NMIH204: Reflection and Practice - Cancer Patient’s Pain - Reflective Essay - Assessment Answer

January 15, 2017
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Question:Reflective Essay

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Looking in


As explained by Luckett et al., (2013 pg 240), they stated that pain needs to be regarded as the patient describe it. The nurses need to accept the patient’s feelings, if they need to understand their pain. Therefore, there is a need for the healthcare service provision to perform an in-depth exploration of the patient’s perceptions of pain. In addition, the exploration should result in the development of outlining patients' experiences that will help in addressing the pain. The understanding of patient perceptions of pain and outlining them may not be entirely the same. Different patients provide their pain reports in various ways. The nature of the pain report largely depends on the intensity and nature of the pain. It also depends on the context that the patient feels the pain (Wagner et al., 2014, pg 16). For example, determination of the patients is getting any distractions from the pain under different nursery conditions.

The perception of pain by the patient is a challenge because it includes what the pain means to the patient. Moreover, it tries to establish the reasons and basis for the pain. The perception also provides information about the indications of the pain in the patients' bodies. It encompasses what might happen to the patient in the future because of the pain. For example, improving, or worsening. The nurses perform the assessment of pain experiences as accounted by the patient and narrate it as a story. It is done by probing on how it started, how the patient is feeling and what it means to the patient. It also seeks to know what the patient has done and what he/she is trying to do about it.

In this paper, the presentation is the exploration of the assessment of the pain as performed on a 70-year-old cancer patient. Even though the paper accounts for an assessment of pain as described by one patient, I develop it and share some few questions and ideas that the condition provokes within me. The ideas will focus exclusively on the pain assessment on the patient. The patient gave me an opportunity to think about other patients and their pain experiences. It also made me imagine about the pain assessments that will be performed in future and what is expected of me as a nurse to help them.

The paper follows the protocol that was described by John framework of reflective thinking. The paper present the patient assessment referred to an episode when the patient was receiving treatment in hospital. The essay also presents the basis and thoughts that the patient has in regards to the life before and during the illness. The assessment also prompted me to evaluate the extent that a community nurse should recommend the use of pain controlling drugs like analgesia. According to Bruera et al., (2013, pg 2425), it is better to focus on controlling pain instead of chasing the pain. The pain was diagnosed with throat cancer and two years before and had previously had her condition treated by the chemotherapy.

The treatment helped him a lot and achieved a remission, which lasted for approximately one year. The cancer returned, and it had spread to his chest and was the cause of his enormous pain. The doctor recommended that the care was extended to the patient was directed and aimed at improving his comfort instead of curing (Lewis et al., 2014, pg 61).

2. Looking out

2.1 The situation

As a nurse, I visited the patient on several occasions for a continuous period of two months. It was at the time that when the patient reported that he was no longer taking the oral opiate as it was recommended by the community nurse. The patient recounted that there had been tearful nights because of the pain. The pain made him feel nauseous; he was also alarmed by the frequency at which he is taking the ‘pain tablets’ and consequently the effect of the drugs on the way he feels about himself. However, the intentions of the prescription that are good, the reliance on the drugs did not feel dignified. For the analgesia, it was working effectively when the patient took them, however, the quality of the life he was leading is not as he was expecting. The community nurse and I paid attention and carefully listened to him. The community nurse then explained to the patient that it was normal to worry about some of the prescribed medications.


Significant issues


3.1 The aesthetics

For the morphine, patients usually report it to be relieving. The community nurse explained that drugs have good reputations among the drug abusers as compared to its therapeutic uses. For the patient, if he uses the drug daily, it would not cause addiction but provides a great deal of reassurance and relief to the patient. The patient also recounted that he had experienced pain in the area of the neck previously. The pain was very severe and together with his wife, they managed to use massage the area around the neck. The patient requested to use the technique where they will use heat packs in massaging the neck. The patient said the technique was soothing and very much relieving. The patient was requested to be assisted by the wife and morphine to be exclusively for emergencies when that patient experiences sleeplessness and could not eat because of discomfort.

