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Non-pharmacologic

Pain Management

Amanda Strickland

transcutaneous nerve stimulation

music

Examples

1

Guided Imagery

deep breathing exercises

Meditation

  • May be spiritual for some clients.
  • The client shifts their concentration inward rather than to the pain
  • May be combined with other CAM therapies, such as guided imagery
  • Nursing considerations: provide a quiet and distraction-free environment if possible; determine if client has a set schedule for meditation, and accommodate it if possible
  • Safety measures: ensure the area is safe for the client; ensure no candles, lighters, etc. are in the area if around oxygen or other flammable objects

meditation

acupuncture/acupressure

  • Eastern medicine technique that employs insertion of thin, sterile needles under the skin (acupuncture) and pressure to specific areas of the body (acupressure)
  • Popular worldwide
  • Disadvantage: not commonly used in hospitals because these techniques require a person to have specialized training.
  • Safety Considerations: Ensure the client uses a provider who is reputable and qualified. Ensure that clean needles are being used on the client. Ensure that the pressure and/or needles will not cause further injury/infection to the client.

acupressure/acupuncture

progressive muscle relaxation

  • Stimulates the parasympathetic nervous system and decreases autonomic nervous system stimulation.
  • May be used in conjunction with other methods.
  • Involves the systemic contraction and then relaxation of muscles in each part of the body, starting from the feet and ending with the head/face
  • Nursing Interventions: assess pain type, intensity, and location. Provide education on proper technique to avoid over-straining muscles and causing injury. Evaluate effectiveness.
  • Safety precautions: ensure that PMR will not cause further pain/injury. Do not perform PMR on injured parts of the body.

Progressive muscle relaxation

distraction

distraction

  • Consciously focusing on something other than the pain
  • May include, music, reading, watching television, or any other hobby the client has.
  • Nursing Interventions: determine the best source of distraction for the client and make it available, if possible. Ensure a safe environment is always kept. Offer self to client. Evaluate effectiveness.
  • Safety considerations: Ensure that distraction will not cause harm to the client. Ensure that any supplies that could be shared between clients are properly sanitized. Provide distraction supplies that are age and developmentally appropriate.

biofeedback

Biofeedback

  • The client wears a monitoring device that tracks heart rate, blood pressure, skin temperature, respiration, sweating, brain waves, and muscle tension. The client becomes aware of these functions and can eventually control the body's response to pain, anxiety, etc.

  • Nursing Interventions: Assess type, intensity, duration of pain. Educate about use of monitor. Apply sensors as needed. Answer client's questions. Ensure safety. Monitor findings. Evaluate effectiveness.

Prayer

Prayer

  • Scientifically indicated that prayer is effective for relief of stress, anxiety, and pain.
  • Nursing considerations and safety are similar to that of meditation. Ensure that the area is safe and free from flame if in an area where oxygen is used or stored; determine the client's usual schedule, and adhere to it whenever possible
  • Contact local clergy if requested by patient.
  • Understand that your beliefs may differ from that of your client.

Allows the client to maintain a sense of control in their care

why is

non-pharmacological pain management important???

2

Enables the RN to provide culturally competent care

Relief of

symptoms without side effects of medication

Better client outcomes

3

impacts on nursing care

Opportunity for continued education

What if your client is refusing pharmacological treatment?

4

Why is your client refusing pharmacological treatment?

Assess!!!

  • Is there a knowledge deficit about medication?
  • Is the client afraid of dependence on the medication?
  • How are pain and pain management viewed in the client's culture?
  • What is causing the pain?
  • How does the client normally manage their pain?
  • What methods of pain management are they willing to try?
  • As nurses, it is always vital that we ASSESS every aspect before we can plan care!

Nursing diagnoses that may affect pain management

  • Acute Pain
  • Chronic Pain
  • Knowledge Deficit
  • Acute Confusion
  • Chronic Confusion
  • Fear
  • Spiritual Distress R/T Conflict Between Religious or Spiritual Beliefs and Prescribed Health Regimen

Diagnose

what are the goals for this client?

  • The client will report improvement in pain by at least 2 points on the appropriate scale by end of shift.

  • The client will express interest in three pain management techniques by end of shift.

  • The client will share normal methods of managing pain with the nurse during initial encounter.

Plan!

What are we doing to help reach these goals?

Implement

  • The nurse will complete a thorough pain assessment during each encounter.
  • The nurse will monitor VS Q4H/PRN.
  • The nurse will provide a non-judgemental environment with the client.
  • The nurse will assess effectiveness of selected pain management techniques.
  • The nurse will provide client education about alternative forms of non-pharmacological pain management, pharmacological pain management, and benefits of each.
  • The nurse will answer any questions the client has about treatment.

were the goals met?

Evaluate

  • Were the goals realistic?

  • Did the nurse follow through with all planned interventions?

  • Did the client's symptoms improve?

  • Always remember that we as nurses must honor the patients wishes. If the patient is not willing to use pharmacological forms of pain control, we must do everything in our power to still help the client remain safe and comfortable. It is also important that the patient's refusal and their response to alternative therapies are documented appropriately.

references

  • Biofeedback. External User Login - Lippincott Advisor for Education. https://advisor-edu.lww.com/lna/document.do?bid=19.

  • Burke, A. (2020, July 07). Lifestyle Choices: NCLEX-RN. RegisteredNursing.org. https://www.registerednursing.org/nclex/lifestyle-choices/.

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