I wrote the paper already,but I got it back for revision.I am attaching the paper with revision instruction.Pls use same reference list and you can add more if needed.Pls correct the reference list also.
Nursing attitudes towards pain control in Substance abuse patients:
A Literature Review
Anu Merly Thomas, RN, BSN
Western Governors University
Bruce is a 35 year old with history of substance abuse, admitted in hospital with diagnosis of endocarditis. The pain medications administered during hospital stay did not relieve his pain because of preexisting tolerance. The nurses misjudged his complaints about pain and label him as “drug seeking patient”. He left the hospital after signed “against medical advice” form without completing the antibiotic treatment. He met his old drug dealer on his way back home and started using heroin again. After 5 days, he readmitted in worse condition.
Pain is the number one reason people seek medical care, is often undertreated. Pain assessment and management continues to be challenging for health care professionals. Pain management in patient with substance abuse disorder may be difficult. The challenge which clinicians face when treating substance abuse patient is to identify true pain from drug-seeking behaviors. The prevention and control of pain is a key feature of health care. Pain control is an important goal to reduce patient’s discomfort and improve quality of life. Inadequate pain management causes number of undesirable outcomes.1) The risk of developing chronic pain is increased due to inadequate management of acute pain there by impacting different aspects of patients’ life negatively. 2) Financial burden: Uncontrolled pain in substance abuse patients results on extended hospital stays. Poorly managed pain affects their daily activities. 3) Patient’s satisfaction is influenced by inadequate pain management. In order to monitor the satisfaction with the care provided, many hospitals and clinics make use of commercial patient satisfaction surveys.
Many hospitalized substance abused patients receive inadequate pain management. Health care professionals have many concerns and feel inadequately prepared to assess and treat pain in a population of people with addictive disorder. Unfortunately, nurses whether related to their personal experience or the previous encounters they had with patients’ holds biases towards the patients. Adverse physical and psychological patient outcomes are seen in patients with inadequate pain management causing difficulties for themselves and their families. The studies have identified that health care professional who holds negative attitudes towards patients with substance abuse history and has negative impact on the quality of care delivered. The judgmental inferences of the term “addict” will follow the patient throughout the health care system. (RM Evans, 2005). The goal of this paper is to identify and explore nurses’ attitudes towards hospitalized substance abusers in pain and how to improve pain treatment in this population.
Pain management outcomes for hospitalized substance abuse patients are often inadequate. Health care professionals tend to undertreat pain in this population due to biases, misconceptions, lack of knowledge and systems issues. Pain in this population can be managed more effectively by appropriate assessment and treatment. Further research is needed to understand knowledge, biases and system barriers in order to obtain effective pain management for hospitalized substance abuse patients.
List of References
1) Bernhofer, E., (2011) Ethics and Pain Management in Hospitalized Patients
OJIN: The Online Journal of Issues in Nursing Vol.17 No. 1.
2) Blay, N., Glover, S., Bothe, J., Lee, S., & Lamont, F. (2012).Substance users’ perspective of pain management in the acute care environment. Contemporary nurse, 42(2), 289-297.
3) Clark, M. R., Stoller, K. B., & Brooner, R. K. (2008). Assessment and management of chronic pain in individuals seeking treatment for opioid dependence disorder. Canadian journal of psychiatry, 53(8), 496-508.
4) Fouladbakhsh, J. M., Szczesny, S., Jenuwine, E. S., & Vallerand, A. H. (2011). Nondrug therapies for pain management among rural older adults. Pain Management Nursing, 12(2), 70-81
5) Horbury, C., Henderson, A., & Bromley, B. (2005). Influences of patient behavior on clinical nurses’ pain assessment: implications for continuing education. Journal of Continuing Education In Nursing, 36(1), 18.
