RESUMO
The growing number of patients admitted to acute care settings with the dual problem of pain and chemical dependency is bringing this major dilemma to the forefront of clinical nursing practice. Orthopaedics is one of the clinical areas likely to encounter an increased proportion of such patients. The care of chemically dependent patients with pain is not only often enormously challenging but also potentially frustrating. Planning care for these patients is best accomplished with a team approach that includes the expertise of several specialties, particularly pain and addiction. Although considerably more research is needed to identify the most effective approaches to the care of chemically dependent patients with pain, sufficient information now exists to support suggestions for guidelines. This article addresses definitions of pain and chemical dependency, methods of identifying the chemically dependent patient, the prevalence of pain and addiction, clinical conflicts and dilemmas related to relieving pain in addicted patients, a framework for planning care, and specific guidelines for individualizing the plan of care. Orthopaedic nurses are challenged to accept a leadership role in improving the care of chemically dependent patients with pain by evaluating these guidelines and developing additional approaches.
Assuntos
Avaliação em Enfermagem/métodos , Dor/enfermagem , Planejamento de Assistência ao Paciente , Transtornos Relacionados ao Uso de Substâncias/enfermagem , Educação Continuada em Enfermagem , Humanos , Dor/complicações , Transtornos Relacionados ao Uso de Substâncias/complicaçõesRESUMO
Current knowledge about the use of options for the management of patient pain opposes conventional practice, which is guided by misunderstandings and personal attitudes and beliefs. An understanding of substance abuse and the behavior and needs of the person with substance dependence are important elements in a nurse's knowledge base. This understanding allows him/her to safely and effectively manage pain in all patients. Effective pain management education needs to be comprehensive and should include not only updated information, but also explore origins of beliefs about pain and substance abuse and how these beliefs affect current practice. This article discusses the common myths that often guide nurses' management of patient pain and offers strategies for care that are based on current understandings.