The community nurse provided him with the assurance that everything was under control, and he would be prescribed to use the analgesia. The nurse made some notes and announced that the patient was being referred to the cancer pain clinic. The nurse explained that the cancer pain clinic will help him in taking stock of the condition. The nurse was right to suppose that the use of morphine could be a problem in regard to establishing the appropriate morphine dosage, as opposed to the use of supplemental pain relief interventions (London et al., 2015, pg 72). The patient insisted as though he was not being understood. The nurse assured him that she had heard and understood him; moreover, his point of view is respected. The nurse further assured him that there is nothing lost if the clinic helps in the further management of the condition. With that, we excused ourselves and left the patient.

3.2 Feelings

During the assessment of the patient, I experienced a mixture of feeling that includes confusion, anger, impotence, and anger. The patient seemed to have been planning and rehearsing for the moment to face the community nurse. As a student nurse, I was not prepared for such an encounter with the patient. Later, when I recollected what happened, it was better to refer the encounter with the patient as a confrontation. The patient confronted the nurse, and in most part of the episode, I was reduced to being just a witness. As the community nurse continued talking to the patient, I could make some supportive statements of the heat packs as suggested by the patient. However, I glanced at the community nurse and noticed that she wanted me to be silent.

Moreover, because of her experience in the nursing environment, I decided to leave the discussion with the patient with her and remained largely as a witness of the event. My initial anger was initially directed towards the patient for failing to show the least of appreciation to what we were trying to provide. But during the interview, I felt like I understood the patient perspective and supported the community nurse in trying to recommend for better pain management drugs. However, after the discussion, I was angry towards the community nurse. It is because she seemed to be having an agenda that expected the patient to comply with our concerns at the expense of the patient suggestions. In addition, the community nurse appeared to be crudely saying that she was experienced in such matters. She encourages me that the scenarios create anxiety, but I can manage to work through them. I am strongly convinced that the community nurse did not get the significance of the conversation with the patient. For the patient, it was a very important decision that he wanted the nurse to accept. As explained by Greer et al., (2013, pg 357), it is very important to consider and emphasize the needs of the negotiated care programs and planning.

The feeling of impotence I experienced associates strongly with the few experiences I had on clinical conditions. Despite the many placements I performed, despite the excellent mentoring that I get, new experiences and situations that get me off my comfort areas still face me. In such scenarios, I have been reduced to a witness and lacking in responses. At my level, I feel less knowledgeable and younger that is should be. I want to be in a position that I can provide support to my colleagues, reassurances to the patients and to provide relevant advice (Zimmermann et al., 2014, pg 1727). However, I still lack enough confidence to help me to do that. During the scenario when the community nurse was talking to the patient, I could not even offer any suggestion, the second opinion or an idea that would have benefitted the patient.

To my annoyance, I was unable to manage that as we left the patient. The community nurse had made some fair suggestions. She appeared to be very concerned and particular with the patient’s needs. However, she did not get the expectations of the patient’s as a result of her conversations and assessments. The patient explained how he has been dealing with his condition, and he was desperately asking for better help. The help that according to him was not forthcoming. Thus, he made the suggestion to use the heat packs for the pain management.

3.3 Experience evaluated

After the conversation with the patient, it prompted doubts and created a debate about nursing aspects that are vital to me. In spite of the etiquette of learning in clinical practice, there is a lack of challenging a qualified nurse in the presence of the patient. From the conversation, there were problems that are associated with the provision of support to the patient dignity. The assumptions that related to the use of analgesia and pain control strategies were not patient oriented. Dignity concern more with simply the use of appropriate terminologies in addressing and protecting the privacy of the patient and being available to attend to their needs and interests. The dignity requires the clarification of the ways that the patients live and the treatment that is appropriate for an individual patient (Wandner et al., 2014, pg 730). It also includes the process of finding out what factors enable the patient to say they are feeling well and are good about themselves.

3.4 empirics

Upon the process of reflection, I have a feeling that from the scenarios, not much is being done to discover the factors that enable the patient to rate the quality of life. Also, not much is known about their control of both the situations and life. From the conversation of the community nurse and the patient, it shows that we are more concerned with the provision of resources and sharing research findings. There is a need to evaluate the theories about medications. Nurses and practitioners in the health care need to question the familiar misconceptions that are associated with the use of drugs (Fayers and Machin, 2013, pg 48). For example, patients using morphine that is prescribed by the doctor. Therefore, this just refers to the fact that nurses and other practitioners miss the opportunity to understand the patient in many encounters that we do with them. As the patient request for help, report problems, anxieties or present the decision that they have agreed with their carers.

