Managing Acute Pain in Hospital Settings: Essay Sample

How can acute pain be effectively managed for adult medical patients in hospitals?

Introduction

Pain is perceived as one of the most common symptoms experienced by hospitalised adults and is viewed as highly prevalent in many patient populations and settings. There is a myriad of guidelines for pain management as outlined by various institutions (Khatib & Razvi, 2018). While these strategies exist, they have not been rigorously evaluated. In particular, institution-wide quality improvement studies that have applied some of the guidelines have met with only modest success in improving pain assessment rates and at the same time have not yet demonstrated improvements in pain intensity (Nunn et al., 2017). However, these studies suffer from small sample sizes, targeted at isolated hospital units or patient populations such as those with cancer, lacked adequate control groups, and in some cases used cross-sectional rather than longitudinal studies (Bhandari & Swiontkowski, 2017).

In an effort to understand acute pain management for adults’ medical patients in hospitals, this study conducts a systematic review of a number of studies to understand strategies and approaches used to effectively management acute pain (Chan et al., 2013). This is in line with the need for evidence-based practice that is a process of problem solving to clinical issues that involves the incorporation of best evidencae from well-designed studies to make decisions that improve patient care (Jager & Ahern, 2004). Hence, along this perspective, the use of evidence-based practice allows for ease of problem solving by aggregating evidence from different studies on how to manage acute pain in hospitalised patients (Macaluso & McNamara, 2012).

To achieve the above aim, the study will be divided into the following sections. These include: the introduction section; search and the approach to identifying the evidence and studies used in this report; the discussion section that presents the evidence that was gathered during the search process; and a conclusion section.

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Search

Search terms/Key words

The search terms refer to the key words that are used to conduct the search process. The key words can be a single term or a combination of words that are used with the intention of helping arrive at the required studies when conducting a systematic review(Marvasti, 2018) . In line with this therefore, the study topic was: how can acute pain be managed for adult medical patients in a hospital. The key words that were used include the following: acute pain, acute pain management, pain management in adults, pain management in hospitals, pain management among medical patients. Some of the key words were combined into numerous search terms in the process of conducting the search in order to help arrive at the required articles. The appendix one shows the search terms and the number of articles that were identified through the search process.

Databases used

There are many databases that are used in the process of conducting any research. Databases refer to an aggregated reservoir of articles and research materials about specific topics. These databases are often categorised on the basis of the different disciplines in order to make it easier to identify the articles for specific use (Rajalingam, 2021). In the context of this study, given that the study involved a health-related issue, the databases that were used were health-related. Some of the common health related databases that can be used in the process of conducting research include: PubMed, CINAHL, EMBASE, Cochrane Library, TOXNET among others. In the context of this review, the focus was on using articles from nursing databases and hence CINAHL was used as the primary database. CINAHL was accessed via EBSCOHOST, using the university’s library. This database was also used because of the multitude of articles that it has on various nursing related issues that effectively helps the study achieve its objectives with ease. No other database was considered in the process of conducting this study.

Inclusion and Exclusion Criteria

Establishing inclusion and exclusion requirements for study participants is a common procedure needed when developing high-quality research protocols. Inclusion requirements are identified as the main features of the target population that the investigators can use to address their study questions (Davidavičienė, 2018). Typical criteria for inclusion include demographic, clinical and regional characteristics. On the other hand, exclusion criteria are characterized as characteristics of prospective research participants that satisfy inclusion criteria but have additional characteristics that may conflict with the effectiveness of the study or increase their likelihood of an unfavourable outcome (Davidavičienė, 2018). Popular exclusion parameters include the attributes of qualifying persons that make them particularly likely to be lost to follow-up, miss planned data collection appointments, have incorrect data, have comorbidities that may impact the outcome of the analysis, or raise their risk of adverse events.

In the context of this study, the inclusion criteria include the following elements

• Studies published between 2015 and 2020.
• Studies on pain management in adults in medical hospitals.
• Primary research studies which include direct patient participation in the study.
• Studies on adults in medical hospitals
• Studies with a sample size of more than 50 patients.

