Literature Review of Pain Assessment Tools

Literature Review of Pain Assessment Tools Introduction This essay will identify the issue of poorly addressed acute pain in hospitalized patients and critically compare and discusses a range of pain assessment tools referring to contemporary research literature and practice guidelines for patients who are able to self describe their pain and who are unable to self describe their pain due to verbal communication barriers, critical illness or delirium/dementia. Main Body According to the International Association for the Study of Pain, pain is an unpleasant sensory and emotional experience arising from actual or potential tissue damage (1). Clinically, â€Å"Pain is whatever the experiencing person says it is, existing whenever he/she says it does† (McCaffery, 1968). The temporal profile classification is most commonly used to classify pain.This broad classification of pain duration is often used to better understand the biopsychosocial aspects that may be important when conducting assessment and treatment. For example, many times chronic pain is a result of unresolved acute pain episodes, resulting in accumulative biopsychosocial effects such as prolonged physical reconditioning, anxiety, and stress. It is obvious that this type of time categorization information can be extremely helpful in directing specific treatment approaches to the type of pain that is being evaluated (Gatchel Oordt, 2003). Acute pain is usually indicative of tissue damage and is characterized by momentary intense noxious sensations (i.e., nociception). It serves as an important biological signal of potential tissue/ physical harm. Some anxiety may initially be precipitated, but prolonged physical and emotional distress usually is not. Indeed, anxiety, if mild, can be quite adaptive in that it stimulates behaviors needed for recovery, such as the seeking of medical attention, rest, and removal from the potentially harmful situation. As the nociception decreases, acute pain usually subsides. Unlike acute pain, chronic pain persists. Chronic pain is traditionally defined as pain that lasts 6 months or longer, well past the normal healing period one would expect for its protective biological function. Arthritis, back injuries, and cancer can produce chronic-pain syndromes and, as the pain persists, it is often accompanied by emotional distress, such as depression, anger, and frustration. Such pain can also often significantly interfere with activities of daily living. There is much more health care utilization in an attempt to find some relief from the pain symptoms, and the pain has a tendency to become a preoccupation of an individuals everyday living. According to Buckley (2000) nurses are the primary group of health care professionals responsible for the ongoing assessment and monitoring of patients to ensure that pain is effectively and appropriately managed and that patients and families are informed of the consequences of acute pain. Assessment of pain can be a simple and straightforward task when dealing with acute pain and pain as a symptom of trauma or disease. Assessment of location and intensity of pain often sufà ¯Ã‚ ¬Ã‚ ces in clinical practice. However, other important aspects of acute pain, in addition to pain intensity at rest, need to be deà ¯Ã‚ ¬Ã‚ ned and measured when clinical trials of acute pain treatment are planned. If not, meaningless data and false conclusions may result. The 5 key components: Words, Intensity, Location, Duration, Aggravating factors pain assessment are incorporated into the process. Objective data are collected by using one of the pain assessment tools which are specià ¯Ã‚ ¬Ã‚ c to s pecial types of pain. The main issues in choosing the tool are its reliability and its validity. Moreover, the tool must be clear and, therefore, easily understood by the client, and require little effort from the client and the nurse. According to Husband (2001) to measure the pain severity or intensity, several scales can be used such as a numeric rating scale (NRS), the visual analog scale (VAS), observation scales with indicators of pain, and even creative depictions of pain intensity with scale using a pain thermometer. The numeric rating scale allows patients to rate their pain on and 11-point scale of 0 (no pain) to 10 (worst pain imaginable). The majority of patients, even older adults can use this scale. The thermometer scale may be useful in the elderly, according to Rakel and Herr (2004). It shows a picture of a thermometer arranged on a background with a vertical word scale. Finally categoric scales use verbal descriptors to quantify the level of pain and those scales have been validated and are considered to be reliable. Chronic pain has a major impact on physical, emotional, and cognitive function, on social and family life, and on the ability to work and secure an income. Meaningful assessment of long-lasting pain is therefore a more demanding task than assessing acute pain. This is true both in clinical practice and when conducting trials of management of long-lasting pain. A comprehensive assessment of any chronic complex pain condition requires documenting (i) pain history, (ii) physical examination, and (iii) specià ¯Ã‚ ¬Ã‚ c diagnostic tests. Chronic pain assessment tools are the Brief Pain Inventory (BPI), which assesses pain severity and the degree of interference with function, using 0 – 10 NRS, and the McGill Pain Questionnaire (MPQ) and the short-form MPQ (SF-MPQ) evaluate sensory, affective–emotional, evaluative, and temporal aspects of the patient’s pain condition. Pain assessment in older adults can be challenging and very difficult in some situations (Rakel Herr, 2004). When the patient cannot report his/her subjective pain experience, proxy measurements of pain must be used, such as pain behaviours and reactions that may indicate that the person is suffering painful experiences. Besides communication difà ¯Ã‚ ¬Ã‚ culties caused by language problems, patients in the extremes of age, and critically ill patients in the intensive care setting, are common assessment problems. Older patients may prefer to use alternate means to express their pain through the use of word descriptors that best characterize the pain, such as aching, hurting, and soreness (Herr Garand, 2001). Significant challenges occur when assessing patients who are unable to communicate verbally, in writing, or by gestures, or when they are cognitively impaired. Pain assessment should be ongoing at regular intervals, individualised and documented clearly to facilitate treatment and communication among health care clinicians. Conclusion In conclusion, adequate assessment of pain, using validated tools appropriate to the population or individual, is an essential prerequisite of successful pain management. It has been shown in many countries that inadequate pain assessment is common, with resultant failings in management of pain. Inadequate pain control can prolong the recovery period, increase length of stay, and increase overall health care costs ( Shang Gan, 2003) Only by regularly assessing and measuring pain, as routinely as the other vital signs, can we hope to make pain visible enough to those caring for patients and thus improve management. This is especially true for the patients that anaesthetists care for every day, those with acute pain after surgery, trauma, and in the intensive care unit.

