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Dealing with denial in patients nursing essay

Vol17No01EthCol01 Optimal pain care for hospitalized patients continues to remain elusive.

Handling the Angry Patient​​​​​​​​

Although pain research has resulted in a better understanding of pain modalities and the development of new treatments, patients report little increase in satisfaction with the management dealing with denial in patients nursing essay their pain while hospitalized Department of Health and Human Services, 2011. This column will examine how the deliberate use of ethical principles, when making pain management decisions for hospitalized patients, may provide more optimal outcomes.

Assessment and treatment of pain is often complex. Regrettably, the intrinsic subjectivity of pain is often disregarded. The ethical principles of autonomy, beneficence, nonmaleficence, and justice should guide all health professionals when they make assessment and treatment decisions.

Autonomy Autonomy is the right of dealing with denial in patients nursing essay to make decisions regarding their own healthcare regardless of what others think of these decisions Evans, 2000. It is the right of self-determination American Nurses Association, 2001. Individuals must be treated with respect for their personal healthcare decisions regardless of whether the healthcare provider agrees with these decisions.

Patients have the right to know, consider, request, and refuse any treatments that they believe will help manage their pain. They also have dealing with denial in patients nursing essay right to have all medications, side effects, and other treatments clearly explained to them in order to make the right decisions.

Interestingly, when patients are fully extended their right to autonomy, their pain is often better managed, and they report better satisfaction with their care. When patients perceive that they are understood, and can make their own decisions regarding dealing with denial in patients nursing essay control, they often do better.

One example of this is the growing use of Patient Controlled Analgesia PCA for the treatment of acute pain in the hospital setting. Beneficence Beneficence is defined as doing good for an individual National Institutes of Health, 1979. In the modern hospital setting, it is very rare that pain must be allowed for diagnostic reasons; and it is even rarer that severe pain cannot be controlled in some fashion. Many reasons are often given for not providing pain relief expeditiously.

Excuses range from nurses being too busy, to difficulties in getting medication orders from physicians and pharmacy departments. Patients sometime wait hours for pain relief. The principle of beneficence is upheld when the appropriate amount of medication or other treatment is administered to the patient in a timely fashion resulting in the best pain control with acceptable side effects. Nonmaleficence The principle of nonmaleficence is defined as refraining from doing harm National Institutes of Health, 1979.

Herein may lie the greatest obstacle to ethical adherence in deciding the appropriate treatment for pain in the acute care setting.

Ethics: Ethics and Pain Management in Hospitalized Patients

Nonmaleficence is dealing with denial in patients nursing essay the principle of ethics invoked by nurses and practitioners when having difficulty deciding on pain treatments: There certainly can be a reasonable fear on the part of the practitioner of causing harm while treating pain since so many treatments for pain have potentially dangerous side effects. It is imperative to understand, however, that pain itself may be more harmful to the patient than the side effects of the drugs used to control it.

As stated previously, untreated pain can have detrimental physical and emotional effects on a patient. This fear is often unsubstantiated in the hospital setting since the administration of opioids and their effects are carefully monitored. Nurses must remember that expecting a patient to remain in unacceptable pain can cause harm in many ways ranging from mild anxiety to severe suicide.

For example, when choosing a pain medication for a person who is 80 years old, age must be considered since certain medications have been shown to be more harmful in older people. However, all safe pain treatments should be considered for a patient who is 80, just as they would be for a patient who is 40. When a demanding and wealthy socialite receives more consideration in the management of her pain than the quiet, unassuming, poor, single mother, the principle of justice is violated.

Disparities in treating pain continue. It is important for nurses to be aware that these discrepancies still exist in modern hospitals and to examine their own biases when treatment decisions are made. Ethical Pain Management Due to the inherent subjectivity of pain, assessment and treatment decisions can easily be dealing with denial in patients nursing essay by bias and emotion.

Evans 2000 makes the case that adhering to the principles of ethics principlism provides a very practical, unemotional way of making right decisions. In making decisions about pain management, it may be helpful for nurses to ask themselves questions similar to the following: Does the patient benefit experience good from my pain treatment decisions?

What can I do to decrease harm nonmaleficence when deciding on a pain treatment regimen? Conclusion In order for ethical principlism to become a practical and integral way of making pain management decisions, the nursing culture must embrace it as a matter of course. The conscious use of basic ethical principles can help nurses to see their own biases clearly and make evidence-based decisions that provide optimal pain treatment for every patient.

But management of pain is complex and influenced by the personal values and biases of practitioners. Although consciously following the principles of ethics when deciding on pain treatment can be time consuming, applying the four basic principles to pain care in every situation is imperative if pain is to be managed at optimal levels.

Making unbiased, ethical decisions in the treatment of pain dealing with denial in patients nursing essay hospitalized patients instills confidence and trust in patients and may ultimately lead to greater patient satisfaction with pain management.