindfulness and meditation practice as moderators of the relationship between age and subjective wellbeing among working adults. Mindfulness, 8(4), 1055-1063.

Bridges, A. J., & Anastasia, E. A. (2016). Enhancing and improving treatment engagement with Hispanic populations. In G. Sherwood & J. A. McNeill (Eds.), Integrated care for pain management among Hispanic populations (pp. 125-145). Cham, Switzerland: Springer.

Eckard, C., Asbury, C., Bolduc, B., Camerlengo, C., Gotthardt, J., Healy, L., … Horzempa, J. (2016). The integration of technology into treatment programs to aid in the reduction of chronic pain. Journal of Pain Management and Medicine, 2(3). Web.

Masters, K. (2015). Models and theories on nursing goals and functions. In K. L. Rich (Ed.), Philosophies and theories for advanced nursing practice (pp. 383-412). Sudbury, MA: Springer.

McMorran, D., Robinson, L., Henderson, G., Herman, J., Robb, J., & Gaston, M. (2016). Using a goal attainment scale in the evaluation of outcomes in patients with diplegic cerebral palsy. Gait & Posture, 44, 168-171.

Schmidt, S. (2016). Recognizing potential barriers to setting and achieving effective rehabilitation goals for patients with persistent pain. Physiotherapy Theory and Practice, 32(5), 415-426.

Urgelles, J., Pitts, M., & Gorog, L. (2016). Hispanic children and integrated care. In L. T. Benito & W. O’Donohue (Eds.), Enhancing behavioral health in Latino populations: Reducing disparities through integrated behavioral and primary care (pp. 145-162). Reno, NV: Springer.

Whetsell, M. V., Gonzalez, W., Moreno-Fergusson, M. E. (2015). Models and theories on nursing goals and functions. In J. B. Butts & K. L. Rich (Eds.), Philosophies and theories for advanced nursing practice (pp. 413-444). Sudbury, MA: Jones & Bartlett Learning.