Review of related lit and studies

According to Manfred Ours Koch (2011 who compiled a lot of studies involving meal combinations, having a great meal combination won't just give the customer the satisfaction they deserve but it will also give the right benefits that the body needs even if the said meals are comprised by simple ingredients. Poor meal combinations might cause the enlargement of the intestine and can be the cause of excess eating that leads to obesity.According to Fatima (201 1), Operational decisions and actions related to menu such as standardizing and offering a consistent quality, minimizing arrive failures, accurately predicting demand to menu items, and assuring food safety are essential components of providing a prosperous meal experience. For instance, customers may be dissatisfied when their orders are delayed or cannot be served due to shortage of ingredients because of poor sales forecasting.Moreover, customers who are attentive to food safety issues may assess all visible cues such as cleanl iness of utensils, serving temperature and personal hygiene of service staff in order to be certain the safety level of food and these assessments may influence their satisfaction tit meal experience. Penmen – Malice said in his blob in POS Sector for Restaurants and Bars that dishes from the menu combos are the best selling items of a restaurant and the most often choice of the guests no matter of its price. It is mandatory to include them in a restaurant offer.Not only that it will affect to increase the traffic in a restaurant, but will refresh offers, facilitate the sale of targeted menu items, and be the silent partner in suggestive selling. Pairing food from menu with drinks and tasty side dish is proven and effective method to improve sales and profits. Using menu engineering and combo meals has not been typical only for fast-food restaurants anymore, it increasingly taking place in all other full service restaurants where Offer has been only â€Å"a la carte† f ew years ago. Erica's 1 and 2 offers a lot of combo meals in their menu. It consists of Pork, Beef, Chicken or Fish dish, side dish, rice, and a regular size drink. The items in their combo meals complement each other. According to Carline (2009) there is mounting empirical evidence to suggest that the law of one price is violated in retail financial markets, there is significant price dispersion even when rodents are homogeneous. Also, despite the large number of firms in the market, prices remain above marginal cost and may even rise as more firms enter.In a non-cooperative oligopoly pricing model, I show that these anomalies arise when firms add complexity to their price structures. Complexity increases the market power of the firms because it prevents some consumers from becoming knowledgeable about prices in the market. In the model, as competition increases, firms tend to add more complexity to their prices as a best response, rather than make their disclosures more transparen t. Because this may substantially decrease consumer surplus in these markets, such practices have important welfare implications.Local Literature Foreign Studies French (2003) said that the individual dietary choices are influenced by the taste, cost, convenience and nutritional value of foods. Food pricing and marketing practices are important components of the eating environment. Recent studies have applied economic theories to changing dietary behavior. Price reduction strategies promote the choice of targeted foods by lowering their cost relative to alternative food choices. The studies that were conducted demonstrated that the price reductions are an effective strategy to increase purchase of more healthful foods in work place and schools.Reducing prices on healthy foods is a strategy in public health that should be implemented through policy initiatives and collaborating in the industry. Local Studies Esther (1998) Jollied Foods Corporation leads the Philippine Food Service in dustry by continuing to strengthen its competitiveness. It continues to be the most visited among both hamburger and total fast food chains throughout the country. The Jollied brand today is one of the most well recognized and best loved consumer brands in the country.She said that Jollied should continue to offer superior taste through their best selling products for them to stay as the leading fast food restaurant in delivering the highest quality standards of products and customer service. Their proposed plan aims to strengthen its market leadership by focusing on the 1 5 to 40 years old male and female market from classes C and D. The proposed marketing plan will present a more filling meal combo at an affordable price f POP to target medium heavy eaters.It also aims to provide Jollied consumers with more variety in value meal combinations. To evaluate the proposed plan, monthly sales monitoring and transaction reports will be done. Product Quality Surveys will also be conducted to monitor consumers' acceptance of the product. Periscope's has the most number of branch of fast food in Mandible area. All the branches offer the same menu. They must offer valuable meals for them to attract more customers. They should also know about the budget of the students so that their products will be fast moving.

