Sedation and Pain Management; Sedation scales
One of the greatest challenges faced in the medical and nursing professions is the management of pain among patients, although the inception of sedative processes and procedures has helped overcome the same. There are several studies giving insights into sedation and pain management while also giving a glimpse of preferable sedation scales. To start with, Hogarth and Jesse in their article focus primarily on key concepts including sedation, analgesia, and mechanical ventilation. Hogarth and Jesse (40) state that the primary objective of sedating patients is to see the provision of relief while minimizing a possible development of drug dependency and over sedation. The article also mentions that mechanical ventilation and sedation go hand in hand because during mechanical ventilation where the patient is provided with increased oxygenation or an airway is secured; the patient has to be provided with an adequate comfort that is only achieved through sedation. It gives an example that most patients admitted to an ICU for mechanical ventilation often receive 1-3 sedative medications.
According to this article, there are several reasons for sedation, one of them being to overcome the respiratory drive from a climbing carbon IV oxide level especially for patients undergoing a strategy for permissive hypercapnia as well as ensuring that a patient receives safe and proper care. This article highlights some complications that might accompany sedation such as impaired metabolism related to frequent organ failures associated with critical illnesses and drug accumulation with protracted depression of the function of the central nervous system. This article also pinpoints some drugs used for sedation such as opioids, benzodiazepines, propofol, and haloperidol. Careful management of sedation is a responsibility of medical and nursing professionals, and some of the recommended practices include daily interruption of sedation and intermittent administration of sedation. Concerning the topic in focus, this article does not highlight sedation scales used by medical or nursing professionals.
Pasero (186-90) also focuses primarily on the concept of sedation, its assessment and the impact of poor sedative practices in health care organizations. This article begins by stating that one of the most serious of the adverse effects of sedation is life-threatening respiratory depression. However, one of the strategies or interventions of preventing significant respiratory depression is having nurses perform systematic assessments of sedation levels of their patients. Patients experiencing gradual increases in sedation ought to be attended to with a prompt reduction in opioid dose and frequent monitoring and examination until they demonstrate acceptable levels of sedation. One of the primary objectives in sedative environments is to ensure clear communication between members of the healthcare team as well as evaluating trends in the levels of sedation in patients. The achievement of this objective relies on the designing of a simple and easy-to-understand sedation scale, which is commonly used in hospitals in the US. Pasero (186) opines that one of the most commonly used sedation scales in health care organizations is the Pasero Opioid-induced Sedation Scale (POSS). POSS is critical to sedative processes because it links nursing interventions to the various levels of sedation and it also helps nurses to make appropriate decisions about how to proceed with opioid treatment.
Sedation scales help nurses make critical decisions such as increasing the opioid dose in patients who are easy to arouse and report unacceptable pain relief as well as holding or decreasing the opioid dose in patients who are excessively sedated. This article also identifies other sedation scales such as the Richmond Agitation-Sedation Scale and Ramsay Scale that are not recommended for use during opioid administration for pain management but are used to assess purposeful and goal-directed sedation during procedures or in ventilated critically ill patients. Essentially, according to this article, several hospitals, and other health care organizations opt to use sedation scales depending on the goals of treatment; whether for assessment of sedation during opioid administration for pain management and purposeful sedation. On the topic in focus, this article focuses more on sedation scales and overlooks or fails to give a clear explanation of the role of sedation in pain management.
Jarzyna et al (118-145) also examine and give detailed explanations of the concepts of sedation and pain management. The article is of the opinion that an increase in the complexity of analgesic therapies has resulted in the establishment of priorities of care with the aim of balancing aggressive pain management with measures to prevent or reduce adverse implications and to ensure the provision of safe and quality care to patients. Notably, one of the primary pharmacologic interventions for managing pain in hospitalized patients is sedation, which, however, can result in adverse events such as unintended advancing sedation and respiratory depression. This article opines that the occurrence of the mentioned adverse events can be influenced by factors such as route of administration, opioid dosage, duration of therapy, desired goals of therapy, and patient-specific factors.
Sedation should serve the purpose of pain management rather than result in adverse events, and as such, it is imperative to educate all members of health care teams about the dangers and potential or possible attributes of administration of sedating medications concomitant with opioid analgesia as well as the importance of initiating rational multimodal analgesic plans to help minimize or prevent adverse events. The roles of nurses during sedation cannot be overlooked, and they include identification of patients at risk for unintended advancing sedation and respiratory depression from opioid therapy, implementation of plans of care with the aim of assessing and monitoring patients, and intervention with the aim of preventing worsening of adverse events. Despite focusing on the concepts of sedation and pain management, this article does not highlight sedation scales, which also form part of the topic in focus.
