Management Of Chronic Arthritis Pain In The Elderly †Free Samples

Question: Discuss about the Management Of Chronic Arthritis Pain In The Elderly. Answer: Introduction The assignment is the annotated bibliography pertaining to the chronic health condition. The aim of the annotated bibliography is to develop the critical analysis and the solution focused skills. The annotated bibliography is based on the critical evaluation of the evidence-based literature. For the purpose of the assignment, a chronic health condition is selected and a clinical practice issue related to chronic care nursing. The assignment deals with the arthritis in the aged-care setting. The issue with the chronic care nursing selected is the pain management. In order to guide the literature review a research question is developed. For annotated bibliography the completed search strategy is detailed. The annotated bibliography consists of summary and critical discussion. The bibliography consists of atleast 5 scholarly sources. It is followed by the synthesis of all the articles reviewed. Chronic health condition A chronic illness is the long term condition that has no complete cure and is associated with several comorbidities. One of the chronic health conditions that will be discussed in the paper is arthritis in the aged care setting. Rheumatoid arthritis, gout and osteoarthritis are the common problem faced by the elderly patients. Arthritis is the chronic disease that attacks women, men and children at any age. It damages the body joints causing intense pain and discomfort. The most commonly affected joints are the Knees, ankles, neck, back, hips, hands, wrists, fingers, ankles and toes (Walker, 2012). This chronic deforming disease and associated pain can render anyone disabled without proper treatment. Patients with this disease live in uncertainty about the unknown consequences in future. Some types of arthritis are difficult to diagnose. The treatment for arthritis usually consists of pain killers, anti-inflammatory disease and anti-rheumatic drugs. Apart from the pharmacological treatment, non-pharmacological treatment includes modification of lifestyle and pain management techniques. Some of the symptoms of the arthritis is so debilitating that the patients lose mobility and joints strength. The patients are thus forced to change the lifestyle to be able to manage the activities of daily living (Jia Jackson, 2016). Issue related to chronic care nursing The common challenge for the nurses caring for arthritis patients is the symptoms management such as pain and flares. On a daily basis in the emergency room it is heartbreaking to see the patents with arthritis. The patients arrive in ER with intense pain or flares. Middle aged men and women are most frequently encountered in the emergency room. Arthritis and ageing are associated with several comorbidities. It includes osteoporosis, cardiovascular disease and malignancies. With the increasing aging population the prevalence of arthritis especially rheumatoid arthritis is estimated to increase (van Onna Boonen, 2016). These factors significantly hamper the management of arthritis. Over the years there is an increasing concern among the nurses failing to handle pain management concerns of the patients with arthritis. On the other hand, the elderly patients too lack the knowledge required to manage the symptoms, which is a challenge for nurses. As per the literature, there is inadequa te treatment of the pain as it tends to be underestimated. In the management of the patient care, the nurses act as mediator between the patients and the physicians. Nurses play a vital role in outpatient pain management. Pain management is centre in health care today given the opioid crisis (Fitzcharles, Lussier Shir, 2010). There is a lack of knowledge on factors acting as barriers for nurses to implement effective pain management strategies. The rationale for the chosen nursing issue is the experience observed from one of the relative suffering from the arthritis and dissatisfied with the pain management strategies. Patients satisfaction with pain control is known to be associated with the key contributions of the nurses. Thus, it is necessary to identify and understand the barriers of the nurses to manage pain symptoms of the arthritis patients. Search strategy: Research question The research question to guide the literature review as a part of the evidence based medicine, which involves developing a question based on the issues identified with the disease or the patient. Using the research question, evidence will be identified. The research question for the annotated bibliography is- What are the educational needs and barriers of the nurses caring for the patients with arthritis (gout, rheumatoid arthritis, and osteoarthritis)? 2. The key topics expressed in the research question are the nursing education needs in caring for arthritis patients. The topic also expressed is the challenges faced/perceived by the nurses in caring for the arthritis patients. 3. Search terms The search terms used for extracting the research papers for annotated bibliography and narrowing the research are- Arthritis care, rheumatoid arthritis care, gout management, osteoarthritis, nursing care, arthritis nursing care, pain management arthritis, nursing educational needs for arthritis, nursing barriers for arthritis treatment, provider barriers in gout management, and patient and provider educational needs in osteoarthritis. For effective research the Boolean operators AND, OR and both were used. Databases used To find the best available literature the electronic databases searched were MEDLINE, Cochrane library, and Google scholar. The Cochrane and MEDLINE database are chosen as it is regularly updated. The hierarchy used for searching is the prospective cohort studies and then moving down to the case reports (Rollyson, 2016). The search was restricted to articles published in English language and between 2015-2018. 