Pain Management, Ethical Responsibility, and Leadership in the Opioid Epidemic

Pain Management Ethical Responsibility and Leadership in the Opioid Epidemic
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Pain Management Ethical Responsibility and Leadership in the Opioid Epidemic
Introduction
Nurses have a responsibility to alleviate pain and improve patient's quality of life. Yet, they are often hindered by issues such as difficulties in assessing patients' pain levels, especially because some critically ill patients cannot verbally communicate their pain level (Rababa et al., 2021). Also, nurses and other healthcare providers sometimes underestimate the patient's pain level, leading to under-treatment (Paul-Savoie et al., 2018). As a result, nurses fail to enhance patients' quality of life with chronic pain by providing suboptimal treatment. The American Nurses Association (ANA) (2018) indicates that nurses must identify strategies to help them address the consequences of pain under-treatment. As a nurse, my role involves balancing the benefits of opioids in pain management and the risks of opioid misuse and addiction. To do so, I must incorporate evidence-based pain management interventions that can improve patient's quality of life without threatening their safety.
Pain Management Strategies
Effective pain management is highly dependent on effective pain assessment. Nurses must be familiar with the standard approaches in pain assessment for acute and chronic pain. According to Cooney and Quinlan-Colwell (2021), pain assessment involves clinical judgment to establish pain intensity, duration, causes, and experiences based on the healthcare professional observations and patient expression of pain. Nurses should question the patient about their pain experience and utilize pain assessment tools. In acute pain, assessment involves establishing the intensity of the pain (Cooney & Quinlan-Colwell, 2021). However, such an assessment fails to represent the full complexity of pain by not focusing on other dimensions of pain. In contrast, in chronic pain, the assessment is more comprehensive, addressing all the aspects of pain. Pain assessment scales are utilized for effective pain management. They include (1) verbal rating scales, which uses phrases to describe the level of pain, such as "no pain" to "severe pain," (2) numerical rating scales, which uses numbers to represent pain, such as from 0 to 10, and (3) visual analog scales, which assess pain levels against the most imaginable pain intensity (Benzon et al., 2017). Nurses must consider the context of the patient’s pain during pain assessment. For instance, cultural influences affect patients' pain responses and communication (Cooney & Quinlan-Colwell, 2021). Nurses must apply cultural sensitivity when assessing pain. After effective pain assessment, healthcare professionals can establish how to treat the pain. Often, pain treatment involves the use of pharmacological interventions such as analgesics, complementary therapies, and physical therapy (Cooney & Quinlan-Colwell, 2021).
The World Health Organization (WHO) also introduced the analgesic ladder to ensure cancer patients receive optimal pain relief. According to Anekar and Cascella (2022), the ladder proposes three steps for pain management. The first step involves mild pain, which should be treated using non-opioid analgesics and optional adjuvants. The second step involves moderate pain, which should be treated using weak opioids and optional adjuvants/ non-opioid analgesics. The third step involves severe pain, which should be treated with potent opioids and optional adjuvants/ non-opioid analgesics. The ladder is essential in ensuring that patients' pain levels are thoroughly assessed and appropriate medication is given to promote patients' quality of life without threatening their safety.
For those needing palliative or hospice care, pain management is necessary for their comfort and quality of life during the end of life. According to Sinha et al. (2022), the pain management approaches in palliative or hospice care models include pharmacological, non-pharmacological, and psychosocial approaches. Pharmacological approaches involve using non-steroidal anti-inflammatory drugs (NSAIDs) and opioids. Non-pharmacological and psychosocial approaches involve using relaxation techniques, alternative therapies such as acupuncture, spiritual counseling, and basic care, such as grooming and oral hygiene. The goal is to ensure the patient is comfortable.
Ethical Considerations
Nurses have an ethical obligation to avoid harm and promote good. Pain management raises ethical concerns because when promoting good by using opioids to relieve pain, healthcare professionals can also cause harm in the form of opioid addiction. Also, according to Carvalho et al. (2018), healthcare professionals have a duty to relieve pain, but this duty has been neglected or unfulfilled, further adding to ethical concerns. ANA (2018) indicates that nurses have been unable to meet this duty because of the following:
1 Moral disengagement: Involves separating the ethical and moral codes from the actions compatible with codes.
2 Biases: Refers to stereotypes that influence nurses' perception of patients' experiences with pain.
3 Knowledge deficits: Refers to gaps in knowledge and evidence-based practices for pain management.
4 Economic limitations: Refers to the limited coverage of effective pain management/treatment interventions.
5 Environmental considerations: Refers the quality improvement efforts, institutional ethics committee consults, shared governance, and collective efforts to facilitate an ethical environment for pain management.
These issues should be considered while making ethical decisions in pain management. Nurses must also apply the ethical principles of autonomy, beneficence, non-maleficence, and justice in pain management (Carvalho et al., 2018).
Another consideration is opioid diversion, which is a contributing cause of the opioid epidemic. According to Kaye et al. (2017a), opi...