6) McCaffery, M., Grimm, M.A, Pasero, C., Ferrell, B., & Uman, G. (2005) On the meaning of ‘Drug seeking’. Pain Management Nursing, 6(4), 122-136.Retrieved from EBSCO host
7) Natan, M., Beyil, V., & Neta, O. (2009). Nurses’ perception of the quality of care they provide to hospitalized drug addicts: testing the Theory of Reasoned Action. International Journal of Nursing Practice, 15(6), 566-573. doi:10.1111/j.1440-172X.2009.01799.x
8) Rosenblatt, A. B., & Mekhail, N. A. (2005). Management of pain in addicted/illicit and legal substance abusing patients. Pain practice: the official journal of World Institute of Pain, 5(1), 2-
9) Wintle, D. (2008). Pain management for the opioid-dependent patient. British Journal of Nursing, 17(1), 47. Retrieved from EBSCO host
10) Ziegler, P. P (2005). Addiction and the treatment of pain. Substance Use & Misuse, 40(13-14), 1945-1954
Literature Review Organization
The literature review covers selected studies associated with nursing attitudes towards pain control in Substance abuse patients. Qualitative studies will help to understand nurses’ knowledge deficits and attitudinal barriers to effective pain control in in Substance abuse patients. This literature is a focus to capture current evidence in practice. The scholarly and peer reviewed articles were reviewed for this literature review. All the articles are credible because it was written by well-respected authors who are experts in the same subject. Literature review will be organized into three sections: nurses’ attitudes and beliefs, risk factors that contribute to abuse and best practices and alternative treatments.
Nurses’ Attitudes and Beliefs
Nurses often struggle to provide adequate pain management for their patient in health care setting often due to lack of knowledge and negative attitudes. According to McCaffery, Grimm, Pasero, Ferrell, & Uman (2005) the term “drug seeking” is frequently used but poorly defined. The authors conducted the survey to understand the term “drug seeking” used by the nurses and to understand whether this is helpful in identifying any useful information about the patient. When talking about the patients more than 50% of nurses from each group admitted using the term “drug seeking”, but only less than 10% used it for documentation. During the care imparted to a patient who is labeled as drug seeking, a high level of misperception and humiliation are likely to be present. The term “drug seeking” is not at all helpful in order to determine whether the patient have or have not addictive disease since the term is vague, ill-defined, does not have stable criteria and is subjective. (McCaffery, M., Grimm, M.A, Pasero, C., Ferrell, B., & Uman, G., 2005).This article is aimed towards assisting nurses to understand their prejudices and judgments and will help to lighten the patient’s pain.
The research article written by Natan, Beyil, & Neta (2009) was done a study by using correlation design to examine the attitudes and subjective norms of nursing staff displayed in the intended and actual care of drug users based on the Theory of Reasoned Action. The management of patients who frequently request for pain medicine is deemed difficult by nurses to tend to hold a negative label. The authors suggest that better way to relieve hardships related to caring for substance abuse patients are by conducting workshops for nurses aimed at identifying difficulties, coping with and providing support for work with drug addicted patients. The research is successful and provides ground for further research.
Risk factors that contribute to abuse
After reviewing nurse’s negative attitudes and bias towards substance abuse patients, it is important to look for the risk factors that lead to an individual to become drug dependent or started to overuse prescribed pain medicines. The researchers are looking for answers as to how these patients get into drug addict state? Targeted research studies and articles that attempt to answer these questions were reviewed.
An article by Blay, Glover, Bothe, Lee & Lamont (2012) explores that incompetent management of pain which includes insufficient and de including inadequate and tardiness with administering pain medicine leading to the development of problematic behavior in substance abusers. Some nurses have the bias that patient is an addict, when he or she asks for pain medicine frequently. Regularly, whether the patient have or have not an addiction to pain medication is not properly assessed and certainly the diagnosis of addiction is not documented on the medical records of the patient. The number one side-effect of opioid analgesia is respiratory depression. Because of this respiratory distress, clinicians are extremely conscious when administrating opioid analgesics. Clearly, addiction is a major concern which involves patients, nurses and physicians. It is of paramount importance that apt education is the key to make sure that facts are conveyed, not myth to all parties involved.
