Multidisciplinary Team Pain Management

Multidisciplinary Team Pain ManagementIntroductionIn spite of advances in infliction commission (Apfelbaum et al., 2003 Fotiadis et al., 2004 Powell et al., 2004 Wu and Richman, 2004), operative distressingness still remains a major clinical problem confronting healthcare providers (Klopfenstein etal., 2000 Klopper et al., 2006 Sjstrm, Dahlgren and Haljame, 1999). Many patients continue to experience postoperative hurting (Gilmartin and Wright, 2007 Manias et al., 2005 Schafheutle et al., 2001) with ab pop 69% of them experiencing moderate to severe offend after surgery (Apfelbaum et al., 2003).According to the International Association for the Study of Pain (1979 250), spite is an unpleasant sensorial and emotional experience associated with actual or potential tissue damage described in terms of such damage. This definition emphasises on the subjective reputation of the pain experience which bed be cropd by multiple factors (International Association for the Study of Pai n, 2003). As a result of this, McCaffery (1983 14) defines pain as whatever the experiencing individual says it is, existing whenever she says it does.Apart from pain signifying an actual or potential tissue damage, it is of no significance and leads to detrimental effects (Apfelbaum et al., 2003). Unrelieved postoperative pain can lead to disturbed emotional states, sleep deprivation, reduced physical and social performance, impaired quality of life (Reyes-Gibby, Aday and Cleeland, 2002 Strassels, Cynn and Carr, 2000), patient dissatisfaction (Shang and Gan, 2003), delayed discharge (Rejeh et al, 2008), increased apply of healthcare resources (Fortner et al., 2003 Mystakidou et al., 2005 OMahony et al., 2005) and its associated high tolls of hospitalisation (Huang et al., 2001).From an ethical point of view, postoperative pain should be properly managed to prevent engageless suffering and avoidable complications (Kehlet, 1989), so as to increase function and to improve the qual ity of life (Goudas et al., 2001 Reyes-Gibby et al., 2002 Strassels et al., 2000). Notwithstanding several barriers prevent the successful management of pain.The aim of this proposal is to justify the need for a study that impart explore the barriers to effective postoperative pain management from a multidisciplinary health team approach. The proposal forget commence with a literature review on barriers to effective pain management followed by the appropriate question methodology that can be used in carrying out the study. Finally, the contributions of the inquiry in filling the gaps of previous studies get out be discussed.Literature ReviewIn spite of numerous studies conducted on the different aspects of pain, the factors that call for pain management train not been completely identified (Rao, 2006). Greater research efforts are therefore required to identify the factors that affect the effective management of pain (Weissman et al., 2004). Barriers to effective pain managem ent have been classified into that of the patient, clinician and the healthcare system (Cleeland, 1987 Joranson, 1993 Von Roenn et al., 1993 Ward et al., 1993).Specifically, patient-related barriers have been categorised into communication (Glajchen et al., 1995), psychological (Glajchen, 2001) and attitudinal factors (Ward et al., 1993). According to Im, Guevava and Chee (2007), there is misfortunate patient communication concerning pain and undermedication due to language barrier and insufficient money to purchase additional drugs. Psychological issues such as anxiety, distress, depression, anger and frenzy have also been shown to cloak the symptoms of pain leading to poor pain management (Glajchen, 2001). Also, patient attitudes serve as the greatest impediment to the effective management of pain. These include fear of addiction (Dar et al., 1992 Ferrell, 1991 Melzak, 1990), tolerance (McCaffery and Beebe, 1989), side effects (Levin et al., 1985), fear of injections (Twycross a nd Lack, 1984), feelings of fatalism (Diekmann et al., 1989 Levin et al., 1985), association of pain with worsening disease states (Diekmann et al., 1989 Twycross and Lack, 1984), belief that pain is inevitable and irrepressible (Ward et al., 1993), fear of distracting clinicians from treatment focus (Cleeland, 1987 Diekmann et al., 1989) and the desire to please clinicians (Cleeland, 1987 Twycross and Lack, 1984).On the other hand, insufficient knowledge, poor pain assessment skills, negative attitudes and physician reluctance to impose analgesics have also been shown as some of the clinician-barriers to effective pain management (Cleeland, 1993 Von Roenn et al, 1993). A study conducted in Iran revealed that institutional policies and regulations, limited time, poor communication, work overload, the right way physicians and the subjection face up by the nursing profession are some of the nursing-related barriers to postoperative pain management (Rejeh et al., 2008). Another stu dy conducted by Rejeh et al. (2009) also interpret nurses limited authority, poor patient relationship, inadequate educational preparation and the interruptions in pain management measures serve as impediments in the effective management of postoperative pain in Iran.Some of the barriers in the healthcare system include strict regulatory scrutiny (Cleeland et al., 1994), changes in reimbursement policies (in cases where older patients have to pay for the cost of outpatient prescription drugs) (Glajchen et al., 1995), the lack of neighbourhood pharmacies, poor