5. Database searched with keywords and phrases. A total of 110 articles obtained The articles were scanned for titles, and abstracts to determine the relevancy. It will help eliminate the irrelevant articles. For further elimination the full text articles are scanned to determine the relevancy. 6. The first 20-30 articles were related to dementia, knee arthoplasty, aged care setting and the challenges faced by the nurses in these areas. In addition there were some more papers on the recommendations for the arthritis management and patients barriers in arthritis management. There were a total of 67 articles and not many were relevant. Therefore, the search was refined by modifying the search terms. 7. For researching the databases the search terms used were: rheumatoid arthritis AND provider barriers, osteoarthritis AND nursing barriers, gout AND provider barriers, nurses training needs AND arthritis management, nurses educational needs AND caring arthritis, nurses educational needs AND rheumatoid arthritis OR osteoarthritis. These key terms further helped to narrow down the research. The search generated 33 relevant articles 8. The same databases were again used for extracting the research papers using the modified search terms. The inclusion criteria were research paper published between 2012-2018. The patients must be suffering from arthritis and includes nurses and the patients as the research participants. The study conducted in Australia as well as in other country is considered for broad perspective. The exclusion criteria were review papers, reflection reports and case reports. This further narrowed the search. Using these criterion 12 articles were excluded. The search then generated 21 articles and after scanning through titles, abstracts, and full text 16 articles were excluded. Finally five articles were selected for annotated bibliography considering it to be most appropriate. Annotated The study explored the patient and providers perception of the illness, which is gout. The study used qualitative research paradigm. Upon conducting the semi structured face-to-face interview with the patients and the nurses, it was found that the nurses had lack of knowledge about the nature of gout and its recommended management. The nurses failed to utilise the clinical guidelines for gout. The nurses were found to give only suboptimal information. It was due to lack of training and education of gout related best practice. Another barrier for nurses was lack of incentives to improve treatment and symptoms management. Based on the interview the patients too had misconceptions concerning the nature of gout. However, the findings of the study limit generalisability due to caveats and there is small sample size (Green et al., 2015). The strength of the paper is its implications with improving the standards of care and education needs in this condition. The overall text is well organis ed and the research objective is fulfilled. The cross-sectional survey intended to identify the educational needs of nurses caring for osteoarthritis and rheumatoid arthritis. The nurses respondents were found with less confidence in their skills and knowledge when caring for osteoarthritis patients. The method of investigation was appropriate considering the research objective. The nurses were incompetent in pain medication for the patients, advising patients on exercises and unsure about the symptoms management when caring for the rheumatoid arthritis patient. The study implies for future training that must contain key components like medication and joint protection. The study is based on adequate background research and the arguments are well supported with the relevant sources. The results are well explained with graphical illustrations and text is well organised. The survey however, had limitations like small sample size and the recruitment resembles that the professionals were already acquainted with the nurses. The char acteristics of the non respondents were not known thus, there must be bias in the interpretations of the results (Little Rubin, 2014). The nurses perceiving that they do not have the adequate knowledge and skills may not be related to the actual skills and knowledge. There is a need of objective assessment. The study described the kind of education needed by the nurses caring for patients of rheumatoid arthritis. The author conducted survey and analysed using the thematic and summative content analysis. It was found from the survey that the nurses demanded to strengthen their knowledge in medically reacted care. There was lack of knowledge among nurses about the medicine-based information about rheumatoid arthritis. Lack of continual and update education was perceived as a barrier by the nurses. Rheumatoid arthritis has considerable impact on the patients life and nurses need ever widening areas of knowledge (Walker, 2012). Only then nurses can provide the patients with suboptimal information. The overall study is well organised with supporting literature. The research objective was clearly defined; the methodology and the results were presented in easily understandable format. Owing to the difficulty in performing the summative content, the reliability of the paper may be doubted (Gree n et al., 2015). There are different natures of the expressions provided by the nurses and there may be difference in the exact amount of simplifications. The strength of the paper is the consistency in results with other sources. The study explored the nurses involvement in educating patient with rheumatoid arthritis. According to author, the important part of the nurses role is to provide the patient education in rheumatoid arthritis. Based on the qualitative study the nurses perceived educating the non-adherent patients as challenge. It was easy to educate the patients who were committed to their health. The non-adherent patients have different perception of the disease and acceptance, motivation and autonomy. As per the semi structured interview the nurses would be benefitted with more training on dealing with the non-adherent patients. The interview was not enough to understand the experiences faced by the nurses. As the interview is conducted only in one hospital