Advancing Nursing Practice in Pain Management

Eloise Carr is Associate Dean Postgraduate Students, School of Health & Social Care, Bournemouth University. She serves on Council for the British Pain Society and Chairs a Special Interest Group in Pain Education. Mandy Layzell is lecturer practitioner, Acute Pain Service, Poole Hospital NHS Foundation Trust, and the School of Health & Social Care, Bournemouth University. Dr Martin Christensen is Senior Lecturer, School of Health & Social Care, Bournemouth University and clinical educator in a general intensive care unit. 

Contributors’ biographies xi

Foreword 1 - Professor Judy Watt-Watson, University of Toronto, Canada xv

Foreword 2 - Professor Kim Manley, Head of Practice Development, Royal College of Nursing xvii

Preface xix

Acknowledgement xxi

1 Introduction to advancing practice in pain management 1
Eloise Carr and Martin Christensen

Introduction 1

Advanced practice 1

The context of pain management: definitions and prevalence 5

Advancing practice in pain management 6

Bringing together advanced practice and pain management 7

Conclusions 8

2 Nurse-led femoral nerve block service for patients with fractured neck of femur 11
Mandy Layzell

Introduction 11

Pain control 12

Under-treated pain 13

Pharmacokinetics 13

Pharmacodynamics 13

Changes in pain perception 13

Assessment of pain 14

Analgesic drugs and the elderly 14

Femoral nerve block 15

Benefits of FNB 15

Risks of FNB 16

Rationale for a nurse-led service 16

Developing the service 17

Protocol development and training 17

Patient information sheet 18

Patient group directions 18

Data collection and evaluation of the service 19

Training 19

Problems encountered with the training 19

Challenges in implementing a new service 20

Evaluation of the 1-year pilot study 21

Service feedback from staff 23

Service feedback from patients 23

Justifying the advanced nursing contribution 23

Conclusions 25

Acknowledgements 26

3 New directions in acute pain management: ketamine 29
Gillian Chumbley

Introduction 29

Developing the service 33

Challenges in implementing a new service or area of practice development 37

Evaluation of using ketamine for pain relief 38

Justifying the advanced nursing contribution 40

Conclusions 42

4 Developing a nurse-led clinic for the treatment of neuropathic pain 45
Eileen Mann

Introduction 45

Definitions and causes of neuropathic pain 45

Prevalence of neuropathic pain 46

A proposal and rationale for a nurse-led clinic for sufferers of neuropathic pain 47

Identifying stakeholders 50

Developing a business plan 51

Assessment tools 52

The challenges and reality 54

Evaluation of the service 57

Justifying the advanced nursing contribution 58

Conclusions 58

Appendix 1: Original business plan 59

Appendix 2: Text of an open letter to all local general practitioners informing them of the proposal to commence a nurse-led clinic for painful diabetic neuropathy 63

Appendix 3: Example of a typical letter to a general practitioner, at the time pregabalin was not available for prescription 64

5 Nurse-led strategies to improve patient safety in acute pain management 71
Felicia Cox

Introduction 71

Media exposure 72

Injectable medicines 72

Intravenous opioid PCA 72

Epidural analgesia 73

Analgesic medicines and risk 74

Nursing contribution to medicines management 74

New role 74

Blurring of roles 75

Developing the service 75

Oral and PCA analgesia 77

Challenges in implementing the changes in practice 84

Ongoing evaluation and audit 87

Justifying the advanced nursing contribution 88

Conclusions 89

6 Developing an acupuncture service for chronic pain 93
Ruth H Heafield, Christine M Haigh, Christine M Barnes and Elaine Beddingham

Introduction 93

Rationale for setting up an acupuncture clinic for pain management 94

Staff development: education and maintaining competencies 102

Clinical governance 105

Conclusions 109

Editors’ note 109

7 The advanced nurse practitioner: developing alliances 113
Ruth Day and Dee Burrows

Introduction 113

Alliances and strategic alliances 113

Changing workplaces 114

Skill acquisition 114

Developing entrepreneurial services in pain management 115

The challenge of forming alliances to enable implementation 119

The challenge of maintaining standards 121

Advanced nursing practice and strategic alliances 123

Conclusions 124

Acknowledgements 125

8 An overview of advanced nursing practice in the development of pain clinics in primary care: new ways of working 127
Paul Bibby

Introduction 127

Background – an overview of the provision of pain services 128

Developing the service 129

Challenges 132

Evaluation 134

Conclusions 139

Appendix 1: Pain clinic audit 140

9 Development of nurse-led pain management programmes: meeting a community need 143
Dee Burrows

Introduction 143

Developing the service 145

Challenges in implementing the service 150

Maintaining standards and evaluating the service 153

Justifying the advanced nursing contribution 158

Conclusions 159

Appendix 1 159

Red flags indicative of possible serious spinal pathology 159

Psychosocial yellow flags – the beliefs and behaviours which may predict poor outcome and which pain management programmes address 159

Acknowledgements 160

10 Nurse prescribing in acute and chronic pain management 163
Trudy Towell and Martin Christensen

Introduction 163

Acute pain 165

Chronic pain 165

Rationale for service development 167

Evaluation use of audit and CPD 172

Justifying the advanced nursing contribution to develop nurse prescribing in pain management 176

Conclusions 177

11 Nurses leading the development of interprofessional education in pain management 181
Ann Taylor

Introduction 181

Developing a formal educational qualification in pain 184

Challenges in establishing and managing an interprofessional course 187

Evaluation and the use of audit 189

Justifying the advanced nursing contribution 191

Conclusions 192

12 New knowledge for advancing practice in pain management 195
Martin Christensen and Eloise Carr

Introduction 195

Advancing practice in pain management 202

Conclusions 204

Index 207