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Clinical Practice Guidelines for Chronic Pain

Written by kimmel52 on January 8, 2013 – 9:55 pm

Relax, there is a study guide to help you

Relax, there is a study guide to help you

Clinical practice guidelines for chronic Pain
nancy kimmel
October 18, 2014

Clinical practice guidelines for chronic Pain
The purpose of this paper is to identify the current clinical nursing guidelines regarding the treatment of chronic pain and its financial impact on the healthcare system, community, patients and their families. Additionally, this paper will explore the expectations of the BSN in the implementation and documentation of evidenced based practice.
Nursing management of chronic pain
Pain is a symptom that frequently goes unreported and unrecognized in patient care settings. Pain also has negative effects on the patient and their families.(Stenner, Carey, & Courtenay, 2012, p. 3335) “It’s disheartening for frontline nurses and other providers to feel they are not meeting their patients’ needs,” LaFevers said. “Not everyone can go to a pain specialist.”(“Better management needed,” 2014, para. 37)
Chronic pain and its significance in nursing practice
Chronic pain is an individual experience. Nurses face many challenges in helping those who suffer from chronic pain.(Dysvik & Furnes, 2012, p. 187) Pain is the main reason that patients seek healthcare.(Gretarsdottir & Gunnarsdottir, 2011, p. 16) Research shows that over 50% of these patients have suffered pain within 24 hours of seeking medical help.(Gretarsdottir & Gunnarsdottir, 2011, p. 16) An individual nurse may be able to help relieve the patient’s pain during their shift, whereas the next nurse on duty may not be able to provide the needed relief. Nurses working collectively as a team can better manage the effects of chronic pain in patients than a nurse acting alone. The management of pain as a group effort requires nurses’ to have a thorough knowledge of pain theory and the use of the behavioral and cognitive approach.(Dysvik & Furnes, 2012, p. 187)
The expectation of the BSN in chronic pain management
Belonging to a supportive team with clear roles helps in the complex management of chronic pain.(Dysvik & Furnes, 2012, p. 189) The BSN nurse typically assumes the leadership role.(Video Laureate Education, Inc., 2009) The group leader in the management of chronic pain is multifaceted.(Dysvik & Furnes, 2012, p. 189) The BSN must utilize the current research on the management of chronic pain and present this to the group. It is the moral and ethical duty of the BSN to utilize evidenced based practice.(Video Laureate Education, Inc., 2009) They are also the catalyst of change for their group.
Clinical practice guidelines in the management of chronic pain
According to the National Guideline Clearing House, chronic pain management should begin with assessment of the pain, the duration, intensity, description in the patient’s own words, location, onset, quality and duration.(Institute for clinical systems improvement [], 2013) The nurse should also take into consideration the psycho-social factors the chronic pain may influence, such as depression and drug abuse.(ICSI, 2013) The treatment of chronic pain is a mulifactorial group approach led by the physician and nurse leader.(ICSI, 2013) Treatment should be addressed in levels with medications not being the sole focus.(ICSI, 2013) Comprehensive patient assessment algorithms for chronic pain begin with addressing the psycho-social factors. These factors include the patient’s reaction to their pain, their scioeconic status, their support or lack of support system, family history of pain therapies and their cultural and ethnic beliefs on the management of pain. The nurses understanding of the biopsychosocial model helps with the implementation of a pain treatment protocol that will benefit the patient’s long term goals.(ICSI, 2013)
The impact of chronic pain on the patient and the community
The under treatment of pain is a global problem.(Gretarsdottir & Gunnarsdottir, 2011, p. 16) Unresolved treatment of pain can have negative impact on the quality of life, economic productivity and healthcare utilization.(Gretarsdottir & Gunnarsdottir, 2011, p. 16) In 2011 at least 100 million American adults have common chronic pain conditions.(“Relieving pain in America,” 2014, para. 12) Pain is a significant public health problem that costs society at least $560- $635 billion annually,( an amount equal to about $2000 dollars for everyone living in the U.S.).(“Relieving pain in America,” 2014, para. 12)
The cost of pain to the healthcare system
In 2008 the cost of pain to the federal and state government for medical expenditures was $99 billion dollars.(“Relieving pain in America,” 2014, para. 13) Analysis from the CDC showed that nearly half a million emergency department visits in 2009 were from people abusing or misusing prescription pain killers.(“Relieving pain in America,” 2014, para. 13)

Dysvik, E., & Furnes, B. (2012). Nursing leadership in a chronic pain management group approach [Chronic pain management group approach]. Journal of nursing management, 187-195.
Facts on pain. (2014). Retrieved from
Gretarsdottir, S., & Gunnarsdottir, E. (2011). Systematic review aimed at nurses to improve pain management [Magazine]. Nordic journal of nursing research and clinical studies, 31(4), 16-21. Retrieved from
Institute for clinical systems improvement. (2013). Assessment and management of chronic pain. Retrieved from
Stenner, K., Carey, N., & Courtenay, M. ( 2012, February 9th). Prescribing for pain – how do nurses contribute? A national questionnaire survey [Prescribing for pain]. Journal of Clinical Nursing, 21(23/24), 3335-3345.
The state of pain-better management needed. (2014). Retrieved from
Video Laureate Education, Inc. (2009, ). Research and scholarship for evidence-based practice: Introduction to evidence-based practice and research [Video file]. Retrieved from

