Pain management is one of the most critical needs for nurses in inpatient care settings. Many individuals are treated at the hospital with episodic and chronic pain, a situation that demands high cost because of the resources necessary to serve the physical and psychological needs of such patients. Best practices dictate the use of case managers, who play an essential role as part of interdisciplinary care teams to deal with pain and support patients to have quality care outcomes (Schwenk et al., 2018). A comprehensive case management process requires a continuum of care from the intake and needs assessment to delivery of care and transition from the hospital. Although nurses play many other roles in inpatient care, the need for case management among patients with chronic pain is one of the most important. It involves the use of community resources to achieve a proper continuum of care.
The Health Concern and the Associated Best Practices
Chronic pain is one of the serious medical issues affecting many patients in the United States. The American Academy of Pain Management reports that approximately 50 million Americans suffer from chronic pain due to disorder, disease, or accident (Schwenk et al., 2018). Pain is a significant health care challenge because the condition affects all aspects of a person’s life, including social, mental, and physical outcomes. The American Pain Foundation gives additional statistics to show the seriousness of the medical challenge in the US. The organization revealed that six out of 10 patients experience advanced pain at least once daily (Schwenk et al., 2018). Most people with chronic pain feel like they lack control over their pain. Furthermore, people experiencing pain acknowledge that it harms their daily activities, including work and that it strains their relationships with friends and family. Besides the physical pain, as many as 80% of people experiencing pain report the inability to have a comfortable sleep. Pain is also a cause of depression among affected individuals.
Specific Goals for a Patient with Chronic Pain
Mr. John is a 45-year-old man who had an accident seven months ago, which led to nerve damage on both legs. The patient has had three surgeries since then, but the chronic pain persists. Sometimes the pain is so much that he cannot walk, sit, or sleep. His wife informs the nurse that he is always in pain and requesting pain medication to control it. Besides the physical pain, the patient has been feeling depressed, angry, and anxious about the injuries and pain. Although he often comes to the hospital for check-ups and when the pain is unbearable, the case management nurse has decided to create a pain management plan that will help John to recover from the pain. The specific goals, in this case, include helping John to relieve the pain in his legs and to promote his quality of life, such as improving his ability to walk and sleep well. Another goal relates to the need to reduce the level of depression and anxiety to restore his mental health.
Community Resources for a Safe and Effective Continuum of Care
The case management process will include strategies to address the patient’s unique needs and concerns at the hospital and after transitioning from the healthcare organizational setting. The nurse recommends a multimodal pain management plan for John. The strategy is a customized approach to pain management, which will include the treatment plan to help the patient to overcome the pain and its related consequences (Broderick et al., 2014). The plan will include multiple medications and techniques, such as prescription or over-the-counter pain relievers (opioid and non-opioid), topical medications, and nonpharmacologic therapies in both the hospital and community settings. Some of the medications that the patient will use include Nonsteroidal anti-inflammatory drugs (NSAIDs), such as Ibuprofen; Acetaminophen; COX-2 inhibitors; opioids, such as Hydrocodone; and antidepressants (Carter, Watson, & Sminke, 2014). The multimodal pain management plan will include regular communication with the patient and the primary caregiver out of the hospital to participate in the care process. It will also involve collaboration with the person(s) providing therapy to the patient at home. The patient will use a professional therapist who will provide home services because the client needs regular rehabilitative therapy to relieve the pain and restore mobility (Manworren, 2015). The coordinated care plan will achieve the continuum of care for John to achieve the identified objectives.
Conclusion
Pain is a serious health challenge for many patients in the hospital and out of hospital settings. Therefore, proper management and continuum of care are necessary to relieve the pain and improve the quality of life of the affected patient. John is one such patient suffering from chronic pain after an accident that caused nerve damage. He has been receiving care at the hospital for the pain, and the case management nurse recognizes the need to create a coordinated care plan to take advantage of community resources, such as the out of hospital therapy. The case management nurse will coordinate with John, his out of hospital caregiver, and the therapist providing rehabilitative therapy at home. Such coordinated care will achieve the intended goals and support John in the healing process.
References
Broderick, J. E., Keefe, F. J., Bruckenthal, P., Junghaenel, D. U., Schneider, S., Schwartz, J. E., … & Gould, E. (2014). Nurse practitioners can effectively deliver pain coping skills training to osteoarthritis patients with chronic pain: A randomized, controlled trial. PAIN®, 155(9), 1743-1754. doi:10.1016/j.pain.2014.05.024
Carter, J.J., Watson, A.C., & Sminke, P.V.(2014). Pain management: screening and assessment of pain as part of a comprehensive case management process. Prof Case Manag. 19(3):126-34; doi:10.1097/NCM.0000000000000029.
Manworren, R. C. (2015). Multimodal pain management and the future of a personalized medicine approach to pain. AORN Journal, 101(3), 307-318. doi:10.1016/j.aorn.2014.12.009
Schwenk, E. S., Viscusi, E. R., Buvanendran, A., Hurley, R. W., Wasan, A. D., Narouze, S., … & Cohen, S. P. (2018). Consensus guidelines on the use of intravenous ketamine infusions for acute pain management from the American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine, and the American Society of Anesthesiologists. Regional Anesthesia & Pain Medicine, 43(5), 456-466. doi:10.1097/AAP.0000000000000806
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