Pain assessment and Richmond Agitation – Sedation Scale (RASS)

Pain assessment and Richmond Agitation – Sedation Scale (RASS)

Unformatted Attachment Preview

APA FORMAT and STRONG ACADEMIC WRITING PREFFRED (Total pages Limited to 4 pages excluding Cover page and reference) Pain assessment RASS documentation (Running head) Pain assessment and Richmond Agitation – Sedation Scale (RASS) documentation on patients using patient Controlled Analgesia (PCA).( title of project) Goal Pain is the most common symptom experienced by patients with cancer. Mostly seen in patients followed by stem cell transplant patients using High dose chemotherapy. Untreated or undertreated pain impairs physical and psychological health, functional status, and quality of life. The purpose of this project is to identify the personal pain goal (PPG), Promote optimal pain management through assessment, control pain by using Patient Controlled Analgesics (PCA), and improve RAAS documentation by staff education. The expected outcome of the project is to increase patient safety, increase staff knowledge and compliance on pain assessment and RASS documentation on patients using PCA. Improve patient satisfaction and HCHAP score, and maintain compliance with the JCAHO standards. Aim: Increase staff compliance on pain assessment and RASS documentation by 90% on patients using PCA, in stem cell unit SW POD by December 2017. Methodology (Develop following findings) 1 Why: Noncompliance on RASS documentation on patients on PCA. What: Pain assessment and RASS (Richmond Agitation Sedation Scale) documentation. Where: Stem Cell Transplant Unit G-18 SW pod. When: project is done in a 6 month period, will be completed by December 2017.( Project 1 and 2 together.) Who: Clinical nurses. (Nurses who care for patients with pain, using PCA) Costs: ? And how: Random chart audit is done. Total 34 charts audited in almost two-month period for Different patients using PCA. Most of the nurses working in day and night shift were audited. Total no. of nurse audited 34. Out of 34 nurses, 25 nurses did not document RASS, Please make a chart. 2 Applicable change theory or other nursing or quality theory (at least one). (These are the two-theory provided by the school) 3. Role of the CNL in the project. Is it appropriate for the CNL and what CNL roles fit in the project? 4. Literature review, very brief, from attached 8 references (previous literature review ATTACHED) 5.The student’s anticipated outcome(s) – 25% 6. Pain assessment and Richmond Agitation – Sedation Scale (RASS)

The Capstone Committee members – 5% Capstone committee members 1. Dr. Patricia Davis DNP, RN-BC, MS, NEA-BC, CNL. (Major Professor) 2. Joylynmae Estrella MSN, RN, CNL (Clinical co coordinator) 3. Clem Banglorioso MSN, RN, CNL (Preceptor) 4. Alice Thomas BSN, RN, CPN. (CNL student) 5. Lourine Davis BSN, RN, OCN (Associate Director SCT Unit G-18) 6. Anita Aickareth BSN, RN, BMTCN (Nurse Educator) 7. Victoria Showunmi RN, BSN, MSN, CCM (Case Manager) 8. Ancy Mathew BSN, RN (Clinical Nurse in SCT Unit- G-18). 7. Initial References (in APA format) – 15% Rubric Structure and Design of the Capstone Proposal and Project The design of the proposal and project depends upon the topic and methods for measurement. The project and proposal will use evidence from the literature and a quality framework to organize the presentation. A nursing theory and/or change theory should be applied within the project. The role of the CNL is to be considered in both the proposal and the project Proposal Minimum Requirements The written (Word) and verbal proposal (PowerPoint) will share the following information headers presented using APA format to the degree possible. The grading rubric is indicated for each area of the proposal as a % of 100 points: 1. Cover page (APA format) – 5% 2. The title and topic to be addressed – 10% 3. The goals of the project to be undertaken – 10% 4. The methodology (processes) to be utilized – 30% – Why, what, where, when, who, costs, and how? – Applicable change theory or other nursing or quality theory (at least one). – Literature Search is described briefly. Library orientation is a requirement in the first CNL Roles course. If students need a refresher they can request help from the UTMB library at any time. – Role of the CNL in the project. Is it appropriate for the CNL and what CNL roles fit in the project? 5. The student’s anticipated outcome(s) – 25% 6. The Capstone Committee members – 5% 7. Initial References (in APA format) – 15% Length – Not to exceed 4 Word processed pages, not including title page or references. Running head: LITERATURE REVIEW 1 Literature Review Instructor name Submitted by Date LITERATURE REVIEW 2 Chapman, S. (2013). Compact Clinical Guide to Cancer Pain Management Compact Clinical Guide to Cancer Pain Management. Cancer Nursing Practice, 12(5), 8-8. The author states that the unrelieved cancer pain is a major issue during cancer treatment. More than 50 percent patients complain about the severe pain during the treatment. Additionally, almost 25 percent to 50 percent of the survivors face severe pain because of treatment and medical conditions. Around 80 percent patients face pain during terminal stage of cancer. Past trends do not show any improvement in the level of pains faced by the people at various stages. The author also explains how the nurses can help in providing practical information to the clinicians who aim to improve the level of pain in oncology patients. Nurses have always taken an active part in the improvement of patient’s condition in previous three decades. Nurses can recommend strategies to the physicians on the basis of evidence based information to improve the pain management plan of cancer patients. The emphasis is laid on the evidence based interventions. The nurses must be readily available with texts that support in providing important information for the treatment. Chumbley, G., & Laura, M. (2010). Patient-controlled analgesia infusion pumps for adults. Nursing Standard, 25(8), 35-40. Retrieved June 22, 2017. Chumbley & Mountford (2010) stated that Patient Controlled Analgesia (PCA) with the help of pump results in the experience of pain by the patient. The pain is mainly because of trauma, minor exacerbation of unending situation, or surgery. Pain assessment and Richmond Agitation – Sedation Scale (RASS)

