Annotated Bibliography on Pain Management in the Emergency Department
The study by Vlahaki and Milne (2008) seeks to examine pain management in a rural setting. Their study was motivated by the lack of literature that examined poor pain management in rural emergency departments. Using data from the National Ambulatory Care Reporting System of a rural hospital in Ontario, the researchers discovered that pain management in emergency departments of rural hospitals is not as poor as in urban hospitals.
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Downey and Zun (2010) conducted a study to identify the relationship between pain management in the emergency department and patient satisfaction. The researchers used several tools, including the Visual Analogue Pain Scale, Brief Pain Inventory, and Medical Interview Satisfaction Scale. A sample of 159 patients took part in the research. The patients were given some type of relief for their pain immediately after they arrived at the ED. The researchers found that pain management is significantly and positively correlated with patient satisfaction.
Pain management can also be improved by establishing a link between the emergency department and community health centers. This is what Staiger, Serlachius, Macfarlane, and Anderson (2010) found in their study. They argued that the major benefit of this type of pain management strategy is that it ensures the continuity of care. Thus, patients leaving the ED do not necessarily have to go back to the ED to obtain further care. The significance of continuous care has also been highlighted by Stupar and Kim (2007). The researchers argue that without continuous care, patients involved in a motor vehicle accident can develop severe pain, which can become fatal. Thus, continuous care and assessment are required.
Many patients think of using medications to manage their pain. Nevertheless, pain can also be effectively managed through physical therapy. This is the strategy that is proposed by Fleming-McDonnell, Czuppon, Deusinger, and Deusinger (2010). The researchers argue that physical therapists should be part of the ED core team of medical personnel. They further state that most pain problems are associated with functional problems, which can best be addressed by physical therapists. In addition to this, physical therapy provides a long-term solution, thus reducing the costs incurred by patients. The use of physical therapy is also supported by Lau, Chow, and Pope (2008).
Lau et al. (2008) made use of the Numeric Pain Rating Scale and the Numeric Global Rating of Change Scale to measure pain and patient satisfaction, respectively. The researchers found that participants in the experimental group (the group that received physiotherapy) were more satisfied with the pain management than the participants in the control group.
Victims of motor vehicle accidents (MVAs) are common in emergency departments. Accidents lead not only to pain but also to muscle spasms which make the pain worse. Thus, many physicians manage the pain using pain relievers in conjunction with muscle relaxants. Based on this, Khwaja, Minnerop, and Singer (2010) wanted to examine the effectiveness of muscle relaxants on pain management. They used a randomized controlled trial in which patients were administered to either the ibuprofen or cyclobenzaprine groups or both. The researchers found that the addition of muscle relaxants has no significant benefit in pain management in the ED.
Poor pain management in the emergency departments is affected by various factors, chief of which is the administrative practice. Thus, improving pain management in ED requires improvements in the department’s administration as well as analgesic practice (Thomas, 2007). In their study, Yanuka, Soffer, and Halpern (2008) proposed a structured intervention to improve the administration of analgesics in an urban ED. The intervention resulted in a 99% increase in the number of patients receiving analgesics and a 50% decline in the time it takes to administer analgesics to patients suffering from pain, thereby leading to improved quality of care and satisfaction among patients. Quality of care and patient satisfaction in the emergency department are also realized when the administration of pain relievers is part of a standardized protocol. This is what Zed, Abu-Laban, Chan, and Harrison (2007) discovered in their study. In the study by Zed et al. (2007), patients were administered propofol through a standardized protocol. This led to a high satisfaction level among the patients and physicians basically because the protocol was considered to be safe and effective in pain management.
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Tools Used and Efficacy of the Therapeutic Approaches
The researchers reviewed the above-made use of different tools to measure the variables of the studies. However, I do not believe that the tools used affected the results of the studies in any way. This is because, in the studies that appeared to be similar in the objectives and variables to be measured, the results were similar despite the fact that different tools were used. A good example is a study by Lau et al. (2008) and Downey and Zun (2010). Both of these studies measured the level of satisfaction of patients with pain management but used different tools, yet the results were similar.
