The Role of the Palliative Advanced Practice Registered Nurse (APRN) in Pain Management

 

The focus of this module is pain management in patients with serious and life limiting disease. This module reviews advanced principles of pain management, including pain assessment, diagnosis, non-pharmacological and pharmacological pain therapies, invasive techniques, as well as other treatments, with a focus on advanced nursing practice. This module also includes emphasis on the development of policies and procedure for complex pain issues. Key messages include: • APRNs must perform a comprehensive pain assessment that includes the medical and pain history, assessment of current pain(s), physical examination and diagnostic testing to develop an appropriate pain diagnosis, and an interdisciplinary management plan. • APRNs must understand the basic principles of pain to manage patients with serious or life threatening illnesses in any setting. • APRNs must document appropriately and develop safe prescribing practices. • APRNs must have knowledge about complex pain situations in order to provide care in extraordinary situations. • APRNs must work collaboratively with the interdisciplinary team in order to optimally manage pain and suffering. • APRNS must formulate a comprehensive pain plan in collaboration with the patient and family, as well as with the healthcare team and/or other professionals.

$20.00

Hours: 1.00
REL-HEN-1011

Certificates

Certificates provided by accrediting body (7 Match)

California Board of Registered Nursing

1.0 HOURS


Provider approved by the California Board of Registered Nursing, CEP# 13791

Nurses will receive 1.00 contact hours for participating in this course.

District of Columbia Board of Nursing

1.0 HOURS


DC-RN -- District of Columbia Board of Nursing Approved Continuing Education program (CE Provider #50-290).

Nurses will receive 1.00 contact hours for participating in this course.

Florida Board of Nursing CE

1.0 HOURS


Florida Board of Nursing CE Provider #: 50-290

Nurses will receive 1.00 contact hours for participating in this course.

American Nurses Credentialing Center

1.0 HOURS


Relias, LLC is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

Nurses will receive 1.00 contact hours for participating in this course.

Georgia Board of Nursing

1.0 HOURS


Georgia Board of Nursing CE Provider #: 50-290

Nurses will receive 1.00 contact hours for participating in this course.

South Carolina Board of Nursing

1.0 HOURS


This program was approved by the South Carolina Board of Nursing Approved Continuing Education Program (CE provider #50-290) CE Broker Course # 20-[Custom_Code]

West Virginia Board of Registered Nursing

1.0 HOURS


Course Details

Course Code: REL-HEN-1011
Hours: 1
Type: Online Course
Content Expiration Date: 6/30/2020
Learning Objectives:
Identify critical components of a pain assessment: history, physical examination, and diagnostic testing.
Develop a pain diagnosis based on etiology and characteristics that impact management strategies.
Define key terms used in pain management.
Describe the use of pharmacological therapies for pain and how to prescribe them.
Describe the use of nonpharmacological pain therapies and how to utilize them.
Discuss safe pain management practices.
Delineate the use of interventional pain procedures.

