NURS 4221 Week 2 Discussion: Applying Measurement Tools

NURS4220/NURS4221 Leadership Competencies in Nursing and Healthcare

Week 2 Discussion

Applying Measurement Tools

One example of a measurement tool is the Healthcare Effectiveness Data and Information Set (HEDIS) comprehensive care measures. Review the eight components of HEDIS comprehensive diabetes care; then consider the following scenario.

You are a staff nurse working in a private primary care practice. It is a small practice with 2 MDs (internists), 2 nurses, 1 medical assistant, and an office staff for billing. There are approximately 1,000 patients in the practice. You have had no EHR until the last year, but all charts are manual, historically. Your physicians are starting to inquire about quality incentives, particularly regarding patients with diabetes. NURS 4221 Week 2 Discussion: Applying Measurement Tools

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NURS 4221 Week 3 Assignment 1 (Walden)

Quality Improvement Process; FADE Model

Walden University

Nurs 4221

Quality improvement process involves an entire team, not just one person, manager, or nurse can change anything. With change for the best, it takes a team approach. Once the problem …

NURS 4221 Week 4 Assignment 1 (Walden)

Applying the FADE model

For the problem that I will be addressing using the FADE process, pain management in the terminally ill, I will be considering the aspects previously stated and giving an explanation as to why it will work. The process of FADE was selected to help to analyze and implement a plan that could change the score on the satisfaction survey to indicate that the patients who were dying were without pain. The FADE model is an advancement of the original PDSA/PDCA improvement cycle (Spath, 2013). The steps of the model are focus, analyze, develop, and execute.

NURS 4221 Week 6 Assignment 1 (Walden)

The Management of Pain in the Terminally Ill Patient

Leadership and Competencies in Nursing and Healthcare; NURS-4221-19

The Management of Pain in the Terminally Ill Patient

?The topic that I chose for this paper is the management of pain the terminally ill patient.

Measurable Quality Indicator, Pain Management in the dying Patient

The quality indicator that I have chosen is pain management in the dying patients. Quality indicators were developed by the America Nurses Association (ANA), taking the reports,

The Management of Pain in the Terminally Ill Patient

The purpose of this paper is to note that we do have a problem with patients who are dying and the families reporting that they had pain when dying and finding measures to increase

Literature Review

1. Use of Opioids and Sedatives at End-of-Life

2.Perspectives of Asians living in Texas on pain management in the last days of life

3. Evaluation of Therapeutic Choices for the Treatment of Pain in the Terminal Oncologic Patient Before and During Hospice Admission

4. Limits and Responsibilities of Physicians Addressing Spiritual Suffering in Terminally Ill Patients

5. Pain relief, spiritual needs, and family support: Three central areas in intercultural palliative care

Applying the FADE Model.

Resources

Conclusion

Assessing Pain in Patients at the End of Life

The first step in managing severe pain in patients with terminal illnesses is through a comprehensive pain assessment. Pain must be continually reassessed as the patient’s condition can progress rapidly. Pain that has not been treated early often takes longer to subside in patients who suffer from terminal illnesses; therefore, it is vital to treat pain as soon as possible for best outcomes (Pasero & McCaffery, 2010). Once the patient has been placed on an individualized pain regimen, continue to assess pain, monitor the effects and side effects of the interventions, document these findings, and report any changes in status to the attending physician.

Current and Usual Pain

Assessing pain in patients nearing the end of life involves a comprehensive approach. This includes establishing a good understanding of the patient’s current and usual pain experience. It is important to understand the patient’s typical presentation of pain and pain-related symptoms. Some of the more commonly and easily used tools include the Numeric Rating Scale and Faces Scale, which can provide information about the intensity of the pain, and the Pain Map, which can provide details about the location and radiation (if any) of the pain (Ruder, 2010). This information will help the home healthcare/hospice team evaluate further disease progression and develop an individualized pain management plan. Home care nurses have the advantage of getting to know their patients well because they are able to observe them in their natural home environment. This is an important facet of the assessment, as the nurse can obtain a firsthand look at how the patient is functioning with pain in their daily life.

Terminal illnesses may progress to a point when the patient is no longer able to communicate or describe the pain. This can result from unresponsiveness due to organ system failure, cognitive impairments due to decreased cerebral perfusion or underlying dementia, delirium caused by terminal agitation or restlessness, and/or physical impairments as seen with progressive musculoskeletal disease (Morita et al., 2003). The communication capacity of patients is greatly decreased during the last week of life with only 43% (5 days before death), 28% (3 days before death), and 13% (1 day before death) of patients able to communicate (Morita et al.). Among patients who did not take a narcotic medication, the ability to communicate was only slightly higher (Morita et al.).

Pain Assessment in Unresponsive Patients

Assess and document the location, intensity, quality, and duration of pain at every visit and evaluate the effectiveness of the pain management regimen. There are many clinical tools available for assessing pain intensity. Some of these include the Behavioral Pain Scale, Critical Care Pain Observation Tool, Multidimensional Observation Pain Assessment Tool, and Checklist of Non-Verbal Pain Indicators (McGuire et al., 2016). Most of these tools rely on evaluating common pain-related behaviors such as vocalizations, restlessness, and facial expressions and can be utilized in any care setting. You can also ask the family caregiver to describe the patient’s usual pain behaviors and whether they believe the patient has pain. This can be particularly useful when the patient has limited responsiveness or ability to self-report their pain upon admission to home care. Although the family caregiver’s report can be helpful, research suggests this is not the most ideal way to evaluate pain in an unresponsive patient as family assessment often underestimates pain, resulting in undertreatment (Masman et al., 2018).

When assessing an unresponsive patient, observe common nonverbal signs that could be signs of discomfort. These include facial grimacing, vocalizations that may indicate discomfort such as moaning or crying, excessive perspiration, shaking or trembling, and guarding of specific areas of the body (End of Life Nursing Education Consortium [ELNEC], 2010). Observe these signs during patient care and/or turning and positioning the patient, as some pain may become aggravated or worsen with movement. When a patient with an end-stage terminal illness becomes unresponsive, it indicates that the illness has progressed and the patient is nearing the final stages toward end of life. This can take a great toll on family caregivers and it is imperative to ensure proper pain assessment and management throughout the remainder of the actively dying, transitioning and imminent phases of the end-of-life processes.

NURS 4221 Week 2 Discussion: Applying Measurement Tools