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The issue of pain management and by extension pain relief is an essential component of nursing practice and methods of administration and detection are constantly being designed and evaluated every day. The usual obstacles faced while attempting to ascertain pain levels are compounded when the patient in question is incapacitated due to illness or medication leading to an inability to verbally or otherwise describe or express the pain they are experiencing. Much like conventional pain detection techniques, pain measurement and assessment techniques of nonverbal patients continue to evolve and means of evaluation are constantly being scrutinized and reassessed.
Accurate and authoritative methods for pain measurement among alert patients including both adults and children are numerous. These include various verbal, pictorial and numeric scales which rely on the patient's ability to indicate the level of pain experienced by them (Kabes, Graves, Norris, 2009). The issue of pain assessment of patients that are unable to indicate pain levels due to various forms incapacitation is far more problematic as [url=http://www.1855sacramento.com/woolrich.php]woolrich bologna[/url] measurement is based solely on observation and observed measurements cannot be confirmed or denied by the patients. Nonetheless, methods including Faces, Legs, Activity, Cry and Consolability Scale (FLACC) have been used in the past. FLACC is a method of pain measurement used primarily to asses pain levels for infants and children that are unable to speak.
This method has largely been discredited in terms of application on incapacitated patients due to its reliance on "crying and comforting methods" (Kabes, Graves, Norris, 2009). As a result two methods specifically designed to assess pain levels in unresponsive patients have been isolated, these include: Behavioral Pain Scale (BPS) and Non Verbal Pain Scale (NVPS). NVPS was ratified for further research purposes by the Hospital Research Council due [url=http://www.maximoupgrade.com/hot.php]hollister france[/url] to it's the range of indicators it encompasses which incorporates both behavioral and physiological signs compared to the BVS which only uses behavioral observations (Kabes, Graves, Norris, 2009). The purpose of this study was ultimately to ascertain whether or not the NVPS was the best method available for assessing pain levels in nonresponsive patients.
Pain management is in itself considered to be [url=http://www.davidhabchy.com]barbour outlet[/url] a standard of nursing care (Bach et al., 2006) and best practices in pain management are often measured using the Hospital Consumer Assessment of Health Providers and Systems (HCAHPS) index (Martin, Kelly, Roosa, 2012). An essential element in optimal pain management is the accurate assessment of pain levels in patients. According to the Board [url=http://www.mxitcms.com/tiffany/]tiffany[/url] of Nursing all professional nurses are required to have knowledge of the standard of care involved with pain management (2001).
The standard of care involves: acknowledgement of the patients pain, identifying the source of the pain, regularly assessing the patients pain using an accurate pain measurement tool and methodology as well as reporting the patients pain. The final stage involves creating a plan to address the patients pain (Board of Nursing, 2001). Research by Martin, Kelly and Roosa [url=http://www.sandvikfw.net/shopuk.php]hollister sale[/url] highlighted the findings of a best practice group for pain [url=http://www.1855sacramento.com/peuterey.php]peuterey outlet[/url] management in a 30 bed ICU, which stated several practices which would be ideal in pain identification and alleviation. These included the administration of ketamine as well as consistent nursing interventions in the form of premedication, dressing downs and leaving supplies (2012).
The best practice for assessing the pain levels of a patient are undoubtedly one in which the assessment mirrors the patients [url=http://www.vivid-host.com/barbour.htm]www.vivid-host.com/barbour.htm[/url] self report. However, in cases where the patient is unable [url=http://www.ilyav.com/uggpascher.php]ugg pas cher[/url] to communicate either verbally or otherwise, methods which contain the least likelihood of error need to be isolated. This is necessary in order to meet the requirement of not only the Board of Nursing Standards but also the Joint Commission Standards of Care. The research conducted on NVPS by the hospital research council confirmed that it was a potentially useful method of measuring pain in patients that were unable to self-report. The sample study was based in Creighton Hospital's twenty-five bed ICU and patients involved were selected due to their inability to self-report. The NVPS was based on a five pronged criteria which included indicators such as facial expressions, activity, guarding, vital signs (physiologic I), respiratory movement and physiologic II indicators.
Observations of nurses involved in the study were brought into sync with those of the principle investigator through repeated practice usage, only nurses that achieved 90% interrater agreement with the principle investigator were included in the study. The study was segmented into three stages and the subsequent changes in each indicator after the conclusion of every stage. The first stage was the stage preceding a painful nursing procedure, the second stage was during a painful nursing procedure and the third stage involved measurements immediately after the painful nursing procedure. Each indicator showed heightened levels during the painful nursing procedure confirming the original hypothesis of the study, thus affirming NVPS as a reasonable method of pain measurement (Kabes, Graves, Norris, 2009).
Follow-up research, which [url=http://www.rtnagel.com/airjordan.php]nike air jordan pas cher[/url] was far more comprehensive and included research on the validity of both BVS and NVPS, and involved a wider sample which included 8 hospitals, reaffirmed the findings of the Creighton Hospital research and validated BVS as an acceptable and fairly accurate method of pain measurement. There are several nursing interventions that are absolutely crucial in the usage of both BVS and NVPS in assessing pain levels in nonresponsive patients.
Generally, the most important requirement is constant and acute observation of the patient by the nurse. A detailed study of all of the criteria set forth under both methodologies which include facial expressions, movement, respiration, guarding Physiologic I and Physiologic II with regards to NVPS and facial expression, ventilation compliance and upper limb movement in terms of BVS. Close attention to each of these indicators is an absolutely vital nursing intervention. Incorporating these interventions into daily nursing practice should not be a challenge as keen observation of the patient is a basic requirement of the profession. The skill required in this instance would to hone ones observational abilities according to the criteria set above and making certain of noting thee observations when dealing with a critically ill unresponsive patient. Upon noting these observations it is essential that they are shared with other nurses and medical staff in order to formulate a coordinated effort to detect pain levels in a particular patient.
This dissemination of information may enable other nurses to know what particular interventions a specific patient may require. For example: if a patient displays signs of a great deal of pain while being turned over, [url=http://www.mansmanifesto.fr]doudoune moncler[/url] nurses may share this information amongst themselves and perhaps devise a better method of turning the patient over. This applies to any intervention, which may include medication and the correct dosage, dressing down, bandaging etc.
Lastly, the noted observations should be according to a consistent system, whereby ratings do not deviate greatly from each other as this may lead to inaccurate measurements of the actual pain the patient [url=http://www.mxitcms.com/tiffany/]tiffany outlet[/url] is experiencing [url=http://www.1855sacramento.com/peuterey.php]peuterey[/url] and hence invalidating whichever system of measurement is being employed. In addition, coordination with family members or relations of the patient in terms of using their assistance to identify behavioral patterns of the patient may also be important.

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