Multidisciplinary Team Pain Management

Multidisciplinary Team Pain Management Introduction In spite of advances in pain management (Apfelbaum et al., 2003; Fotiadis et al., 2004; Powell et al., 2004; Wu and Richman, 2004), postoperative pain still remains a major clinical problem confronting healthcare providers (Klopfenstein etal., 2000; Klopper et al., 2006; Sjà ¶strà ¶m, Dahlgren and Haljamà ¤e, 1999). Many patients continue to experience postoperative pain (Gilmartin and Wright, 2007; Manias et al., 2005; Schafheutle et al., 2001) with about 69% of them experiencing moderate to severe pain after surgery (Apfelbaum et al., 2003). According to the International Association for the Study of Pain (1979: 250), pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage described in terms of such damage. This definition emphasises on the subjective nature of the pain experience which can be influenced by multiple factors (International Association for the Study of Pain, 2003). As a result of this, McCaffery (1983: 14) defines pain as whatever the experiencing person 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 use of healthcare resources (Fortner et al., 2003; Mystakidou et al., 2005; OMahony et al., 2005) and its associated high costs of hospitalisation (Huang et al., 2001). From an ethical point of view, postoperative pain should be properly managed to prevent needless suffering and avoidable complications (Kehlet, 1989), so as to increase function and to improve the quality 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 will explore the barriers to effective postoperative pain management from a multidisciplinary health team approach. The proposal will commence with a literature review on barriers to effective pain management followed by the appropriate research methodology that can be used in carrying out the study. Finally, the contributions of the research in filling the gaps of previous studies will be discussed. Literature Review In spite of numerous studies conducted on the different aspects of pain, the factors that affect pain management have 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 management 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 poor 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 dementia 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 and 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 an d Lack, 1984), belief that pain is inevitable and unmanageable (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 prescribe 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, powerful physicians and the subjection faced by the nursing profession are some of the nursing-related barriers to postoperative pain management (Rejeh et al., 2008). Another study conducted by Rejeh et al. (2009) also depicted 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 subsequent 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 quantitative studies conducted on chronic conditions such as cancer(Glajchen 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 involved in postoperative pain management will enable a more targeted approach to improved patient care (Manias etal. 2005; Schafheutle etal. 2001). Research Methodology My research seeks to gain an in-depth understanding of the factors that impede the effective management of postoperative pain from a multidisciplinary health team approach. As a result, a qualitative design 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 included 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 purpose 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 (Hove 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. Healthcare 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 content 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 full 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 Research Conducting 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 of 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 interest of each of the professionals groups thereby enlightening each other about the barriers and how they can be solved. Ultimately, this will improve patient care, enhance staff satisfaction and boost the integrity of our health institutions.