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Evidenced Based Practice as a Change Agent

Written by kimmel52 on January 8, 2012 – 10:03 pm


Evidenced based practice as a change agent
nancy kimmel
November 4, 2014

Evidenced based practice as a change agent
Researching as a Team
Change begins with acknowledging a common problem and having the curiosity to research that problem in hopes of finding documented solutions(Schmidt & Brown, 2012). The BSN nurse is trained to be the agent of change(Video Laureate Education, Inc., 2009). The change agent should encourage nursing staff to participate in research regarding the problem at hand. This helps with building the teamwork ethic among staff. Assessing the literature requires a keen eye for gaps. Gaps, are what is known about a problem or if that problem has not been thoroughly tested(Schmidt & Brown, 2012, p. 69). Gaps also occur when there is only one or two case studies regarding a problem, insufficient information or lack of proven results(Schmidt & Brown, 2012, p. 69). For instance, a single study that only incorporates 50 test subjects, regardless of the strength of the statistical results is not sufficient evidence for evidenced based practice to be implemented. On the other hand, 20 or more similar case studies with strong statistical evidence to support the research question, would allow one to generalize the findings to a wider population(Schmidt & Brown, 2012, p. 69).
Practical Transition
Finding a solution to a problem as a group is a euphoric experience. However, taking that solution and putting into practice is a different matter. There are many pitfalls to the implementation of any new ideas or practice theories. Suppose the change that will take place requires a special device. This device costs money. The question is, will the hospital provide the financing for such equipment or supplies? All new protocol must be documented on the floors policy and procedure manual which utilization review must first approve. Hence, the red tape.
The Iowa Model for EBP (Evidenced Based Practice) is a systematic method for organizational change(Schmidt & Brown, 2012, p. 390) The Iowa Model diagrams the necessary steps to incorporate EBP in promoting better health care(Schmidt & Brown, 2012). The model provides a series of logical steps that assist the change agent in the decision making process.
Common Errors and Pitfalls
Not everyone is on the same page. The change agent should be sensitive to the fact that some nurses have no desire to engage in research, nor implement new care skills(Schmidt & Brown, 2012). Complex statistical evaluation and knowledge diffusion poses barriers to most practical nurses(Schmidt & Brown, 2012, p. 396). Change is a process that creates an alteration in a person or the environment(Schmidt & Brown, 2012, p. 397). While there is no exact answer how to implement change, theorists have suggested that preparation should be the first step(Schmidt & Brown, 2012). Beginning a journal club helps to engage others and encourages participation(Schmidt & Brown, 2012). The disciplined clinical inquiry model is helpful in structuring the journal club, by empowering nurses in clinical practice to consider the patient, clinical setting and resources(Schmidt & Brown, 2012, p. 399). Kotter’s eight change phases model is simple in design and begins with establishing a sense of urgency(Schmidt & Brown, 2012, p. 407).
While there is no one model fits all, the change agent should be aware of the important role they play in advocating change. Finding solutions to promoting better health care and positive patient outcomes is a responsibility of every nurse. Some nurses find that this is too much of a burden to bear in the context of their daily routines. Therefore the change agent needs to help with facilitating the process through preparation, empowerment of their staff nurses, encouragement and communication. Identification in the gaps of patient care is a team effort and all teams need a leader.

Huston, C. J. (2014). Collective Bargaining and the Professional Nurse. In Profesional issues in nursing challenges & opportunities (3rd ed., pp. 19-23. Baltimore, MD: Lippincott Williams & Wilkins, a Wolters Kluwer business.
Schmidt, N. A., & Brown, J. M. (2012). Evidence-based practice for Nurses appraisal and application of research (2nd ed.). Sudbury, MA: Jones & Bartlett Learning .
Video Laureate Education, Inc. (2009, ). Research and scholarship for evidence-based practice: Introduction to evidence-based practice and research [Video file]. Retrieved from

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Nursing Entrance Test, Reading Comprehension Passage

Written by kimmel52 on December 9, 2009 – 8:12 pm

The following is an example of a reading comprehension passage that you would find on THE NURSING ENTRANCE TEST OR THE N.E.T.. The student who is sitting for the NURSING ENTRANCE TEST needs to remember that they must not bring any previous knowledge into answering the questions. The passage will be on a computer screen and the student must scroll through out the passage until finally arriving at the questions. Time yourself on the passage below.