The topic “Sedation and pain management; sedation scales” is highlighted and examined in the studies or articles summarized above. In recent years, health care organizations and providers have placed more emphasis on sedation and pain management, given the increase in the number of neurologically compromised patients admitted to the intensive care unit (ICU). Besides, the emphasis on sedation has been triggered by the desire or perceived need for patients to receive pharmacotherapy with the aim of controlling pain. In the ancient times, pain management was not taken seriously by health care providers and practice where high doses of medication were purposefully administered to render patients unresponsive was common. However, this has changed in recent years with more organizations and health care professionals championing for the need for attending to an awake yet comfortable patient. The evolution of pain management among patients, especially in ICUs, has seen more emphasis placed on analgesia guideline and improved sedation as well as reducing or doing away with the use of neuromuscular paralysis (Jarzyna et al 118).
With the embracing of the perspectives of sedation and pain management, critically ill patients are likely to be more awake and responsive than previous eras of critical care. Moreover, with sedation and pain management, patients are less likely to suffer adverse effects of neuroactive agents. The fact that sedation and pain management have taken center stage in health care organizations and that they have played an integral role in revolutionizing the health care sector makes them of great importance in modern society. Today, with sedative practices, nurses, and other medical professionals have an easy time attending to critically ill patients because physical aggression among patients caused by irritation and excruciating pain is minimized. In nursing practice, sedation is used when attending to patients who have undergone surgical operations, removal of wisdom teeth, and other significantly painful treatments. The failure to use sedation in such situations is likely to compromise the provision of quality and safe care, and this is why nurse and medical professionals and practitioners ought to be educated on the need of using sedation. It is imperative for nurses and medics to assess sedation to determine whether to increase or reduce sedation levels of patients, an objective that is achieved by leveraging on different types of sedation scales. These and other concepts related to sedation and pain management will be addressed in the capstone project.
Research indicates that the perspectives of sedation and pain management are yet to be embraced fully in the global health care sector. This is a surprising fact given the high levels of pain that patients experience while undergoing treatment in various health care organizations. Moreover, with the advancement of medical and nursing knowledge and skills, sedation and pain management ought to be part and parcel of operations and procedures in health care organizations. As such, the primary target of this presentation will be nurse practitioners who are yet to understand the importance of sedation and pain management. This project will be presented to nurse practitioners in the staff lounge during lunch break, a period set aside for families and friends to visit patients.
Undoubtedly, the presentation of this project’s information to nursing practitioners will have positive implications on financial, regulatory, accrediting, safety, and patient satisfaction aspects. As already mentioned, this project aims at ensuring that sedation and pain management is embraced in all health care organizations to pave the way for the provision of safe and quality care to critically ill patients. From a financial perspective, the provision of this information to nurse practitioners would ensure that sedation drugs and pain management interventions are used during the treatment of critically ill patients thereby reducing the period of stay in health care organizations translating to a reduction in the cost of services provided (Jarzyna et al 120). Besides, the provision of this information would help enhance the safety of critically ill patients as nurse practitioners would embrace sedation and pain management interventions while attending to them. Moreover, the provision of this information would impact positively on accreditation of more health care organizations as more of the same would be obliged to implement standards for sedation and pain management in hospitalized patients. From a regulatory perspective, the provision of this information to nurse practitioners who are the targeted audience would ensure that more health care organizations abide by the regulations put in place by bodies such as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Most importantly, the provision of sedation and pain management information would have a positive impact on patient satisfaction because pain during experiences such as surgical operations would be minimized.
The following objectives of the presentation are specific, measurable, attainable, realistic, and timely (SMART). The first objective as listed below is timely as it is expected to be achieved immediately by the end of the presentation. The final objective’s timeliness is expected to be achieved between 2 weeks to 30 days after the presentation.
- It is expected that at the end of this presentation, the targeted nurse practitioners should be able to define the concepts of sedation, pain management, and sedation scales.
- With this information, the targeted nurse practitioners should be in a position to administer sedation drugs to critically ill patients.
- A long term objective (2 weeks to 30 days) of this information is that the targeted nurse practitioners will collaborate with newly established health care organizations to ensure that sedation and pain management are integrated into their operations.
Some of the content topics that will be presented during the project are as follows:
- Definition of the concepts of sedation, pain management, and sedation scales.
- Administration of and types of sedation drugs
- The reasons for sedation and the importance of having all health care organizations embrace the practices of sedation and pain management.