Freedom and Determinism

â€Å"Freedom, Determinism, and the Case for Moral Responsibility: A Look Back at the Murder of Jamie Bulger† begins by telling of the heinous crime that is the centerpiece of this paper. On February 12th 1993, British toddler Jamie Bulger abducted at a local shopping mall in Liverpool, England. Evidence that the two year old was beaten, sexually molested, and clubbed to death with bricks and an iron bar before discarding his body on train tracks. The age of his two assailants, Jon Venables and Robert Thompson, ten years old.Then they begin to explain the difference of opinions on the responsibility of the murderers. One side labels the boys as savages and criminals, while the other argues that they are â€Å"victims of broader social, economic, and cultural processes. † Sparking the question, are we truly responsible for how we act in society? The essay then moves on to the defense of determinism and how it relates to this specific event, stating that, â€Å"From a de terminist point of view, Jon Venables’s and Robert Thompson’s fate was set even before their birth.Born to ill-educated, working class parents, the details of the boys’ lives constitute a veritable catalogue of social ills. † The paper enlightens us on the rough and negative environments that both Jon Venables and Robert Thompson were raised in. Jon’s parents were â€Å"unstable and depressed,† and his dad eventually abandoned his abusive mother, himself and his â€Å"developmentally challenged† siblings. Thompson was the second youngest of â€Å"seven violent and aggressive boys†¦ one of whom was an arsonist and another who was a master thief. His parents were drunks and he witnessed his mother being beaten by his father in many alcoholic driven violent outbursts. The question is raised if Venables and Thompson are morally responsible for the actions leading to the murder of little Jamie. Here is where the paper really dives int o the determinist philosphy, stating â€Å"the Determinist argument holds that a person’s heredity and environment fix the choice before it is made. † Using legitimate sources such as â€Å"The Delusion of Free Will† by Robert Blatchford and â€Å"What Means This Freedom† by John Hospers, the essay presents sound reasoning to the determinist view.Taking from Blatchford, the point â€Å"that teaching is part of our environment and that we act as we have been taught that we ought to act. Thus, though we may act as we choose, we will choose as heredity and environment cause us to choose† John Hospers suggests that one holds no responsible for any of ones actions because actions â€Å"grow out of his character, which is shaped and molded and made what it is by influences . . . that were not of his own making or choosing† The paper also presents some arguments against the deterministic view from the free will perspective.Another essay, â€Å"A B rief Defense of Free Will† by Tibor Macha, and his opinion â€Å"the fact that some people with bad childhoods turn out to be crooks while others are decent would seem to indicate that people can cause and are responsible for at least some of what they do,† is examined. In â€Å"The Problem of Free Will,† W. T. Stace states, â€Å"In the case of Jamie Bulger’s murderers, young as they were at the time, the drive to inflict unimaginable pain on the toddler, at the moment they did it, does not seem to have been externally caused. They desired to do it. They were not motivated by any external factor, such as the proverbial gun to the head.They were morally responsible for their action and thus deserved to be punished. † While this paper makes a reasonable and knowledgeable argument for us to try to look at crimes like this from a more deterministic view, I have a hard time converting. Being that I am a criminal justice major, I am aware that there are many different theories on why crimes are committed, and not only what should be done to help prevent them from happening again, but what kind of treatment or punishment the perpetrator(s) should receive to more effectively rehabilitate them.I am one that stands with firm justice on brutal acts like this, regardless of age. Although in a violent and criminalistic environment, the kids were not directly forced to commit such a gruesome act, nor did they ever witness it from their parents. Therefore, in my opinion, the responsibility lies within the kids for their desire to not only torture, but kill.