Childhood behavioral disorders such as ADD and ADHD have been are on the rise. It is important for parents to realize that children are not fully developed with respect to their bone growth and metabolism as adults. Just as an expectant mother’s deficiency in folic acid can lead to defects in the newborns neural tube, so can metal ions and complex organic compounds cause damage to a child’s bones, liver, kidneys and neurotransmitters. Why should we as parents, educators and doctors treat the symptoms of the above mentioned disorders with more chemicals in the form of pills? It is interesting to look at what are some of the chemicals that go into foods that we consume regularly. Below is a list of some of the food additives taken from Casarett and Doull’s Toxicology, The Basic Science of Poisons, 4th Ed.,McGraw Hill copyright, 1991. Page 823. Read more »

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Studying for the N.E.T. will help you become a Nurse Medical Expert

Written by kimmel52 on September 12, 2009 – 12:31 pm

Nurse Medical Experts
So you are thinking about your career or next career as a nurse. Your first hurtle is to pass the Nursing Entrance Test, the HESI or the TEAS TEST. The next step is nursing school. What then? Well, there are many avenues that nurses can take other than hospital or long term care nursing. There is the field of professional nurse medical expert.
The primary role of the nurse medical expert is to offer up their opinion to the jury in a fair and balanced manner. Nurses with specialty experience and training are more often called in as medical experts in many cases.  This is a upcoming field in the realm known as forensic nursing.  Forensic nursing is a relatively new medical practice that combines elements of law enforcement with health care. Forensic nurses may treat victims of violent crime, perform crime scene investigations or work as detectives in a clinical setting to help police catch and convict perpetrators. One of the most important duties in forensic nursing is assisting in the physical and emotional recovery of patients while protecting their rights.  The wealth and breadth of nursing experience in their field of specialty is widely accepted as testimony. Nurses are used in hotly contested legal proceedings, both sides have bias and both want to win. The goal of the nurse medical expert is to showcase his or her knowledge in an impartial way. However, this is difficult in some cases, especially since each side often hires its own medical expert, and the medical expert is collecting his paycheck from the attorney, who has a clear and strong bias. Read more »

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Nursing Entrance Test Online Practice

Written by kimmel52 on January 24, 2009 – 5:44 pm

Online practice for the HESI, the TEAS, and the N.E.T.

Online practice for the HESI, the TEAS, and the N.E.T.

Taking the nursing entrance test can be very stressful.  Preparation is key to successfully passing the N.E.T..  Students can now get all of the practice that they will need to pass the NET.  with a new online tutorial that simulates the computerized version of the Nursing Entrance Test.  Whether the student is preparing for the H.E.S.I., the TEAS, or the NET, they will find up to date similar tests at the Nurses Learning Center.

It is becoming increasingly difficult for students preparing for the nursing entrance test to find adequate preparatory materials that will give them the edge that they need to pass with qualifying scores.  Just passing the nursing entrance test is no longer enough to get into nursing school.  Now students are required to pass with a high score to be able to compete with the throngs of others taking the N.E.T.  How are student’s able to to this, if there is not sufficient preparatory material specifically tailored to the many tests currently required by nursing schools?  Look no farther.  At the Nurses Learning Center, the student will find that they have all of the preparation that they need to be able to pass with high scores and increase their chances of being first on the list for nursing school.

At the Nurses Learning Center the student will have access to tests such as Anatomy and Physiology, Biology, Chemistry, English Grammar, Math and Reading Comprehension. They will have access to all of the tests and answers without ever having to worry that their access will be denied after a set number of hours or days, like many of the actual test centers require.

The Nurses Learning Center provides the student with unlimited access to all of the tests for as long as the student needs, without a cut off date. The fee for accessing the tests is nominal and the student will get new questions added on a daily basis.

Students are able to take tests of their choice, and they can decide whether to take a timed exam or an un-timed exam. It is proven that test preparation that is similar to the actual test increases students scores. Not only will the student increase their scores, but they will have the most accurate testing information that is as close to the actual test material allowed.

There are over one thousand questions and answers on all of the topics. The student can feel assured that they have the correct answer because all of the answers are completely explained so that the student can follow the reasoning and formulas. The student can keep track of their scores to see how they are improving and thus build their confidence and skill level. This is the very first tutorial of its kind that gives the student unlimited access and full control of how they choose to study.

The program helps to increase the students critical thinking skills. The questions include much of the nursing process which the student will study in their first semester of nursing. This is why the program is superior to many other paper study guides. Just using guides that prepare students for graduate school will not help the student pass the Nursing Entrance Test. The student needs to study material that reflects applicable knowledge to their career in nursing. The student will see from the questions in the online nursing entrance test that the questions are far from random, but actually are based on concepts covered in the students first year of nursing school.

Students that are older learners can feel confident when taking the online tests that they will have sufficient and complete explanations to all of their questions so that they can improve their skills to a level that will build confidence. Many people are choosing nursing as a career today. With so many going into nursing, schools are now raising the bar for those taking the nursing entrance test
The nurses learning center will help students gain that extra edge and points needed to score into nursing school.

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