Wintle (2008) found that knowledge deficiency, along with fear and anxiety leads many nurses tried to avoid caring for this patient population and subsequently reacted negatively. The article also gives a description of how patients become addicted. Age, expectation, gender and life experience can all have an impact on an individual’s pain experience. Patients who abuse opioids tend to report higher pain level for an extended period of time as a result of repeated exposure to illicit drugs, which cause changes in the brain neurons and release of chemicals. This cause mood elevation and individual to repeat the action. Other factors such as genetics, stress, environmental issues are thought to affect the move from drug use to drug addiction.
Chronic pain is internationally common problem. Health care professionals still looking answers for how best to define and measure chronic pain. Clark, Stoller &Brooner (2008, p.497) noted that “chronic pain and substance abuse are independently recognized as complex problems growing in scope and severity” .These article highlight that in the general population, estimate of the point prevalence of chronic pain in the United States range from 10% to>50%. The article identifies some of the articles that associated with opioid dependence among other dependence disorders. The presence of chronic pain increases the risk of poor response to substance abuse treatments .The article reveals that the treatment programs implemented are an improvement of the outcomes, which are tailored to meet the need of individual patients.
Best practices and alternative treatments
Accurate comprehension of all variables is necessary in order to achieve effective pain management for substance abuse patients. Nurses’ stereotypes towards substance abuse patients should be changed. A research article written by Rosenblatt & Mekhail (2005) suggest that before treating one should thoroughly question the subject in need of pain management. These authors also emphasis that one should always assess for underlying pathology, individualized each patient’s regimen, reevaluate for improvement frequently, change drugs, dosing, frequency and route as needed, use the least invasive route of drug delivery as possible ,and use the dose needed to relieve pain with the least amount of side effects. (Rosenblatt, A. B., & Mekhail, N. A., 2005).
Horbury et al. (2005, p.19) identified that “lack of education of health professionals, particularly nurses, is frequently cited as a major reason for under treatment of patient’s pain”. The approaches in the clinical context in order to heighten the awareness among nurses regarding the lack of knowledge for pain assessment and management and the need for innovative teaching strategies is highlighted in this article. A poor attendance by the nurses during in-service sessions when pain management was discussed was the impetus for this study. The research in conclusion found that more education in pain assessment and management to nursing staff is required.
According to Bernhofer (2011), all health care professionals should use principles of ethics such as autonomy, beneficence, nonmaleficence, and justice during the assessment and treatment of pain in hospitalized patients. The article also highlights that health care provider should respect each individual’s healthcare decisions regardless of whether they agree or not with these decisions. The confidence level of the hospitalized patients goes up when unbiased ethical decisions are made for managing the pain and resulting in increased patient’s satisfaction. Nurses can help themselves to see their own biases by consciously using basic ethical principles. They also can provide optimal pain management by using evidence based decisions. It is the right of the patient to understand, contemplate, demand and even refuse any treatments that they believe, may or may not help to manage their pain. In order to make right decision, the patient should be educated regarding all the medications and their side effects. The pain is better managed when the patients have the autonomy regarding the treatment and it enhances the level of satisfaction with regard to the care provided.
Penelope P. Ziegler (2005) suggests that in order to prevent over dosage of the opioid medications which should be held and administered by a trusted other person. Pain management for chronic pain in patient with a substance disorder should be as same as the chronic non-addicted patient. When treating patient with opioid analgesics, it is important to remember that the ability of opioid analgesics are induce tolerance, physical dependence, and addiction. Nurses and other health care professionals should keep in mind that patient with a history of substance abuse are at “high risk” when they acquire painful conditions requiring aggressive treatment. It is recommended to administer the pain medicine on a scheduled time rather than as needed or “prn”. This helps to keep pain under control all the time, along with the tendency to escalate the dose. The articles concluded that when the patient with pain begins to show warning signs of addiction, early intervention, evaluation, and appropriate pain management strategies can prevent severe negative outcomes.
In order to relieve pain and reduce anxiety in patients with substance abuse, the use of complementary and alternative pain management modalities is helpful. Non pharmacological pain management methods were rarely implemented. The study was conducted by Fouladbakhsh, Szczesny, Jenuwine and Vallerand (2011) proved that patient education regarding the use of cold and hot significantly reduce pain upon discharge. Analysis of data from this quasiexperimental two-group pilot study involving 55 adults showed decrease in pain levels when properly educated in using hot or cold packs. The management of pain can be effectively achieved by using physical modalities such as hot or cold packs, reposition the patient and massage.
