Question

Task word
Topic words
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Management of pain in elderly patients is sometimes inadequate. Discuss this statement with reference to recent nursing literature.

Introduction

• 1 paragraph
• 5-10% word limit
• starts with general statement
• contains thesis statements in order of points in body
  (1,2,3,4)
• presents author's stance
• often written last

Nurses play a crucial role in the management of pain of their elderly patients, but it appears that sometimes pain is not managed adequately. Elderly people are at high risk of experiencing acute and chronic pain as a consequence of disease or following surgical procedures. If pain is not treated adequately, not only is there the suffering of patients to consider, but also their long term mental and physical health. One of the major factors contributing to inadequate pain management is ineffective communication about pain by the patients, and resistance to taking analgesics. Finally, although nurses are in the frontline of pain control, it seems that in some cases there are knowledge deficits that contribute to inadequately managed pain.

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Body paragraph 1

• topic sentence
• backed up by references to sources of information
• information mostly paraphrased
• one major idea: pain in old people
• infrequent use of short direct quotations

Elderly patients are at risk of experiencing pain in many circumstances. In one study of pain management in nursing homes (Bernabei et al., 1998, para. 9) it was found that nearly a third of the elderly residents with cancer experienced daily pain, which was frequently untreated. This problem seemed to be worse in the case of patients older than 85 years. Similarly, Ward, Donovan et al. (2000, p. 394) have stated that management of cancer pain is ‘particularly poor’ in elderly patients. Pain is also frequently a problem for many elderly people after surgical operations, both in the short term while still in hospital, and after discharge (McDonald et al., 2001, p. 403). For elderly patients to be experiencing pain that could be relieved with appropriate analgesia is clearly an undesirable situation.

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Body paragraph 2

• topic sentence
• one major idea: impact of pain on future health

Apart from the immediate suffering it causes, inadequately treated pain seems to have consequences for the longer term physical and mental health of the individuals concerned. For instance, pain relief is important for elderly patients’ well being and recovery after operations. For patients recovering from joint replacement surgery, physiotherapy often commences on the day after surgery and is potentially very painful. It is crucial for patients to have effective pain relief for the therapy to be effective and increase the mobility of the new joints (McDonald et al., 2001, p. 408). In the longer term, elderly people can try to avoid persistent pain by decreasing their movement, but immobility in elderly people can have serious consequences such as pneumonia and thrombophlebitis (Olsen, Johnson, & Thompson, 1967, as cited in McDonald et al., 2001, p. 403). For this reason, pain relief is an important component of the ongoing health care of postoperative elderly patients.

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Body paragraph 3

• topic sentence
• one major idea: communication problems

Secondary citation

An important factor associated with pain management in elderly patients is the issue of communication. Elderly patients with dementia may not be able to effectively communicate their pain to nursing staff (McDonald et al., 2001, p. 403). It has also been suggested that even healthy elderly patients would expect to be treated for pain without telling anyone about it (Zalon, 1997, as cited in McDonald et al., 2001, p. 403). This tendency of patients not to communicate pain is one of a number of “patient-related barriers” (Ward et al., 2000, p. 394) which contribute to inadequate pain management in all patients, including, and perhaps especially, the elderly. One of the major reasons for these barriers to communication is patients’ worries about side effects. Studies reviewed by Ward, Donovan et al. (2000) have indicated that patients with high barriers use inadequate analgesics and have a poorer quality of life than patients with fewer barriers to pain management. For this reason, it has been suggested that pain management strategies emphasising pain communication skills may improve pain management for elderly people (McDonald et al., 2001, p. 403) .

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Body paragraph 4

• topic sentence, also linking previous paragraph on problem of pain with role of nurses
• one major idea: nurses' role

Given the evidence of unnecessary and avoidable pain in elderly patients, it seems that the role of nurses in alleviating this problem is crucial. However, it seems that for some time nurses have been part of the problem. According to McCaffery and Ferrell (1997, p. 175), "under- treatment of pain and lack of knowledge about pain management have been evident for approximately two decades". These researchers suggest that there has been recent progress in nurses’ understanding of pain assessment, addiction issues and dosage requirements but that some common misunderstandings persist. In a study of registered nurses in the United States (Clarke et al., 1996, p. 18), it was found that there were misunderstandings about a number of aspects of pain management, in particular, non pharmacological strategies to relieve pain, and discriminating between acute and chronic pain. Given the importance of communication in pain management, it would seem that nurses could play an important role in encouraging and educating patients to discuss their pain, in order to improve management outcomes.

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Conclusion

• 1 paragraph
• about 5% of word limit
• contains no new ideas or angles of argument and no references
• concisely restates major ideas developed in essay, in the order in which they were presented

In conclusion, if nurses are indeed vital players in pain management, they must take responsibility for pain issues in the vulnerable elderly patients. Many elderly people endure acute postoperative or chronic pain which if inadequately managed can decrease their long-term health. One of the reasons for this problem is that many patients cannot effectively communicate their needs for pain relief, or have serious concerns about taking pain-relieving medication. Nurses can have a big impact on the quality of life of their elderly patients by facilitating the best possible communication with them, and by ensuring they are themselves well-informed about best practice in pain management.

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Rewritten
question

Part 2

Annie, a 78 year old woman with secondary breast cancer is in your nursing care. She has previously undergone chemotherapy, and is mentally alert, reserved and relatively uncomplaining. Her family is very concerned about her suffering, and asks you repeatedly if everything possible is being done to help her.

1: What factors could inhibit Annie from asking for pain relief?

• point 1 answered briefly & concisely, about 140 words

Many factors could stop Annie from asking for pain relief, and these have been discussed by Ward, Donovan et al (2000). One of the most common “patient-related barriers” to pain management is fear of addiction, and this is particularly the case with the opioids used to relieve cancer pain. Annie could also be afraid of side effects, perhaps based on her earlier experience with chemotherapy. She may think that she will feel nauseous or lose her mental alertness and be unable to communicate with her family. Another possible reason is that she may be afraid of injections, or worried that she will develop tolerance to the analgesia resulting in her needing higher doses later on.

[Questions 2-7 omitted]

List of
references

• journal article
  

   

• contains all references in the text, and vice versa
• format according to APA

List of references

Bernabei, R., Gambassi, G., Lapane, K., Landi, F., Gatsonis, C., Dunlop, R., et al. (1998). Management of pain in elderly patients with cancer The Journal of the American Medical Association, 279(23), pp. 1877-1882.

Clarke, E., French, B., Bilodeau, M., Capasso, V., Edwards, A., & Empoliti, J. (1996). Pain management knowledge, attitudes and clinical practice: the impact of nurses' characteristics and education Journal of Pain and Symptom Management, 11(1), 18-31.

McCaffrey, M., & Ferrell, B. (1997). Nurses' knowledge of pain assessment and management: How much progress have we made? Journal of Pain and Symptom Management, 14(3), 175-188.

McDonald, D., Freeland, M., Thomas, G., & Moore, J. (2001). Testing a preoperative pain management intervention for elders Research in Nursing and Health, 24, 402-409. Retrieved from http://www3.interscience.wiley.com/

Ward, S., Donovan, H., Owen, B., Grosen, E., & Serlin, R. (2000). An individualised intervention to overcome patient-related barriers to pain management in women with gynecologic cancers Research in Nursing and Health, 23, 393-405. Retrieved from http://www3.interscience.wiley.com/