Outline:
I. The Role of the Palliative APRN in Pain Management A. Practices in accordance with national criteria for palliative care 1. American Nurses Association (ANA) –According to ANA, the definition of nursing is…”the alleviation of suffering through diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations.” Specifically, ANA states, “The APRN assumes responsibility for the safe and efficient implementation of the plan.” (American Nurses Association, 2010 pg. 39.) 2. The Hospice and Palliative Nurses Association promotes pain management as a quality of life issues. In its Pain Management Position Statement, HPNA underscores the suffering caused by pain and the need for adequate assessment and management. But further states that contrary to professional fears, inadequate pain management can hasten death (HPNA 2012). Furthermore, in the Ethics of Opiate Use, HPNA promotes the appropriate use of opioids as part of palliative care for all populations of patients (HPNA 2013). In the Hospice and Palliative Nursing Scope and Standards of Practice specifically describes the tasks the Hospice and Palliative APRN performs in regards to pain management. i. Prescribes evidence-based treatments, therapies, and procedures considering the patient’s comprehensive health care needs. ii. Prescribes pharmacologic agents based on a current knowledge of pharmacology, physiology and physiologic changes, pharmacodynamics, and medication adherence in older adults. iii. Prescribes specific pharmacological agents or treatments based on clinical indicators, the patient’s status and needs, and the results of diagnostic and laboratory tests. iv. Evaluates therapeutic and potential adverse side effects of pharmacological and nonpharmacological treatments. v. Provides patients with information about intended effects and potential adverse side effects of proposed prescriptive therapies. vi. Provides patients with information about financial considerations of evidenced based treatments and alternative treatments and procedures as appropriate. vii. Evaluates and incorporates complementary and alternative therapy into education and practice (ANA, 2010 HPNA and ANA 2007) 2. National Consensus Project Clinical Practice Guidelines Domain 2: Physical Aspects of Care (NCP 2013) a. Guideline 2.1 The interdisciplinary team expertly assesses and manages pain and/or other physical symptoms and subsequent effects based upon the best available evidence. b. Guideline 2.2 The assessment and management of symptoms and side effects are contextualized to the disease. 3. National Comprehensive Cancer Network (NCCN, 2012) a. Pain and other symptoms controlled b. Distress caused by pain will be decreased for both the patient and his/her family (caregiver) c. The patient will have a sense of control d. Caregiver burden will be relieved e. Relationships will be strengthened f. Quality of life will be optimized g. The meaning of life and illness will be enhanced as the patient experiences personal growth as this time. B. The APRN works with a team to assess, manage, and treat pain using evidence based pain management within the disease process and in collaboration with goals and treatment wishes of the patient and family. 1. Consultant for pain management 2. Direct care provider for pain management, a. Primary pain management clinician for many patients 3. Educator of pain management. a. Patient b. Families c. Interdisciplinary colleagues d. Nurses at the bedside e. Other healthcare staff f. Public, third party payers 4. Collaborator and facilitator of interdisciplinary pain management a. Facilitator of consistent pain management b. Educator of pain management across settings to patient, family, and staff c. Communicator of pain management plan C. APRN challenges to pain management (Arnstein & St. Marie 2010) 1. Culture of community, health care organization, patient, and family resistance to medications 2. Setting of care – acute, long term care, home, hospice, or ambulatory care which may lack policies, procedures, and protocols 3. Lack of evidence based practice for pain management in specific conditions beyond cancer 4. Regulatory issues and ARPN opioid prescribing -State and organizational regulations regarding analgesic prescribing particularly opioids. 5. Insurance and financial issues surrounding opioid and adjuvant medications which may promote or support acute pain management rather than chronic pain management for palliative care patients 6. Lack of coverage for nonpharmacological therapies as many of these therapies are not covered by insurance, employment health care accounts, or Medicaid/Medicare D coverage. Therefore, expenses are paid out-of-pocket by the patient and/or their family 7. Formulary issues in various health settings 8. Lack of clinician knowledge and/or experience in pain assessment and management 9. Use of opioids in patients with hypersensitivity, undiagnosed head trauma, severe liver, renal failure, addictive disease. 10. Assessment of specific barriers for each clinical setting is imperative, as it will vary for place to place. Considerations may include peer education and prescribing practices, staff education, formulary barriers, as well as administrative support for focusing on opportunities for improvement. D. More pain research had been done in cancer rather than non-cancer conditions 1. There is less research in non-cancer diagnoses and pain is less understood 2. Many principles of pain management from cancer treatment have been transferred to non-cancer diagnosis. 3. However dosing may be a consideration. E. APRNs usually have little skill building and training with pain medications, particularly in prescribing or ordering opioids. 1. Clinicians may learn by trial and error. It takes time to get comfortable writing opioid orders. 3. The APRN must get comfortable with opioid medications and learn to use them well. The number of opioids available to prescribe will vary, based on clinical setting and role. 4. Find an APRN mentor to promote individual competence and professional development in pain management. F. The APRN will treat a variety of patients with myriad of related prescription issues. The APRN will need to be diligent in working through these issues. 1. Formulary limitations of different commercial and state prescription medication coverage 2. Lack of hospital/institutional policies 3. Lack of pharmacy support At the completion of this module, the APRN will: • Identify critical components of a pain assessment: history, physical examination, and diagnostic testing. • Develop a pain diagnosis based on etiology and characteristics that impact management strategies. • Define key terms used in pain management • Describe the use of pharmacological therapies for pain and how to prescribe them • Describe the use of non-pharmacological pain therapies and how to utilize them • Discuss safe pain management practices • Delineate the use of interventional pain procedures

Instructor: Judith Paice, PhD, RN, FAAN
Judith Paice, RN, PhD, FAAN is currently the Director of the Cancer Pain Program in the Division of Hematology-Oncology and a Research Professor of Medicine, Northwestern University, Feinberg School of Medicine. She is also a full member of the Robert H. Lurie Comprehensive Cancer Center. Dr. Paice is a past President of the American Pain Society, served as Secretary of the International Association for the Study of Pain. Much of Dr. Paice’s clinical work has been in the relief of pain associated with cancer and HIV disease. Her research interests include: chemotherapy-induced peripheral neuropathy; quality improvement measures to foster pain relief; and adverse effects associated with analgesics. In 2002, the American Pain Society honored Dr. Paice with the Narcessian Award for Excellence in Teaching. She has traveled extensively internationally to educate healthcare professionals regarding cancer pain relief. Dr. Paice serves on the editorial board of Clinical Journal of Pain, Journal of Pain, and Journal of Pain and Symptom Management and has published numerous articles, alone and collaboratively, in the areas of pain management and research. Dr. Paice is also a co-editor for the 2015 Oxford Textbook of Palliative Nursing. She earned an MS in oncology nursing from Rush University in Chicago and a PhD from the University of Illinois at Chicago, studying pain modulation pathways in an animal model. Disclosure: Judith Paice, PhD, RN, FAAN has declared that no conflict of interest, Relevant Financial Relationship or Relevant Non-Financial Relationship exists.
Target Audience:
The target audience for this course is: intermediate and advanced level Nurses; in the following settings: Hospice, Palliative Care.
Relias will be transparent in disclosing if any commercial support, sponsorship or co-providership is present prior to the learner completing the course.
Course Delivery Method and Format
Asynchronous/Online Distance Learning; please see certificate details for specifics on delivery format.
Relias has a grievance policy in place to facilitate reports of dissatisfaction. Relias will make every effort to resolve each grievance in a mutually satisfactory manner. In order to report a complaint or grievance please contact Relias.
If you require special accommodations to complete this module, please contact Relias Support by completing the web form (https://www.relias.com/help) or by using the chat functionality.
All courses offered by Relias, LLC are developed from a foundation of diversity, inclusiveness, and a multicultural perspective. Knowledge, values and awareness related to cultural competency are infused throughout the course content.
Reference herein to any specific commercial product, process, or service by trade name, trademark, service mark, manufacturer or otherwise does not constitute or imply any endorsement, recommendation, or favoring of, or affiliation with, Relias, LLC.
All characteristics and organizations referenced in the following training are fictional. Any resemblance to any actual organizations or persons living or dead, is purely coincidental.
To earn continuing education credit for this course you must achieve a passing score of 80% on the post-test and complete the course evaluation.
Accommodations
If you require special accommodations to complete this module, please contact Relias Customer Support by calling (800) 381-2321 or emailing [email protected]