Written by expert advanced nurse practi
Table of ContentsContributors’ 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