Each of the studies reviewed above made a case for the efficacy of the therapeutic approach. This was done by highlighting the effect (either positive or negative) of the therapy on patient outcomes, such as patients’ and physicians’ satisfaction levels, reduced costs, and reduced visits to the emergency department. Besides the study conducted by Khwaja et al. (2010), in which the researchers argued that the use of muscle relaxants has no benefit to pain management, the other studies found their therapeutic approaches to be effective in pain management. Nevertheless, the effectiveness of the therapeutic approaches is affected by many other factors, such as the time taken to provide pain relief and administrative procedures.
Evidence Summary of the Articles
The evidence presented in this paper is based on ten articles generated from an intensive search process. In order to answer the clinical question of this study, some of the articles chosen focus on the use of drugs to relieve pain, while the others focus on other intervention strategies used to manage pain in the emergency department. By including studies that focus on these two different approaches to pain management in ED, it is possible to compare the effectiveness of these two approaches and thereby identify the better alternative. The studies that focus on the use of medications to manage pain in the ED have not-so-promising outcomes in terms of long-term pain management, patient satisfaction, and efficacy of the approach. From the literature review and analysis, it is obvious that pain drugs relieve the pain but only on a temporary basis. Thus patients are forced to make frequent visits to the ED for their pain. On the other hand, the studies that focus on alternative strategies such as physical therapy to manage pain have promising results. It has been observed that physical therapy provides a long-term solution to pain problems, thereby reducing costs incurred by patients and congestion in the emergency department due to reduced visits.
Recommendation of a Nursing Strategy
Based on the evidence presented above, I would recommend a strategy that incorporates pain medications and physical therapy to manage pain in the emergency department. However, the pain medications should only be given upon arrival at the ED to provide immediate relief of the pain. Physical therapy should then be administered to the patients to provide long-term relief of the pain and to eliminate functional problems that come with chronic pain. The strategy should also incorporate improved administrative practices. For instance, more medical personnel should be hired in the emergency department to reduce congestion, waiting times, and queues. The administration of the pain medications should also follow a standardized protocol to ensure the safety and effectiveness of the medications.
Importance of Theoretical Model for Nursing Research
A theoretical model provides guidance to nursing research. It forms the basis upon which researchers formulate their research questions, construct their research design, collect data, analyze data and interpret the data. Without theory to guide the research process, a researcher would produce a study and data that make no sense and which do not add value to the existing knowledge of the practice. A theory can help a researcher to conduct a study that proves whether or not the theory holds in different circumstances. Theory-guided research is thus important in providing evidence-based nursing practice.
Downey, V., & Zun, L. (2010). Pain management in the emergency department and its relationship to patient satisfaction. Journal of Emergencies, Trauma and Shock, 3(4), 326-329.
Fleming-McDonnell, D., Czuppon, S., Deusinger, S., Deusinger, R. (2010). Physical therapy in the emergency department: Development of a novel practice venue. Physical Therapy, 90(3), 420-426.
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Khwaja, M., Minnerop, M., & Singer, A. (2010). Comparison of ibuprofen, cyclobenzaprine or both in patients with acute cervical strain: a randomized controlled trial. Journal of the Canadian Association of Emergency Physicians, 12(1), 39-44.
Lau, P., Chow, D., & Pope, M. (2008). Early physiotherapy intervention in an accident and emergency department reduces pain and improves satisfaction for patients with low back pain: a randomized trial. The Australian Journal of Physiotherapy, 54(4), 243-249.
Staiger, P., Serlachius, A., Macfarlane, S., & Anderson, S. (2010). Improving the coordination of care for low back pain patients by creating better links between acute and community services. Australian Health Review, 34(2), 139-143.
Stupar, M., & Kim, P. (2007). Delayed-onset post-traumatic headache after a motor vehicle collision: a case report. The Journal of the Canadian Chiropractic Association, 51(2), 83-90.
Thomas, T. (2007). Providing pain relief for patients in the emergency department. Nursing Standard, 22(9), 41-45.
Vlahaki, D., Milne, W. (2008). Oligoanalgesia in a rural emergency department. Canadian Journal of Rural Medicine, 13(2), 62-67.
Yanuka, M., Soffer, D., & Halpern, P. (2008). An interventional study to improve the quality of analgesia in the emergency department. Journal of the Canadian Association of Emergency Physicians, 10(5), 435-439.
Zed, P., Abu-Laban, R., Chan, W., & Harrison, D. (2007). Efficacy, safety and patient satisfaction of propofol for procedural sedation and analgesia in the emergency department; a prospective study. Journal of the Canadian Association of Emergency Physicians, 9(6), 421-427.
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