means of transportation and the absence of higher doses of opioids in the health system (Glajchen, 2001). Ultimately, these factors lead to inappropriate selection of analgesics and its ensuant poor management of patients pain (Glajchen, 2001).It can be realised from the literature that, most of the barrier-related studies on pain have mainly been in the form of valued studies conducted on chronic conditions such as cancer(G lajchen et al., 1995 Glajchen, 2001 Im et al., 2007 Joranson, 1993 Ward et al., 1993) and AIDS (Brietbart et al., 1998). This approach often leaves the reader in questioning why and how these factors serve as barriers. Moreover, studies conducted on clinician-related barriers (Rejeh et al., 2008 Rejeh et al., 2009 Van Niekerk and Martin, 2003 Von Roen et al., 1993) have always taken a uni-modal approach (either physicians or nurses) while neglecting other professionals such as the anaesthesiologist/ anaesthetist who also play a part in postoperative pain management. By virtue of this, a comprehensive understanding of the barriers that are faced by the multidisciplinary health team mingled in postoperative pain management will enable a more targeted approach to improved patient care (Manias etal. 2005 Schafheutle etal. 2001).Research MethodologyMy research seeks to sop up an in-depth understanding of the factors that impede the effective management of postoperative pain from a mult idisciplinary health team approach. As a result, a qualitative stick out will be most appropriate in the conduction of the study in Ghana. The reason for choice of the location is that no previous studies have been conducted on the issue in this geographical area.Prior to the commencement of the study, ethical approval will have to be sought from the various ethics committees of the hospitals that would be include in the study. Some of the ethical issues such as the participants autonomy, confidentiality and anonymity during the study period will be addressed appropriately. All participants would be informed of the settle and design of the study, as well as the voluntary nature of their participation. Informed consent will be obtained from the participants in the form of writing and will be signed by them to serve as evidence for their voluntary participation.Semi-structured interviews will be used in collecting the data so as to gain in-depth information to specific questions (Ho ve and Anda, 2005). Like most qualitative studies, the findings of this study cannot be generalised to other settings but would provide rich information on the barriers faced by health care professionals in managing postoperative pain. This will then pave the way for appropriate strategies to be implement in solving this problem. health care professionals with a minimum of 5-year working experience in surgical units, in major hospitals in each region of Ghana would be included in the study. The reason is to acquire professionals who have sufficient work experience to enable them analyse barriers affecting the management of post-operative pain. Also, purposeful sampling technique will be used for recruiting participants in this study.In the conduct of this study, data collection and analysis will proceed concurrently until the development of themes related to health professionals barriers affecting post-operative pain management is achieved. Data collected will be analysed using cont ent analysis (Morse and Field 1995 Sandelowski, 2000) to generate codes, categories and themes. By means of theoretical sampling, additional participants will be selected until theoretical saturation is achieved and no new information emerges. Participants will be contacted after the analysis and will be given a replete transcript of their respective coded interviews with a summary of the emergent themes to determine whether the codes and themes matched their stated barriers. Maximum variation of sampling (in terms of the type of profession, years of working experience) will also enhance the conformability and credibility of data. This sampling strategy will enable the me to capture a vast range of views and experiences (Streubert and Carpenter 2003).Contributions of the ResearchConducting a research is not an end in itself, but a means to an end. As a way of finding solutions to the problem of ineffective postoperative pain management, it will be prudent to understand the causes o f these barriers so as to devise appropriate strategies.The success or failure of pain management largely depends on factors that influence the health professionals practical care for patients with post-operative pain. The findings of this study will provide insights into the factors that affect the management of postoperative pain from a multidisciplinary health team approach. By so doing, it will not only integrate diverse perceptions but also incorporate other key stakeholders in postoperative pain management (anaesthesiologist/anaesthetist) who have been left out in previous studies.Moreover, the proposed study will contribute to already existing literature by giving appreciable insights on the factors that affect the entire health team in the management of postoperative pain. Also, the involvement of the major stakeholders in postoperative pain management will stimulate the wager of each of the professionals groups thereby enlightening each other about the barriers and how the y can be solved. Ultimately, this will improve patient care, enhance staff satisfaction and encouragement the integrity of our health institutions.