PAIN MANAGEMENT FOR THE DYING.   Term Paper ID:26833 Click to get this paper

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Paper Abstract: Nursing perspective on providing pain relief & dignity to terminally ill. Paper Introduction: For many people, dying is the most frightening thing that they can imagine. This is true even for many people who are deeply religious and who believe that they will find beyond this life another and better one, which is something of a puzzle, because eternal joy and salvation should be recompense of a very high order for leaving behind the toils of the world along with its familiar pleasures. So why are people afraid to die? For some it is the fear that all humans feel in some measure for the unknown. For others, it is the knowledge that there is nothing beyond death but nothingness. But for many it is not the fear of death itself but the fear of dying, the fear of unrelieved pain and suffering. This paper looks at this last issue, at pain management for the terminally ill, as a subject that has been receiving increasing amoun Text of the Paper: The entire text of the paper is shown below. However, the text is somewhat scrambled. We want to give you as much information as we possibly can about our papers and essays, but we cannot give them away for free. In the text below you will find that while disordered, many of the phrases are essentially intact. From this text you will be able to get a solid sense of the writing style, the concepts addressed, and the sources used in the research paper. Such assurance will continue inno small way to come, as it does now, from nurses who can serve asknowledgeable, compassionate, informed mediators between physicians trainedto cure and patients wishing to make their last moments a part of livingrather than of dying. Concern for the relief of pain is called "palliative care" and refersto "the relief of pain and other troubling symptoms by appropriatecoordination of all elements of care needed to achieve relief fromdistress" (McDonnell, 1986, p. So why are people afraid to die? (1986). 34). One of the issues important in addressing the treatment of pain in thedying seems almost absurd from the outside but is in fact a serious one:Often doctors have worried about giving the most effective pain relieversto patients because of possible toxicity, possible side effects or - andthis is the absurd part - possible addiction. Pain management in the terminally ill. and Henschell, T. 36). At home with terminal illness: A family guidebook to hospice in the home. ReferencesAppleton, M. Changing roles, emotional reactions to death, and altered concepts and hopes about the future must be dealt with in a human fashion involving shared insights (in DeBellis, 1992, p. Pain management psychotherapy: A practical guide. (eds.) (1992). Anti-anxiety drugs are very useful for treating the dying, Dantonotes, for palliative care should include not just treatment of acute painbut also for the emotional and psychological distress that accompany theknowledge that one is dying. Quality hospice care: Administration, organization, and models. For while part of what the dying person may want iscessation of pain, that person may also want a few last months or weeks ordays or hours to come to terms with issues that they wish to resolve. 121). Nurses should not worry that such self-administered drugs reduce their own importance in patient care,acknowledging instead that such devices simply leave them more time toperform tasks that they alone are capable of doing (Ray, 1997, p. This is another area of treatment of pain for the terminally ill thatinvolves nurses directly and deeply because it is in many cases the nursewho makes treatment humane and personalized. (1994). Ideas about dying withdignity and the importance of hospice care have become part of mainstreammedicine and mainstream society and most doctors and most patients nowbelieve that for the dying of any age heroic intervention (especiallyagainst the wishes of the patient) may not be heroic at all, but simplyshows of egotism on the part of the doctors. 3 4) describes this aspect of practicing medicine: Very early in his career the physician learns to accept limitations with respect to his capacity to prolong any human life in light of certain diseases. New York: Bantam.Saunders, C. The relief of the dying, as Danto and others note, extends beyond whatis generally considered to be simple pain relief even in terms ofpharmacological agents (and setting aside such palliatives as the counselof clergy and therapists, the chance for hospice patients to die infamiliar surroundings with their family and pets nearby, etc.) (Turk andFeldman, 1992, chapter one). Certainly this is not the goal of the ethicalmedical professional, but such professionals do often find themselves inthe position of trying to find the right balance between alleviating painand prolonging life. Again, while the issue addiction is of concern to both the patient andthe doctor as well as the nurse, it may be of especial concern to the nursewho may find herself (or himself) psychologically caught between a doctorconcerned with addiction and a patient who is concerned about quality oflife issues. Health professionals have become increasingly open to new methods ofmanaging pain, including radiotherapy, non-narcotic analgesics, high-dosecorticosteroids, modified chemotherapeutic regimens and hormonemanipulations (Saunders and Baines, 1983, p. 38). The best course for the nurse in such a situation is to familiarizeherself with the literature on addiction in the terminally ill (which is infact not a serious problem) so that she or he may discuss the issueknowledgeably with the physician as well as to become as conversant aspossible with other methods of pain relief so that she or he can suggestthese to the patient (Appleton and Henschell, 1994, p. and Feldman, C. Living with dying: The management of terminal disease. However, we can hope that doctors will havethe ability - and the will - to reduce our pain. For many people, dying is the most frightening thing that they canimagine. This paper looks at this last issue, at painmanagement for the terminally ill, as a subject that has been receivingincreasing amounts of attention in the past decade. Palliative care is seen by medical andethical experts as the appropriate response when a cure is no longerpossible and should be designed "so that the patient can live and relate toothers as normally as possible [and] should neither hasten nor postponedeath" (McDonnell, 1986, p. The dying person may sense