To manage pain, put patient and caregiver on team
To manage pain, put patient and caregiver on team
Redemonstration is key
To effectively manage end-of-life pain, both patients and family caregivers must receive appropriate education. This includes the safe administration of medication.
"Initially, they are taught by having them test back’ what they have learned by redemonstrating to us. An example would be how to measure doses of liquid medications," says Ann Quinlan-Colwell, RN, MS, CHPN, HNC, advanced practice nursing team leader for the pain/stress/palliative care team at Duke University Health Systems in Durham, NC.
Medication education also covers side effects such as nausea, vomiting, sedation, itching, and constipation and how to manage them. In addition, drug/drug interactions and drug/food interactions are taught. If medications are not adequate to manage pain, patients and caregivers are told to contact their health care provider, although they do learn several nonpharmacological interventions such as guided imagery and relaxation exercises.
Teach monitoring skills
Patients learn to effectively use pain scales for the best assessment and to identify their goals for pain management, says Quinlan-Colwell. They also are taught to take "rescue" analgesia to keep pain from exacerbating and to report when the current regimen becomes less effective or new pain develops.
Teach patients and their caregivers to be proactive with pain management, says Justin Engleka, MSN, CRNP, CHPN, nurse practitioner in the palliative care and chronic pain service at the University of Pittsburgh Medical Center. For example, a half-hour before bathing, the patient should medicate to be more comfortable.
They also can learn to keep a daily log to chart the times they take their pain medications, when the pain is at its worst, and what is associated with the increase in pain. For example, did they get upset or agitated? "After a period of time, they can look at the log with their physician to see what is the best way to formulate a plan and increase the medications," says Engleka.
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