Clinical contexts for pain management in nursing

摘要

It has long been my belief that students of palliative care nursing need to develop a three-layered approach to their learning around clinical decision making that clearly embraces the art and science of the discipline. Not dissimilar to Cicely Saunders' concept of 'total pain', where one needs to address the physical dimensions of suffering to open the portal to the in-depth work that may be necessary to meet psychosocial and spiritual needs, students need to develop critical thinking skills (the bane of every scholar) in order to understand how to use judgement in terms of assessment planning and evaluation of care. However, perhaps most important of all for palliative care is the ability to do that with wisdom. Approaching patients' needs with wisdom, knowing when and where to intervene, understanding the benefit of a proactive rather than reactive response to symptom management, and listening to the patient and family report their perspectives of the impact of symptom burden on their lives all demonstrate the wisdom that is needed to underpin robust clinical decision making.