This is to manage their analgesia. Pumps are mainly used for the purpose of opioids for the reason that they are easily available and effective in results. It helps in empowering patients to control the pain faced during surgery or trauma. The results shown by PCA are instant and patient need not wait for long for the effect of LITERATURE REVIEW 3 analgesia. This has enhanced the value of recovery and care. The individual can decide the need of the regimens. This has proved to be useful in certain extreme cases like physiotherapy and changes in dressing. There is a need to maintain safety level during the usage of PCA, so that it may not result in negative impact. The nurses should also provide the assistance to patients about the PCA. Hammer, K. J., Segal, E. M., Alwan, L., Li, S., Patel, A. M., Tran, M., & Marshall, H. M. (2016). Collaborative practice model for management of pain in patients with cancer. American Journal of Health-System Pharmacy, 73(18), 1434-1441. In order to treat cancer, the Seattle Cancer Care made an effort to offer specialized pain service to patients with cancer. (Hammer et al., 2016) In the beginning, the clinic was initiated by one attending physician, as the number of cancer patients increased the clinic size also increased. There were more physicians, pharmacists, nurses, and advanced practice providers. With the help of collaborative drug therapy agreement (CDTA) and credentialing process, the pharmacists were able to provide adequate assistance to patients, helped in developing the plans for treatment, and prescribed therapies. The pharmacists were also able to progress on the dosing for medication to improve the quality of patient care. For the treatment of cancer-related pain, the pharmacists and other health care providers worked to develop the plan as per the principles stated by World Health Organization. The efforts were also laid in for the improvement of functional status and functional goals instead of pain relief. The clinic used validated tools for the assessment of chronic opioid risk. Hochstenbach, L. M., Courtens, A. M., Zwakhalen, S. M., Vermeulen, J., Kleef, M. V., & Witte, L. P. (2017). Co-creative development of an eHealth nursing LITERATURE REVIEW 4 intervention: Self-management support for outpatients with cancer pain. Applied Nursing Research, 36, 1-8. Retrieved June 22, 2017. Hochstenbach (2017) stated that co-creative methods are always useful in complicated nursing interventions. The knowledge of the developmental process is important for the results of the subsequent evaluations. Three phases were designed for the intervention development. In all the phases, technicians and researchers set up five repetitive steps. The steps were research, ideas, prototyping, evaluation, and documentation. Only during the first and fourth stage, patients and health experts were consulted. The association of health experts, patients and researchers proved to be important for the optimization of results. The web application was accessed by the nurses and the mobile application by patients. Patients were guided by the health professionals to estimate the level of pain and its adverse effects. Pain assessment and Richmond Agitation – Sedation Scale (RASS)