Behavior Traits of Successful Businesses

Businesses are resource limited and must determine where and in what way to allocate resources to achieve business mission objectives. This translates to why it is so important for business to be creative and actively plan for innovation correctly. Innovation is a change of direction and it alters investment policy so it is essential from the onset for the business planner to be clear about the current state of product â€Å"portfolio†. The planner must recognize how to balance the current products against possible policies for future development and their likely implications in terms of cash flow, market share, return on capital employed and other key components of company objectives. A successful behavior trait taking hold for successful companies is to develop business models to assess a strategy. These models provide change models expanding on issues such as â€Å"what†, that provide a picture of the company now of analysis; and â€Å"which†, that suggest alternative action paths for the company to take. Both of these models provide information to build a more complete picture of events within the business and options for future development. Managers should make use of these models and many don†t. Those that do are more likely to be successful and have the ability to minimize risk of failure. Business managers who do are far more likely to survive. For planners and non-planners there is not a single universal technique that can be applied in all situations. Use of strategic planning models can be a very important behavior trait for successful companies. Companies that do not use strategic planning models usually don†t because the model does not offer what the customer wants. It may be inadequate because of its analysis of the relationship between company resources and markets. These result in advice about overall investment decisions rather than about the specifics of how to manage the alternatives in the market/business relationship can be shortsighted, since there are always alternatives in order to gain the maximum competitive advantage. Since change is so an important aspect of business continuity, many models don†t necessarily provide assiduous suggestions for what type of change should be considered. An example of modeling one such model in use by Boston Consulting Group (BCG) subdivides their profit centers into four main subdivisions. This breakdown does help in planning for strategic investment matters but it does not assist the planner in identifying a single product development proposal to investigate further from a number of alternatives. The matrix system comprises the following: 1) Stars, which are products generally with negative cash flow 2) Question marks, which are products with generally negative cash flows but with low relative market share in growing markets 3) Dogs, which are products unlikely to be generating substantial positive cash flows due to the fact that they are in slowly growing markets with low relative market shares 4) Cash cows, that are products that generating cash which have high relative market shares and are established in slowly growing markets. BCG model like the previous statement in the above paragraph does not define the product enough and does not create opportunities to explore alternatives in which to improve profitability or market share. The growth concept is divided into five separate levels one being dominant, strong, favorable, tenable and weak and relates this to the stages of market development. The stages are embryonic, growing, mature, and aging, which produce a series of strategic guidelines for company development. The market growth concept provides valuable guidance about broad policies, replacing the concept of market attractiveness in the GE matrix with stages of market growth. A PLC (product life cycle) are frameworks for planning. It suggests that specific changes in product policy should be followed after the initial product introduction. A major problem is that few products follow â€Å"typical† PLC curves. This implies that the organization evaluates the likely progress of each facet of the product†s performance over the ensuing time scale to identify particular areas where investment should be concentrated without a clear indication as to whether that product will follow the predicated path of the PLC. There are several other types of commonly used models and analysis (Product viability, Market newness, technology position, opportunity cost risk, and the Ansoff matrix) that can be employed each having strengths and weaknesses and should be applied to achieve a specific outcome. By carefully defining the likely market attractiveness for innovation and the resource environment for innovation, management can identify the types of innovation that are appropriate for a particular business unit. The key components of the market and resource environments are: 1. Market attractiveness is degrees of synergy, market size, barriers to diffusion, the expected product life and the stage of technological development. 2. Resource components are likely to be market position and personnel resource, which combine to yield a definition of the company core competence. By establishing a weighting scheme the analyst can create a three-by-three grid of market attractiveness versus resource environment to provide a measure of the likely ability of the organization to carry out particular types of innovation and the expected profitability of the proposed innovation policy. Personnel are the hearts of a continuing effective innovation policy. But, it is just as important that management and leaders are made aware of their unique roles and how crucial their behavior is upon the organization – ultimately the success of the company. Managers must be able to stimulate conversation and innovation. Leaders must be clear on how paradigm shifts and leadership is interwoven. Managers must be able to demonstrate paradigm pliancy if they are going to expect others to practice it. The more active managers can be in the search for new paradigms, the more likely those managers will be to have people work with them. An example made in the paradigm text indicated that the piston engine was on its way out in the 1970†³s because of the mandates on for a cleaner environment. Once the engine engineers stepped outside the old boundaries, they found that electronics could help to resolve the issue. Managers must facilitate and encourage cross talk. More and more the answer to a particular problem will lie with someone else and if you don†t apply the cross communication, that idea won†t be brought to surface effectively. It†s especially important that managers listen. Even when some ideas sound off the wall, you want people to approach with their ideas in an on-going fashion. On the other hand, the merger of these ideas though on their own may seem a bit far-fetched; when combined they offer leverage for the manager to generate great and unique solutions. In the text, Paradigm, the author Joel Arthur Barker defines a leader, as a person one will follow to place one wouldn†t go by himself or herself. To be successful in the twenty-first century means that leaders will need to be competent on managing within a paradigm and leading between paradigms. One without the other will not work. Successful leaders tend to lead to new paradigms in a variety of ways. Leaders need to be aware of the pattern of choices that occur during paradigm shifts. Typically three opportunities emerge: 1. Keep the paradigm; change your customer 2. Change your paradigm; keep your customer 3. Change your paradigm; change your customer Warren Bennis set forth a list of characteristics of leaders in the May 1990 issue of training magazine. The manager administers; the leader innovates. The manager has a short-range view; the leader has a long-range perspective. The manager asks how and when; the leader asks what and why. The manager has his eye on the bottom line; the leader has his eye on the horizon. The manager accepts the status quo; the leader challenges it. Roger Milliken, CEO of Milliken and Company, a privately held textile company in South Carolina demonstrated true leadership when he began his company drive to world-class status in the early 1980†³s Though most industry experts predicted the demise of the U.S. textile industry, Milliken continued to pursue excellence. In 1990 Roger Milliken won the noted Malcolm Baldridge Award demonstrating excellence. Employees operate at different levels, some are visionaries (don†t have people following them), some are leaders, some are managers, some are leaders and even a smaller percentage have all four roles – remarkable is a company that has an individual having all four characteristics. The most important factor in sector creating innovation is the concentration on academic and theoretical concept development, which demands a specific organizational framework. They contrast with the rapid developmental demands of performance extension, technological reorganization and process innovations and with the need for close contact with the market required by other types of innovation. Therefore, three broad types of organizational patterns can be described as appropriate for components of the innovation matrix and it can be described as follows: 1. Common room – appropriate for the development of sector creating innovations 2. Rugby scrum – approaches are best for the management of performance extension, technological reorganization and process innovations and those innovations that require a close and continuing contact with the marketplace for effective control 3. Coffee shop – reformation, service, branding, design and packaging are most suited in this sector Once a company has formulated an innovation policy it must evaluate whether to acquire the expertise from outside the organization (acquisition), to borrow it (licensing), to develop it with a partner with some specific expertise in this area (joint venture), or to concentrate on developing the knowledge internally. By studying how knowledge has been acquired and the problems associated with each route, it is then possible to come to some general conclusions about the best overall method for developing competitive advantage in the 1990†³s and beyond.

