post-tami

Respond using one or more of the following approaches:
Ask a probing question, substantiated with additional background information, and evidence.
Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.
Validate an idea with your own experience and additional sources.
Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings.
Expand on your colleagues’ postings by providing additional strategies for addressing barriers to EBP based on readings and evidence.
                                                        Main Post
                                         Introduction/PICOT Question
Pain is the most common complaint of people who present to the emergency department (ED).  It is estimated that 75% of all patients use the ED for pain related complaints (Bergman, 2012).  Patient satisfaction survey results emphasize the importance of adequate pain management (Bergman, 2012). With this in mind, nurses have a responsibility to evaluate, assess, and be advocates for a patient’s pain control.  Studies have shown when an ED department has pain management protocols and delegates these to the nurses there is a reduction in patient’s pain (Hadorn, Comte, Foucault, Morin, & Hugli, 2016).  Discovering patient expectations for pain management allows healthcare workers and patients to understand each other.  Once understanding has taken place, we can evaluate essential questions related to the patient’s pain management.  As healthcare workers are we expected to base pain management protocols solely on self-reported pain by the patient?  If so then an important question to answer is: When patients present with pain in the ED, how does a nurses’ perception of the pain influence the level of pain management the patient receives? 
Evidence-Based Practice
              Currently, in the ED I work in pain guidelines and protocols are in place for the nurse to initiate as needed.  Hadorn et al. (2016) state, “guidelines or protocols are generally used to facilitate the transfer of compelling evidence into clinical practice” (p. 81).  This evidence-based pain management protocol is available for the nurse to initiate based on the patient’s self-reported pain, nursing assessment, and observational data.  At times, nurses evaluate pain based on vital signs, facial expressions such as grimacing, restlessness, self-report, and chief complaint (Hazelett, Powell, & Androulakakis, 2002).  In our organization, the policies and procedures for pain management support the adoption of evidence-based practices.  By using the set protocol for pain, nurses are better able to treat pain promptly.  Nurses have a crucial role in delivering evidence-based healthcare in order to have the best outcomes and treatments for their patients (Majid et al., 2011).
Barriers
       Studies noted a barrier to effective pain management is the nurses’ perception of the individual.  Some patients frequent the ED over exaggerating or making up complaints to seek pain medications (Hazelett et al., 2002).  This repetitive drug seeking over time creates a barrier to compassionate care.  The ED is a vulnerable place for drug abuse, especially by patients attempting to get narcotics or other pain medications (Bergman, 2012). 
Emergency department nurses and staff have a culture within their units that influence everyday practices.  There is often a vast age range in the nursing staff which highlights differences in work ethic, attitudes, and professionalism.  The culture of our ED hinders the initiation of evidence-based practices due to stressed out, overworked, and underappreciated nurses.  With this in mind, it is vital that as an organization we provide opportunities for nurses to have adequate rest and find ways to show appreciation for all their hard work.
             Proper access and initiation of the pain management protocol increases the likelihood of adequate pain control for patients.  By discovering the expectations of patients and barriers to providing appropriate care we can eliminate miscommunication regarding pain control. 
References
Bergman, C. (2012). Emergency nurses’ perceived barriers to demonstrating caring when managing adult patients’ pain. Journal of Emergency Nursing, 38(3), 218-225. http://dx.doi.org/10.1016/j.jen.2010.09.017 
Hadorn, F., Comte, P., Foucault, E., Morin, D., & Hugli, O. (2016). Task-shifting using a pain management protocol in an emergency care service: Nurses’ perception through the eye of the roger’s diffusion of innovation theory. Pain Management Nursing, 17(1), 80-87. http://dx.doi.org/10.1016/j.pmn.2015.08.002
Hazelett, S., Powell, C., & Androulakakis, V. (2002). Patients’ behavior at the time of injury: Effect on nurses’ perception of pain level and subsequent treatment. Pain Management Nursing, 3(1), 28-35. http://dx.doi.org/10.1053/jpmn.2002.29012
Majid, S., Foo, S., Luyt, B., Zhang, X., Thong, Y., Chang, Y., & Mokhtar, I. (2011). Adopting evidence-based practice in clinical decision making: Nurses’ perceptions, knowledge, and barriers. Journal of the Medical Library Association, 99(3), 229-236. http://dx.doi.org/10.3163/1536-5050.99.3.010

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