As seen above, the responsibility of implementing sedation and pain management interventions in health care organizations rests with nurse practitioners. Klein (1-8) focuses on the nurse practitioner role and scope of practice, and she defines a nurse practitioner as a registered nurse in possession of additional preparation and skills in psycho-social assessment, management of health-illness needs in primary health care settings, and physical diagnosis. The article also focuses on the factors that influence the nurse practitioners’ scope or practice and why there is a great concern when nurse practitioners practice outside their scope. Klein’s article also examines the regulations regarding nursing practice and common questions often asked regarding the same. Essentially, this article relates to the project’s chosen area of interest, which is nurse practitioner as it highlights what is needed of nurse practitioners in the execution of their duties and responsibilities. In fact, the nursing practice competencies emphasized in the article are critical to the implementation of sedation and pain management practices when treating or handling critically ill patients in health care organizations.
Why was topic chosen?
The topic “Sedation and pain management; sedation scales” was chosen for this project because of the emphasis and worldwide campaigns on the need for sedation and pain management practices in modern health care organizations. The fact that more organizations and health care professionals have championed for the need for attending to awake, yet comfortable patients in recent years makes this topic of great importance.
Importance of topic
This topic is important as it ensures that all stakeholders in the global health care sector are made aware of the ways of providing quality and safe care to critically ill patients. The importance of this topic is also evident in the fact that it plays a crucial role in improving patient satisfaction outcomes in health care organizations, which is one of the primary objectives of health care providers.
Who will benefit from research?
As already mentioned, among the individuals who will benefit from this research are nurse practitioners who are yet to understand the importance of sedation and pain management. In fact, this research will campaign for the embrace of sedation and pain management in every health care organization thereby enabling nurse practitioners to attend to critically ill patients with ease and without interference from the patients.
Cultural/spiritual influence on chosen area of interest
Despite the emphasis on quality care and service delivery, nurse practitioners’ execution of duties and responsibilities is often jeopardized by myriads of cultural and spiritual issues (Klein 4). For instance, in certain parts of the world, a Muslim nurse practitioner may be restricted from providing services to a non-Muslim patient. Moreover, cultural beliefs of a patient may compromise a nurse practitioner’s service delivery, and this is evident when certain male patients are restricted from receiving medical services from female nurse practitioners.
Capstone Reflective Journal
|Module Journal Entries A separate Journal entry is required for Modules 1-6 by 2359 Saturday of each indicated module. Provide details of your thinking, including insights, challenges, paradigm shifts, and goals. Identify previous course topics, readings, or research that relate to the prompt.|
|Module 2: Identify 3 key points for this module. Reflect on how why each point is important, how it impacts on your work experience or nursing practice, and how will you change your practice in the future based on each key area.|
|Key Point 1||Sedation- this is the administration of anesthetic drugs to produce a state of calm or sleep in a patient. It is important for nurse practitioners as it provides relief while minimizing a possible development of drug dependency and oversedation and it also helps nurses attend to patients with minimal aggression (Jarzyna et al 118).Sedation impacts on nursing experience as it ensures that critically ill patients are attended to with minimal interference that could result from pain or aggression.Sedation is likely to be integrated in every nursing practice procedure when dealing with not only critically ill patients but also other patients including those nursing minor injuries.|
|Key Point 2||Pain Management- this is an interdisciplinary approach that eases the suffering or improves the quality of life for patients or individuals living with chronic pain. In nurse practice, pain management is important as provides comfort and peace to people living with chronic pain and also it prolongs life as it reduces adverse impacts of pain on a patient’s body.Effective pain management results in patient satisfaction, which is one of the primary objectives of the nursing experience (Jarzyna et al 119).Future nursing practice is likely to integrate pain management as a way of ensuring patient satisfaction and achieving other organizational objectives.|
|Key Point 3||Sedation scale- this is a medical scale that is used to measure a patient’s sedation or agitation level. In recent years, it has become one of the most essential components in hospitals that have helped enhance how nurses respond to critically ill patients.Sedation scale impacts on nursing practice as it helps nurses make critical decisions such as increasing decreasing the opioid dose in critically ill patients (Pasero 187).Currently, sedation scales are used in selected hospitals, although this will change as nursing practice will have to integrate the same in every operation prompting a change in how nurse practitioners deliver services.|
Hogarth, D. Kyle, and Jesse Hall. “Management of sedation in mechanically ventilated patients.” Current opinion in critical care 10.1 (2004): 40-46.
Jarzyna, Donna, et al. “American Society for Pain Management Nursing guidelines on monitoring for opioid-induced sedation and respiratory depression.” Pain Management Nursing 12.3 (2011): 118-145.
Klein, Tracy A. “Scope of practice and the nurse practitioner: Regulation, competency, expansion, and evolution.” Topics in Advanced Practice Nursing eJournal 5.2 (2005).
Pasero, Chris. “Assessment of sedation during opioid administration for pain management.” Journal of PeriAnesthesia Nursing 24.3 (2009): 186-190.