The exclusion criteria include the following.

• Studies published before 2015
• Editorial opinions or other forms of secondary studies.
• Studies with less than 50 patients in a medical setting.
• Studies that do not talk about pain management within the hospital setting

Procedures

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PRISMA Framework

In conducting the search process, the PRISMA framework was used. The PRISMA framework is a procedure developed to help researchers to identify a minimum set of items required for reporting in systematic reviews and meta-analyses (Rajalingam, 2021). The framework focuses on the reporting of reviews, evaluation of randomized trials, but can also be applied as a basis for reporting systematic reviews of different kinds of studies especially in the evaluation of interventions.

In the study, the procedures that were used included the following: online search and identification of the articles, evaluation and screening of the articles and lastly is the analysis of the articles to make sense of them based on the PRISMA framework. In the online search and identification step, EBSCOHOST was accessed using the university’s online library which provided the search platform for the articles. The search terms were used to conduct the initial search. This was followed by a narrowing down of the results to include only results from CINAHL. Additional filters were used including the dates as explained in the inclusion and exclusion criteria. Lastly, additional filters on the results were implemented to identify only full-text articles that were peer-reviewed and primary in nature. At this stage, systematic reviews and other opinion articles were eliminated.

After the search was complete to identify those articles that were important for the study, the screening and evaluation process started. The screening and evaluation process focused on reading the study abstracts to ensure that these articles were in line with the inclusion criteria especially when it comes to patients used and the sample size as well as fit with the study topic. A total of 5 articles were identified through the screening process for further analysis and use in the systematic review.

Discussion

The table below provides an analysis of the 5 studies that were selected for evaluation and review. In analysing the findings, the findings are presented in the form of author, the aims of the studies, the methods that were applied in conducting the studies, and the findings of the studies. This is important in making comparisons to understand what was identified and the methods that were used to achieve the study objectives.

Conclusion

The management of acute pain in hospital settings for adults is an issue that remains of critical importance to patients. Existing evidence from studies seem to point a wide range of choices that are made by physicians in order to effectively manage pain and help patients manage their conditions effectively. This systematic review therefore sought to examine existing studies on how acute pain can be managed effectively among adults’ patients in a medical hospital. An analysis of the findings indicated that the different studies that were identified approached the issue from multiple research perspectives, majorly quantitative studies were used, along with various research designs that included cross sectional studies and retrospective studies. The effectiveness of these methodologies however was not evaluated in the context of this study but can be seen to help the studies achieve their objectives. In summary, the findings of the review showed that there were a number of strategies that were used in the process of pain management. Clearly, the pain management strategies can be categorized into pharmacological and non-pharmacological interventions. Most studies seem to suggest the use of pharmacological interventions as approaches that were effective in managing pain. Hence, these studies identified drugs such as adjunct analgesics, ibuprofen, hydromorphone, and acetaminophen, epidural analgesia and local anaesthetic infusions, gabapentin and intraspinal analgesia among others. However, on the other hand, the nonpharmacological interventions that were proposed in the studies were not clear with only one study proposing the use of music therapy especially amongst cancer patient. The studies reported that these interventions were found to be moderate to highly effective in helping manage pain for adults in medical hospitals. Additionally, the retrospective studies also established similar findings which shows the importance of these strategies in helping patients to manage their conditions. Hence, applying these findings and interventions in hospital settings is perceived as important in helping enhance pain management within the hospital setting.

Implications

There are several implications associated with the findings that were established in this study.

First, from a research point of view, the literature search process yielded very few studies on the issue of acute pain management amongst adults in medical hospitals. This means that, there is need for more studies to be done in this area in order to improve the understanding of acute pain management in hospital settings. Specifically, the lack of primary studies on the issue is a factor that has a negative impact on the ability to identify evidence that can be used to help in developing other studies or improving patient care.