the transferability is doubted. However, the study is helpful in addressing the research question. The results have an important implication which is strong involvement of nurses in patient education in rheumatoid arthritis. The results are valu able as it implies about nurses training to deal with non-adherent patients. Unlike other studies this study has opened a new ways of seeing a problem from the eye of non-adherent patients. The conclusion thus satisfies my own investigation. The method of investigation was appropriate considering it an exploratory study and it very well addresses the research objective. The study conducted cross-sectional descriptive correlational study to examine factors in gout patient affecting the adherence to urate-lowering therapy. The study results imply for nurses to learn skills to educate patients on mechanism of urate-lowering therapy and help them adhere to medication. It implies for the nurses to take lead in educating the gout suffering patients to help them adhere to the management. The results implies for nurses to learn skills to modify patients beliefs about medication. The study did well contribute to the limited research on gout patients issue with medication errors. The methodology of investigation is well justified as per research objectives. It implies for nurses the need to develop skills to explore the patients opinions and concerns about gout and ULT. Only with the help of proper training of nurses will be able to develop appropriate interventions. The limitations of the study include potential response bias, due to participants misinterpre tations of the questionnaire. Overall the study contributes well to the personal research question. Synthesis Based on the literature review the nurse barriers to care for arthritis patients are lack of knowledge, inability to provide optimal information to the patient on managing gout, rheumatoid or osteoarthritis, lack of skills among nurses in educating the non-adherent patients, insufficient medical information about the arthritis pain management, lack of incentives for nurses to manage the arthritis symptoms and patients confusion about the nature of the arthritis. These barriers also imply the training and educational needs of the nurses. Upon synthesising the relevant data, the educational needs of the nurses caring for the arthritis patients is a matter of serious concern. The training and educational programmes can address the knowledge gaps of the nurses, enhance the communication with clinicians and improve relationship with patients. The results aligns with the study of Edgerton et al. (2017), according to which adequate training and education will bring behaviour change among nu rses that in turn will increase patients adherence to arthritis management. It will also help nurses to engage in effective communication with patients. Having adequate education among nurses on arthritis management will allow nurses to manage the dissonant patient expectations and provide care that is consistent with the clinical practice guidelines. The results are appropriate and are also confirmed by study of Larsson et al. (2010). According to this study the when the nurses educate the patient about drugs; it gave the patients power, autonomy and security. Thus, it can be concluded that nurses must be well trained about the arthritis symptoms management and educated about skills to address the patients concerns. References Chua, X. H. J., Lim, S., Lim, F. P., Lim, Y. N. A., He, H. G., Teng, G. G. (2017). Factors influencing medication adherence in patients with gout: A descriptive correlational study.Journal of clinical nursing. DOI:10.1111/jocn.13918 Egerton, T., Diamond, L. E., Buchbinder, R., Bennell, K. L., Slade, S. C. (2017). A systematic review and evidence synthesis of qualitative studies to identify primary care clinicians' barriers and enablers to the management of osteoarthritis.Osteoarthritis and cartilage,25(5), 625-638. DOI:https://doi.org/10.1016/j.joca.2016.12.002 Fall, E., Chakroun, N., Dalle, N., Izaute, M. (2013). Is patient education helpful in providing care for patients with rheumatoid arthritis? A qualitative study involving French nurses.Nursing health sciences,15(3), 346-352. DOI:10.1111/nhs.12042 Fitzcharles, M. A., Lussier, D., Shir, Y. (2010). Management of chronic arthritis pain in the elderly.Drugs aging,27(6), 471-490. DOI: https://doi.org/10.2165/11536530-000000000-00000 Green, C. A., Duan, N., Gibbons, R. D., Hoagwood, K. E., Palinkas, L. A., Wisdom, J. P. (2015). Approaches to mixed methods dissemination and implementation research: methods, strengths, caveats, and opportunities.Administration and Policy in Mental Health and Mental Health Services Research,42(5), 508-523. DOI: https://doi.org/10.1007/s10488-014-0552-6 Jia, X., Jackson, T. (2016). Pain beliefs and problems in functioning among people with arthritis: a meta-analytic review.Journal of behavioral medicine,39(5), 735-756. DOI: 10.1007/s10865-016-9777-z Larsson, I., Arvidsson, S., Bergman, S., Arvidsson, B. (2010). Patients' perceptions of drug information given by a rheumatology nurse: a phenomenographic study.Musculoskeletal care,8(1), 36-45. DOI:10.1002/msc.16 Lillie, K., Ryan, S., Adams, J. (2013). The Educational Needs of Nurses and Allied Healthcare Professionals Caring for People with Arthritis: Results from a Cross?Sectional Survey.Musculoskeletal care,11(2), 93-98. DOI:10.1002/msc.1035 Little, R. J., Rubin, D. B. 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Patient and provider barriers to effective management of gout in general practice: a qualitative study.Annals of the rheumatic diseases,71(9), 1490-1495. DOI: https://dx.doi.org/10.1136/annrheumdis-2011-200801 Van Onna, M., Boonen, A. (2016). The challenging interplay between rheumatoid arthritis, ageing and comorbidities.BMC musculoskeletal disorders,17(1), 184.DOI: https://doi.org/10.1186/s12891-016-1038-3 Walker, J. (2012). Rheumatoid arthritis: role of the nurse and multidisciplinary team.British journal of nursing,21(6), 334-339. DOI: https://doi.org/10.12968/bjon.2012.21.6.334