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Pain Assessment. The implementation and rationale for using pain assessment tools is focused on within this essay, with limitations of use being discussed and analysed.

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´╗┐Pain is a common experience for most people (Kingdon et al, 1998). McCaffery (1980) states ?pain is what the patients says it is and exists when the patient says it does?. This is one of the most widely used definitions of pain (Cunningham, 2001) however, if a patient does not say they are in pain how can a nurse identify their pain? Seers (1987) argues that patients do not always tell the nurse that pain has arisen and that they often expect the nurse to know. Therefore effective assessment of pain is a vital part of nursing care. Lawler (1997) maintains that good communication skills are vital in assessing pain in patients. The implementation and rationale for using pain assessment tools is focused on within this essay, with limitations of use being discussed and analysed. Pain management is optimised by increasing our understanding of the neurobiology of pain, combined alongside interactions with the patient, coupled with science and knowledge combined with empathy and humanity (Ducharme, 2000). Since the publication of Melzack & Walls (1965) gate control theory of pain, psychology has been accepted as an integral discipline in the study of pain (Skevington, 1995). The physiological and pharmacological aspects of acute pain, and its management are discussed and analysed within this essay. Acute pain management is more than a collection of interventions, it is a package of care which requires examination as a whole, as well as in its parts (McQuay & Moore, 1998). Holistic nursing care encompasses not only the physical aspects, but also the psychological, emotional and spiritual aspects of human nature. Anxiety can play a major role in an individuals pain experience (Kennerley, 1995). This is an area which is also explored within this essay, with specific focus on reducing anxiety levels by effective communication and development of a therapeutic relationship. Communication is a vital skill within the nursing process to enable accurate assessment, implementation and evaluation of interventions, this is another aspect which is explored and evaluated within this essay. ...read more.


C-fibres are unmyelinated, which are smaller and slower fibres, producing sensations of dull pain (Hawthorne & Redmond, 1998). Disease and injury often result in pain and hyperalgesia. These abnormal sensory events arise in part from the action of inflammatory mediators on the peripheral terminals of nocieptive neurons. Sensory nerves express a variety of receptors from inflammatory mediators. The expression pattern varies between individual mediators, but many of these receptors are found on the polymodal nociceptors. These receptors fall into three main classes: G-protein-coupled receptors, ligand-gated ion channels and the cytokine receptors or receptor tyrosine kinases. There is a considerable body of evidence that kinins contribute to the pathophysiological processes accompanying both acute and chronic inflammation. Bradykinin and the related peptide kallidin are formed from the kininogen precursor proteins following the activation of plasma or tissue kallikrien enzymes by path physiological stimuli such as inflammation, tissue damage or anoxia (Wall & Melzack, 2006). As previously noted the pain that Mrs Green was experiencing was categorised as acute pain. However, a factor which was taken into account when assessing Mrs Green?s pain was the impact of her anxious state, recognising that anxiety can lead to hyperalgesia, thus increasing her pain experience. Therefore the implementation of both adequate pain relief alongside the reduction of anxiety were main considerations when attempting to control Mrs Green?s pain. Pain management As pain can be a mutifactorial, there are a variety of approaches to treating pain. Choosing an appropriate treatment encompasses not only the clinical aspects but also the emotional, psychological and spiritual components that relate to the experience (Hawthorne & Redmond, 1998). The importance of recognising not only the physiology of pain that Mrs Green experienced but also the emotional and psychological impact was paramount to ensure that she received holistic care. The management of Mrs Green?s pain was complex and required the multi-disciplinary team to collaborate to provide effective holistic pain control. ...read more.


Kaufman. C.E. & P.A. McKee. 1996. Essentials of pathophysiology. Boston: Little, Brown and Company. Kenner. D.J. 1994. A total approach to pain management. Australian Family Physician. vol:23, p1267-1283. Kennerley. H. 1995. Managing Anxiety. Second Edition. Oxford: Oxford Medical Publications. Kingdon. R.T., K.J. Stanley & R.J. Kizior. 1998. Handbook for Pain Management. Philadelphia: W.B. Saunders Company. Lawler. K. 1997. Pain Assessment. Professional Nurse. Vol 13:1, 5-8. Lefkowitz. M. & A.H. Lebovits. 1996. A practical approach to pain management. New York: Little, Brown & Company. Livingstone. References Mackrodt K. & White M. (2001) Nurses? knowledge within the context of pain management. Journal of Orthopaedic Nursing 5, 15?21. Manias. E. 2003. Pain and anxiety management in the postoperative gastro-surgical setting. Journal of Advanced Nursing. Vol 41:6, 585-594. Martini F. H. 2007. Fundamentals of Anatomy and Physiology. Seventh McCaffery. M. 1980. Understanding your patients pain. Nursing 80:26. McCaffery. M. & C. Pasero. 1999. Pain Clinical Manual. Second Edition.. St Louis: Mosby Inc. McCaffery. M. & A. Beebe. 1994. Pain. Clinical manual for nursing practice. London: Mosby. McCaffery. M. 1965. Nursing Practice Theories Related to Cognition, Bodily Pain McCance. K.L. & S.E. Huether. 2002. Pathophysiology. The Biologic Basis for Disease in Adults & Children. Fourth Edition. St. Louis: Mosby Inc. McGuire D (1992) Comprehensive and multidimensional assessment and measurement of pain. Journal of Pain and Symptom Management. Vol 7:5, 312-319. McQuay. H. & A. Moore. 1998. An evidence-based resource for pain relief. Oxford: Oxford University Press. Melzack. R. & P.D. Wall. 1965. Pain mechanisms: a new theory. Science, 150: 971-979. Merskey. H. & N. Bogduk. 1994. Classification of chronic pain syndromes and definitions of pain terms. New York: Elsevier Limited. Miaskowski C., Nichols R., Brody R.& Synold T. (1994) Assessment of patient satisfaction utilizing the American Pain Society?s quality assurance standards on acute and cancer related pain. Journal of Pain and Symptom Management 9, 5?11. Montes-Sandoval. L. 1999. An analysis of the concept of pain. Journal of Advanced Nursing. Vol 29:4, 935-941. Naish. J. 1996. The route to effective nurse-patient communication. Nursing Times. Vol: 92, 27-28. NMC. 2002. Code of Professional Conduct. London: Nursing and Midwifery Council. ...read more.

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