The second implication is that nurses still remain at the centre of pain management for patients in hospital settings and hence there is need for them to understand the role played by pharmacological and non-pharmacological interventions in the process of managing pain. This study has shown that there are different pharmacological interventions with different rates of effectiveness. Various forms of analgesics in particular can be used in hospital settings to help improve acute pain management amongst adults. By combining pharmacological and nonpharmacological interventions, nurses will be in a better position to enhance patient care.

Third, the findings of this study also pointed to other important aspects of the nursing practice that when implemented in hospitals help to not only improve patient care but also help to ensure that patients in hospitals can be assisted to manage pain effectively. Some of the aspects that were identified in the studies include: nurse knowledge and skills through education, organizational factors such as workforce planning and workplace environment, and nurse personal characteristics which include attitudes, and communication. The implication of this is that nurses play a crucial role in ensuring that adult patients manage pain effectively. However, this can only be achieved with the right environment and workforce strategies as well as personal characteristics that shape the process of patient care. It calls for medical settings to ensure that nurses are provided with the right environment, education and training in attitude change and communication to enhance overall patient care.

References

Bhandari, M., & Swiontkowski, M. (2017). Management of Acute Hip Fracture. New England Journal of Medicine, 377(21), 2053–2062. https://doi.org/10.1056/NEJMcp1611090

Chan, E. Y., Blyth, F. M., Nairn, L., & Fransen, M. (2013). Acute postoperative pain following hospital discharge after total knee arthroplasty. Osteoarthritis and Cartilage, 21(9), 1257–1263. https://doi.org/10.1016/j.joca.2013.06.011

Davidavičienė, V. (2018). Research Methodology: An Introduction (pp. 1–23). Springer New York. https://doi.org/10.1007/978-3-319-74173-4_1

Fitzgerald, S., Tripp, H., & Halksworth-Smith, G. (2017). Assessment and management of acute pain in older people: Barriers and facilitators to nursing practice. Australian Journal of Advanced Nursing, 35(1), 48–57.

Jager, J. P., & Ahern, M. J. (2004). Improved evidence‐based management of acute musculoskeletal pain. Medical Journal of Australia, 181(10), 527–528. https://doi.org/10.5694/j.1326-5377.2004.tb06435.x

Khatib, S. K., & Razvi, S. S. (2018). Nurses’ Role in Acute Postoperative Pain Management: A Survey of 16 Tertiary Hospitals of Maharashtra. International Journal of Nursing Education, 10(1), 49. https://doi.org/10.5958/0974-9357.2018.00011.9

Macaluso, C., & McNamara. (2012). Evaluation and management of acute abdominal pain in the emergency department. International Journal of General Medicine, 12(1), 789. https://doi.org/10.2147/IJGM.S25936

Marvasti, A. (2018). Research Methods. In The Cambridge Handbook of Social Problems (Vol. 1, pp. 23–38). Cambridge University Press. https://doi.org/10.1017/9781108656184.003

Nunn, M. L., Hayden, J. A., & Magee, K. (2017). Current management practices for patients presenting with low back pain to a large emergency department in Canada. BMC Musculoskeletal Disorders, 18(1). https://doi.org/10.1186/s12891-017-1452-1

Priano, J., Faley, B., Procopio, G., Hewitt, K., & Feldman, J. (2017). Adjunct analgesic use for acute pain in the emergency department. Hospital Pharmacy, 52(2), 138–143. https://doi.org/10.1310/hpj5202-138

Rajalingam, M. (2021). Methodology. In EAI/Springer Innovations in Communication and Computing (pp. 43–53). Springer Publishing Company. https://doi.org/10.1007/978-3-030-53047-1_3

Sundaramurthi, T., Gallagher, N., & Sterling, B. (2017). Cancer-related acute pain: A systematic review of evidence-based interventions for putting evidence into practice. In Clinical Journal of Oncology Nursing (Vol. 21, Issue 3, pp. 13–30). Oncology Nursing Society. https://doi.org/10.1188/17.CJON.S3.13-30

Appendix 1