Nurse's role in controlling cancer pain.

摘要

Nurses spend more time with patients than any other member of the healthcare team. They play a critical, active and very important part in controlling cancer patients' pain and alleviating suffering. In controlling cancer pain the nurse needs to understand the psychological state of the cancer patient, cancer pain, cancer pain treatment, deleterious effects of unrelieved cancer pain and patient's socio cultural background. She needs to understand that there are two types of pain, nociceptive and neuropathic pains and that 80% of the cancer patients in pain could have 2 or more than 4 different pains at the same time. Nurses' role in controlling cancer pain include believing the patient, assessing pain, identifying the root of the problem, planning the care, administering medication, evaluating effectiveness, ensuring good pain control and individualizing treatment. It also includes nursing interventions such as giving tender nursing care, preventing pain, educating, advocating, communicating, comforting, supporting, and counseling the patient. The nurse must use both pharmacological and non pharmacological treatments to individualize treatment, know all the drugs that are used for the treatment of Cancer Pain, how these drugs relieve pain and what their side effects are. She must use the WHO guidelines to treat pain and must choose the right drug, right dose, given at the right times, with the right intervals and to the right patient. She must evaluate effectiveness of treatment, give PRN doses for breakthrough pain and recommend for specific changes. The role of the nurse is to anticipate the patient's pain needs, advocate for the patient for what feels appropriate for him within his cultural context and incorporate the patient's belief. The nurse can physically relieve pain by promoting comfort, support painful area, gentleness in handling the patient and use nursing treatments. The nurse can recommend physiotherapy, (TENS)/Acupuncture, Occupational therapy, spiritual support, social worker, psychologist, and psychiatrist to address different types of pain. She must relieve both pain and other symptoms. and ensure that the patient has good sleep. She must show kindness, compassion and empathize with him. Each patient is unique the process of controlling cancer pain develops differently each time. The nurse's role is challenging, she must demonstrate that she is not only clinically proficient but culturally competent. She has to use creative assessment skills, clinical judgment, psychological support, advocacy and good communication skills in such a way that the contribution of drugs, nursing care, nursing and other non pharmacological treatments are maximized to the patient's benefit. When evaluating the overall care the nurse must find out what is the total effect of all approaches taken to relieve pain. Nurses can make a difference between a patient who suffers until the last breath of his/her life and a patient who is comfortable and dies pain free and in dignity.