I realized that during the training, there is a general assumption that the patient would wish to feel less pain. In addition, the tackling and management of fears about the prospective pains of the patients is an objective of the nursing. I made the assumption that this could be the reason, because the cancer pain represents a huge threat. It is because of its greatness and it is all-encompassing and it needed removal despite the circumstances. The unsettling factor that took the most time was the process of examining the patient pain. The patient acknowledged the severity of metastatic cancer pain; however, he still preferred to manage it by application of the measures that had initially worked in managing the neck pain.

The patient showed willingness to trade off a state of free pain for something that will provide her with an opportunity of having a greater sense of control. The patient challenged all the assumptions regarding the best analgesia practice (Armijo?Olivo et al., 2012, pg15). He also seemed to question the information I got from reading the textbooks in management of pain where it was recommended that it is important to chase the pain rather that controlling it n palliative care conditions.

4. Reflections (learning opportunities)

The encounter with the patient changed my theoretical opinion to pain management. From my perspective, the community nurse also uses regularly uses science in making the decisions in regard to relieving the pain (London et al., 2015, pg 92). Nurses make assumptions that patients will tend to receive all the benefits that are theoretically outlined. It was not about the use of morphine of heat packs, the patient can use both, it was largely on choosing and how patients make their choices. What are the factors that compel him to reach the decisions that he made. For me, it was about accepting the fact that provided that the patients are supplied with all the relevant facts, made to be alert to the available options; they are able to make choices that apply to them.

The fact that the patient illness was incurable, that he manages the pain together with the wife, meant that his approach to the challenge was different from the approaches that many other patients utilize (Dowding et al., 2016, pg 159). Because of managing the pain for some time, the knowledge that the pain would probably get bad meant that he was in a better position than the other that lack experience in making decisions. The decision to share more discussions and get benefits from experts in the pain clinic did not take anything away. Initially, I thought the patient was going to stand his ground by insisting on managing pain his way with the help of his wife.

The fundamental aspect of the assessment was listening to the patient, getting to hear their experiences in perceiving pain. Also, getting to know what they narrate about their pain and attempts to manage it. For example, the patient’s account was all touching on dignity, how to cope, and how to find ways of getting help (Maguire et al., 2015, pg 43). Also understanding how the support enables the patient to tackle terrible illnesses (London, 2015, pg 74).

4.1 Future care

It is not advisable to recommend to patients that overcoming pain does not always refer to the fact that we do not need to experience it. Other patients will welcome the total removal of pain. It is important that all the patients are taught about managing and coping pain in the future. I would not be able to leave the responsibility of evaluating whether I have assessed and explained all that I could in regard to pain management. I will provide a detailed account of the strengths and weaknesses of different approaches to coping with pain. A reflection time will help me ponder the patient’s comments and suggestions and if needed to go back and say to the patient that I was still considering his/her suggestions because I know that this does not make me a lesser professional.

5. Conclusions

There is a need to become patient-centred in nursing. However, it is not easy and requires extensive listening skills and interpretations. The community nurse tried to dissuade the patient from a course of action instead of recommending more situations to appraise the course. Such scenarios usually confront nurses when they are unprepared, and the reaction is considerate as possible. The experiences encountered can be considered to be a valuable teacher that is comparable to textbooks. Nurses should be encouraged to create more interest in nursing so that it can enable them to understand and make sense of patient’s decisions about their illnesses. Thus, help in developing an effective support and care management that is appropriate to the patient condition. There is a need to understand teaching and learning from the experiences of the patient.

The appropriate approach that helps in developing an understanding of the patient perspectives on both the illness or treatment and the pain management approaches. More insight can be obtained from how patients describe the pain, and how they try to manage it. How the patient copes with pain is also important. Above all, there is need to develop an understanding of the patient in order to develop an approach that is used to make the patient feel heroic in the face of pain and illness.

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