Should Marijuana Be Legal - 1464 Words

While marijuana is a potentially harmful drug to those who use it, but it is really no more dangerous than alcohol or cigarettes. Both of these are harmful to the user and they have many fatalities connected to each, directly or indirectly. Marijuana has been on prohibition for far too long now and states are starting to realize that. Marijuana is in our culture, it always has been, and it has medical benefits and can help our economy by putting tax dollars into the system. Marijuana has been used for centuries for religious and medicinal purposes around the world. Jack Herer, best known for his work, The Emperor Wears No Clothes, said that hemp â€Å"possessed a near-limitless potential for replacing petrochemical and timber productions and†¦show more content†¦Regan later came and claimed that marijuana was â€Å"the most dangerous drug in America† (Lee). Today, marijuana is being rediscovered for its medicinal purposes. One such case is the plant named â€Å"Charlotte’s Web†. This plant is named after Charlotte Figi, a 5-year-old girl with Dravet’s syndrome, which caused her to have up to 300 grand mal seizures every day (â€Å"Charlotte’s Web†). Charlotte’s Web is a special strain of marijuana that has all the THC removed from it, which is the psychoactive ingredient that can cause seizures, and it has high levels of cannabidiol (CBD) in it, which has anti-seizure properties in it (â€Å"Charlotte’s Web†). Charlotte’s father said that â€Å"A year ago, she could only say one word†¦ Now she says complete sentences† (â€Å"Charlotte’s Web†). Because it is legal at a federal level, families from across the nation have to uproot their lives and move to Colorado where they can find the plant, â€Å"It includes†¦ families willing to move from J apan and the Philippines† to get these life-saving drugs to their children because the fact is, for most children with the syndrome, without this life-saving drug, they would die before reaching adulthood (â€Å"Charlotte’s Web†). Charlotte’s Web is a lifesaving and life changing drug for those who get to use it, yet we are resisting access to it and making families be torn away from the place they