Bernhofer, E., (2011) Ethics and Pain Management in Hospitalized Patients
OJIN: The Online Journal of Issues in Nursing Vol.17 No. 1.
Blay, N., Glover, S., Bothe, J., Lee, S., & Lamont, F. (2012).Substance users’ perspective of
pain management in the acute care environment. Contemporary nurse, 42(2), 289-297.
Clark, M. R., Stoller, K. B., & Brooner, R. K. (2008). Assessment and management of chronic
pain in individuals seeking treatment for opioid dependence disorder. Canadian
journal of psychiatry, 53(8), 496-508.
Fouladbakhsh, J. M., Szczesny, S., Jenuwine, E. S., & Vallerand, A. H. (2011). Nondrug
therapies for pain management among rural older adults. Pain Management Nursing,
Horbury, C., Henderson, A., & Bromley, B. (2005). Influences of patient behavior on clinical
nurses’ pain assessment: implications for continuing education. Journal of Continuing
Education In Nursing, 36(1), 18.
McCaffery, M., Grimm, M.A, Pasero, C., Ferrell, B., & Uman, G. (2005) Pain Management
Nursing, 6(4), 122-136.Retrieved from EBSCO host
Natan, M., Beyil, V., & Neta, O. (2009). Nurses’ perception of the quality of care they
provide to hospitalized drug addicts: testing the Theory of Reasoned Action.
International Journal of Nursing Practice, 15(6), 566-573. doi:10.1111/j.1440-
RM Evans (2005) Assessing and Treating Pain in Patients with Substance Abuse Concerns
Rosenblatt, A. B., & Mekhail, N. A. (2005). Management of pain in addicted/illicit and legal
substance abusing patients. Pain practice: the official journal of World Institute of
Pain, 5(1), 2-
Wintle, D. (2008). Pain management for the opioid-dependent patient. British Journal of
Nursing, 17(1), 47. Retrieved from EBSCO host
Ziegler, P. P (2005). Addiction and the treatment of pain. Substance Use & Misuse, 40(13-14),
Write a literature review (suggested length of 8–10 pages) in which you do the following:
A. Describe the problem within your professional setting as a reference for the evaluator.
Note: Refer to the introduction and background of your problem as you have presented in task one and two.
B. Provide the list of references you created in Task 2 for at least 10 sources, given in APA format, that are appropriate to the research topic.
Note: If your source list has changed from what was submitted in Task 2, please provide an updated list.
C. Organize the 10 sources from part B by grouping them under relevant headings that address your problem.
D. Evaluate your groups of sources created for each heading in part C for the following three areas:
1. Factors that influence your chosen problem
2. Barriers to the success of a program or intervention
3. Best practice related to your research topic
E. When you use sources, include all in-text citations and references in APA format.
Evaluation Summary for Lit. Review for NrsngRsrch: Literature Review
The paper provides headings to help organize and evaluate the sources. Two of the organizational headings are appropriate for the topic. The third organizational heading is “Best Practices and Alternative Treatments.” The sources under each of the organizational headings must be evaluated for best practices. Once the appropriate headings are identified, the sources under each heading can be evaluated forrs to the success of an intervention or program, and best practices. Please provide more information for aspects C, D1, D2, and D3.
A list of 10 sources is provided. Minor deviations from APA format are noted
All of he organizational headings need to be specific to the problem identified. Two of the headings appear to be appropriate, however, the final heading is “Best Practices and Alternative Treatments.” Best practices should be discussed under each heading.
D1. Influencing Factors
The paper provides a logical evaluation of the sources for Influencing factors under two of the headings. The remaining sources need to be grouped under an appropriate heading.
D2. Barriers to Success
An evaluation of the sources for the barriers to success of a program or intervention is not evident.
An evaluation of the sources under each heading include suggestions by the authors; however, an evaluation for best practices is only apparent under one heading