The nurses helped the patients by giving them valuable advice and treatment recommendations. The ehealth helps in improving the patient health care. The nurses were able to guide the patients as and when requested for the help. Hu, Y., Ku, T., Jan, R., Wang, K., Tseng, Y., & Yang, S. (2012). Decision tree-based learning to predict patient controlled analgesia consumption and readjustment. BMC Medical Informatics and Decision Making, 12(1), 2-15. Pain has the ability to negatively impact the quality of life. With proper postoperative pain management, the stay at hospital and cost can be reduced. Hu et al. (2011) aim to emphasize on Patient Controlled Analgesia (PCA). For the analysis, the sample of 1099 patients was taken. Along with physiological and demographic factors, the features associated with PCA were also studied. To estimate the analgesic consumption and the control readjustment, decision tree based algorithm was used. In order to enhance the class imbalance issues in readjustment settings of LITERATURE REVIEW 5 PCA, neighbor based cleaning method was used. The results obtained by decision tree algorithm for continuous and PCA dose was 80.9 percent, and PCA dose only was 73.1 percent. The analysis shows that decision tree based algorithm was better than support vector machine, artificial neural network, rotation forest, and random forest. With the help of comparative analysis, informative features were identified and correlated with prior work’s requirement of analgesic. The results showed the possibility of the postoperative pain management approach. In-Kyung, S., Hee, P. Y., Jihyun, L., Tae, K. J., Ho, C. I., & Soo, K. H. (2016). Randomized controlled trial on preemptive analgesia for acute postoperative pain management in children. Pediatric Anesthesia, 26(4), 432-442. Retrieved June 22, 2017. Park et al. (2016) aimed to find if the preemptive analgesia is useful as compared to conventional regimens to reduce the postoperative pains. Preemptive analgesia treatments start prior to surgery and help in avoiding central sensitization. For the analysis, total 51 children were selected which were randomly put in two groups control group (group C) and preemptive group (group P). General anesthesia along with intravenous patient controlled analgesia was provided to both the groups. For group P, the process began after skin incision, and 5 min later in group C. There was no significant difference between the outcomes of both the groups. Also, no difference was found in the amount of intravenous patient controlled analgesia delivered to patients, the total times of pushing the intravenous patient controlled analgesia button, VRS, EAS at discharge through the PACU, complications, and requirements. The results proved that the use of preemptive analgesia is similar to the use of traditional regimens for the treatment of postoperative pains. LITERATURE REVIEW 6 J, H. K., M, S. E., Laura, A., Li, S., M, P. A., Melinda, T., & M, M. H. (2016). Collaborative practice model for management of pain in patients with cancer. Pain assessment and Richmond Agitation – Sedation Scale (RASS)

American Journal of Health- System Pharmacy, 73(18), 1435-1441. Retrieved June 22, 2017. In order to treat cancer, the Seattle Cancer Care made an effort to offer specialized pain service to patients with cancer. (Hammer et al., 2016) In the beginning, the clinic was initiated by one attending physician, as the number of cancer patients increased the clinic size also increased. There were more physicians, pharmacists, nurses, and advanced practice providers. With the help of collaborative drug therapy agreement (CDTA) and credentialing process, the pharmacists were able to provide adequate assistance to patients, helped in developing the plans for treatment, and prescribed therapies. The pharmacists were also able to improve on the dosing for medication to improve the quality of patient care. For the treatment of cancer-related pain, the pharmacists and other providers worked to develop the plan as per the principles stated by World Health Organization. The efforts were also laid in for the improvement of functional status and functional goals instead of pain relief. The clinic used validated tools for the assessment of chronic opioid risk. Sessler, C. N., Gosnell, M. S., Grap, M. J., Brophy, G. M., Oneal, P. V., Keane, K. A., Elswick, R. K. (2002). The Richmond Agitation–Sedation Scale. American Journal of Respiratory and Critical Care Medicine, 166(10), 1338-1344. Sesslar et al. (2002) explain in their research that for intensive care patients sedative medications are often used. To know the results, Richmond Agitation-Sedation Scale was used in two phases. The first phase was dealt with five investigators, and the results achieved were beyond their LITERATURE REVIEW 7 expectations (r = 0.95, lower 90% confidence limit = 0.94). For the patients with and without medication of sedation and mechanical ventilations Robust inter rater reliability was used for surgical, coronary, medical, and cardiac surgery patients. The correlation was tested between the RASS and visual analog scale. The results show the high correlation of 0.93. The correlation results of Ramsay sedation scale and RASS was -0.78, and between Sedation Agitation Scale and RASS was 0.78. The nurses were easily able to recall the logic behind RASS and found it easy to administer. RASS demonstrated high validity and reliability in non sedated and sedated, non ventilated and ventilated, medical and surgical patients.

"You need a similar assignment done from scratch? Our qualified writers will help you with a guaranteed AI-free & plagiarism-free A+ quality paper, Confidentiality, Timely delivery & Livechat/phone Support.

Discount Code: CIPD30

Click ORDER NOW..