of special purpose about his life during those remaining days and psychopharmacologic agents may enhance his chances for more enriched living (1992, p. Thetime to resolve important issues may be as important or more important to aparticular patient as relief of pain, as Danto (in DeBellis etal) notes: The author has found that although medical science can extend life during the terminal phase by only a small period, six more months to the terminal person may offer time for a certain kind of fulfillment. Medical care of the dying patient. This is not tosay, of course, that the nurse must simply agree to all of the patient'sdemands, for her (or his) role as the primary caretaker may in fact giveher a better sense of the patient's level of pain than the doctor has. New York: Prentice Hall.DeBellis, R. and Freeman, A. This paper examines the importance of providing appropriate painrelief to the dying person from a nursing perspective, focusing on thedifferent ways that nurses can help people not only die with dignity butalso how to provide the quality of life that all people deserve, regardlessof how much time that they may have remaining. This is one of the ways inwhich nurses can prove themselves invaluable in the care of the terminallyill (Eimer and Freeman, 1998, p. Owings Mills, MD: National Health Publishing.Ray, M.C. There is a thin line between providing sufficient pain relief andtruncating life, and this has been another issue of ethical concern forthose who fear that the dying will simply be written off and drugged into aquick and oblivious death. What makes it possible for him to preserve his own image and sense of worth is the fact that if, despite all his best efforts, he cannot win over disease, at least he can assist in achieving the most effective state of comfort possible for the patient. Improvements in medicine over the last generation as well as changesin ideas about the effectiveness of certain kinds of treatments as well asthe nature of the dying person have lead to some changes in the kinds ofpain relief that are offered to dying patients. Danto summarizes this point: Dehumanization can occur if the doctor or his assistant staff feel that [dying people] are organisms whose limbic systems must be quieted by the administration of some psychopharmacologic agent. (1983). But for manyit is not the fear of death itself but the fear of dying, the fear ofunrelieved pain and suffering. Oxford: Oxford University.Turk, D. New York: Arno Times.Eimer, B. Self-pumps that allow patients toadminister small but continual does of pain relief to themselves not onlyreduce anxiety by making patients feel more in control of their own carebut do not lead to addiction (although, as had been previously noted, theentire idea of avoiding addiction in the terminally ill is probably notworth considering as problematic) Such methods of administering pain-relieving drugs have in fact been found to produce lower overall use ofdrugs like morphine, since injections given by health professionals onlyevery few hours tend to be larger than needed to avoid the necessity of thehealth professionals' having to return before the next scheduled round(Saunders and Baines, 1983, p. and Baines, M. It has become increasinglyacceptable that to acknowledge that the most important service thatmedicine can offer to some patients (and especially those who areterminally ill) is the relief of pain. Such medications should be given in some casesand do not diminish the humanity of the patient but in fact underscore thathumanity. This is true even for many people who are deeply religious and whobelieve that they will find beyond this life another and better one, whichis something of a puzzle, because eternal joy and salvation should berecompense of a very high order for leaving behind the toils of the worldalong with its familiar pleasures. It is indeed surprising that physicians should be so concerned aboutgoing too far in relieving pain, for the relief of pain is one of thepractices that makes medicine so important in a society. This situation of being caught between the potentiallyconflicting concerns of patients and doctors may be exacerbated by the factthat patients are inclined to look to nurses as having the same authorityto dispense medication as doctors. 17). 12). 34). None of us expects physicians to be able tocountermand these realities. For some it is the fear that allhumans feel in some measure for the unknown. All of us knowthat human bodies are fallible, that we will each at some point become sickand that we shall each die. 19) as well as other drugslike antispasmodics that are not strictly analgesics but certainly make thedying person more comfortable (Saunders and Baines, 1982, p. (1997). etal (1992). For others, it is theknowledge that there is nothing beyond death but nothingness. 3 5). 87. The issue of palliative care is especiallyimportant to the nurse because she (or he) is the health-care professionalproviding the most hands-on care, and will therefore in many cases be theone that the patient will turn to for information about what palliativemeasures are possible (Ray, 1997, p. 311). The relief of pain will continue to be of primary concern to thedying, but it may be that in the next generation people will beincreasingly assured that they will have the chance not only to die withdignity, but in relative physical comfort. Danto (in DeBellis etal,1992, p. New York: Haworth Press. The nurse knows his or herpatient - their name, their families, their final concerns - and can andindeed must use this knowledge to create a context in which medical care isdelivered in a personalized, respectful way. New York: John Wiley and Sons.McDonell, A. Certainly, the mainstay ofpain relief for many dying patients remains morphine or other narcoticanalgesics; their potency in a purely chemical (or alternately purelyneurological) definition has not yet been surpassed, although new methodsof administering old drugs like morphine have certainly improved thequality of pain relief for the dying. I'm here to help: A guide for caregivers, hospice workers and volunteers. While it does seem absurd fora doctor to withhold morphine from a cancer patient who has a few weeks tolive on the grounds that the person might become addicted, such instancesdo occur, and it has been one of the foci of the hospice movement to removesuch doubts from the minds of physicians (Danto in DeBellis etal, 1992, p.3 5). (1998). If this paper is not what you are looking for, you can search again: Search for: or Click here to request an essay written just for you.