Helping Teachers Become Leaders Essay

In â€Å"Helping Teachers Become Leaders,† Patricia Phelps (2008) presents a model that teachers, administrators and teacher educators can internalize in order to cultivate effective teacher leadership in our nation’s schools. Phelps begins her discussion of teacher leadership first by defining the concept. She cites Barth’s definition: â€Å"Making happen what you believe in† (p. 19). Phelps then goes on to argue that the development of teacher leadership has often been overlooked by both teacher education programs and by school administrators themselves: â€Å"The importance of cultivating leadership among teachers should not be underestimated as a powerful way to improve schools† (p. 122). The risk then of not empowering teachers to become leaders results in a significant threat to healthy school communities and effective and empowering teaching: â€Å"Those teachers who do not become leaders are typically satisfied with the status quo, easily discouraged, sometimes cynical, perhaps burned out, and may engage minimally in professional development activities† (p. 123). In the school that I have been working at, it is very evident that the handful of teachers who do believe in their ability to become leaders, are indeed the teachers who complain the most without doing anything about it, and seem to be most dissatisfied with their job. After having developed an argument for the rationale behind cultivating teacher leadership, Phelps outlines several key components about what skills, dispositions and competencies teachers need in order to take on leaderships roles within their schools. To begin with teachers must know what they believe about education. Phelps argues that teachers should be presented with opportunities throughout their teacher education program and throughout their careers that ask them to define what they believe about best teaching practices and the purpose of education. Furthermore, Phelps argues, teachers must understand and appreciate the value of becoming a leader in the schools. Teacher education programs and staff development must show examples of how teachers can and should become agents of positive change within their schools. Phelps also reminds teachers that a critical disposition for becoming a teacher leader is resiliency. Inevitably teachers will encounter obstacles along the way either internally from colleague or administrators or externally as a result of federal policy that sometimes fails to take into account the best interests of students. The next step in Phelps’ model is the development of the knowledge base that will help teachers assume a proactive and effective role within the school: â€Å"The knowledge base of teacher leadership consists primarily of the concepts of educational change and school culture† (p. 121). Phelps suggests that there are various types of roles that a teacher leader might assume: advocate, innovator and steward. After explaining how the teacher can best prepare to assume leadership roles, Phelps goes on to suggest that school administrators also play a significant role in determining whether or not teachers will feel comfortable taking on leadership roles: â€Å"By making clear the unique challenges that a school faces, the principal opens opportunities for leadership† (p. 120). I believe that Phelps’ emphasis on administrator’s role in this process is important. Administrators very much set the tone at a school, and when teachers feel that their ideas are valued and appreciated, they will be much more likely to step up to leadership roles. My principal frequently asks for staff input during meetings and asks for volunteers to become members of a committee. For example, when the school was considering whether to implement a dress code, our principal formed a committee and took all of their recommendations when it came time to adopt new policy. This makes staff members at our school feel valued and much more likely to take on leadership roles when they see other ways to improve the school. The process of preparing teachers to become leaders requires the commitment of many, not just teachers themselves. Teachers must be able to articulate what they believe and identify the roles that they can assume within the school to effect change. Administrators must create a positive tone and actively seek input from their staff. Teacher educators have the responsibility of cultivating an attitude and a belief in pre-service teachers that teacher leadership is both possible and necessary. If administrators, teachers and teacher educators take to heart these core components outlined by â€Å"Helping Teachers Become Leaders,† then we will make a big step toward sculpting out positive work environments that welcome and promote innovation. I believe that readings and discussions in this course about why becoming a leader is so important to schools and to individual teachers will help me to seek out and assume leadership roles throughout my career. Especially in the early stages of my career, I see myself most able to assume the role of steward, by exemplifying effective and innovative teaching practices and displaying a strong work ethic and a positive attitude about my profession. Once I begin to establish more of a professional identity, I hope then to be able to assume leadership roles in my school that will result in positive change on an even larger level.

The Social And Historical Context Of A Portrait Of The...

In this essay response I shall discuss the social and historical context of A Portrait of the Artist as a Young Man and My Son the Fanatic and how they enhance our understanding of the texts and then compare the two in their respective contexts. Religious extremism is a social ideology that is heavily implemented into both A Portrait of the Artist as a Young Man and My Son the Fanatic. With Steven Dedalus being subjected to his traditional family views of Catholicism as was the author of A Portrait of the Artist as a Young Man, James Joyce. Throughout the text Stephen is subjected to religious extremism, particularly in Chapter 3 when he attends Arnall s sermon, while on a religious retreat, in which he learns of Hell and sin, beleiving that God had allowed him to see the hell reserved for his sins and that the sermon is directed at him. This leads him to a part of his life where he followed the Catholic faith to an extreme degree, much like in My Son the Fanatic, whereby Ali devotes himself to the Muslim faith. At the time of publication, 1916, Ireland had seen events such as The Easter Rising in which Catholics rebelled against the British and the Protestants in a bid for independence. This mix of both the need for Independence and religious extremism are elements that we see portratyed through Stephen. Knowing this information we can see that Joyce portrays not only his own struggles with religion and independence using this method but also the conflict foundShow MoreRelated Jan Steen’s Self Portrait in â€Å"The Continence of Scipio† as a Social Commentary2561 Words   |  11 PagesJan Steen’s Self Portrait in â€Å"The Continence of Scipio† as a Social Commentary There is a tremendous difference between a fool and a jester. 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