The article by Dawn and Ginny examines under-treatment of pain among patients at advanced age, above 70 years. Although pain relief must be available for all patients, this group continues to experience the highest level of under-treatment. The authors note that there are three main factors that often result in pain under-treatment in older patients. They include fallacies concerning aging, challenges in accessing treatment, and admission of pain related stigma.
The authors emphasize that regardless of the complexities, older patients have the right to access effective management of pain. Nurses who have neglected the same have faced serious legal issues in the past. This task demands that nurses must be equipped with knowledge, as well as skills for assessment and management of pain. Multimodal approaches that employ non-pharmacological methods besides medications are of the essence in older patients’ treatment. Inclusion of advocacy preparation in nursing course produces empowered professionals who understand their duty of principal decision-maker in management of pain. Otherwise, poor pain medicine capability might result in frustration among nurses and lead to improper treatment of pain for older patients.
The authors’ study showed that for effective management of pain in older adults, application of the three beneficence principles in necessary. First, the principles dictate that nurses should prevent pain by anticipating conditions or treatments that generate pain. Second, they also remove the pain by employing effecting multimodal approaches to pain management. Third, nurses should advocate pain relief since this is their ethical responsibility.
Implementation of these recommendations can limit pain under-treatment among older adults. Improvement of nursing practice is necessary. It can be carried out through evaluation of existing policies on pain management and instituting problem-solving strategies. Availing opportunities for pain management training on a regular basis to empower nurses is also essential. Similarly, conducting patient education on how to assess and manage pain should be executed. Implementation of policy-level changes such as an increase in funds to enable pain management in older patients should also be executed. Although pain medicine is the primary role of nurses, solid administrative support is crucial in helping these professionals achieve their objectives.
Nurses and physicians providing end-of-life care often meet patients whose wishes are characterized by ambivalence. On one hand, such patients express a wish to end their life while on the other ask for execution of every possible curative measure. Such opposing statements do result in confusion or annoyance among healthcare providers in several occasions. The article examines ambivalence in two case studies on end-of-life patients; Anna and Carola aged 80 and 75 years respectively.
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Anna was diagnosed with tumor of the abdomen. She rejected advance diagnostics, as well as operation to hasten her death. Conversely, she desired to regain the capacity to resume her normal life. Her conflicting statements caused confusion among caregivers with some insisting that she wants to die and others perceiving impressive ambivalence. Despite experiencing logical contradiction, she did not demonstrate conflict.
Carola, who was diagnosed with a brain tumor, also preferred no extra diagnostics and treatment. Instead, she wanted to die and stop being a burden to other people. Contrariwise, she believed in the divinity of death and would not change its natural pace. However, she was greatly disturbed with becoming a burden to those around her. Helping Carola perceive her new social status in a different way might be necessary for stabilizing her condition.
The authors put forth three crucial arguments concerning ambivalence among end-of-life patients. First, caregivers ought to acknowledge co-occurrence of contrasting wishes that characterize genuine, multifaceted feelings and obtain ethical understandings of patients with terminal ailments. Second, healthcare providers have to comprehend that conflicting demands depict tensions of end-of-life patients that call for support. Third, healthcare providers need to be cautious to avoid negative labeling on patients’ statements that appear inconsistent. The evident limitation of this article concerns the small number of samples of end-of-life patients used as examples. Since only two cases are discussed, making generalizations in cases of ambivalence becomes untenable.