Ethics As Applied To Pain Management

Ethics As Applied To Pain ManagementCritically gauge the avail qualified order regarding the skilfulice impressions in context of chronic low wo(e) in call of Mrs. Alices sequel employment.IntroductionThe relief of put out is a core value-systemal duty in medicine(Johnson2007, P.1). There be m some(prenominal) honourable exposes associates with smart in the neck circumspection. So it is important that the wellness c ar passe-partouts should chthonianstand the ethical principles, which whitethorn help to deal with problem effectively, (Please appendix 3 for principles of ethics think to medical practice).The people in the founding have different views related to umpire and dark. They could describe numbers of examples of iniquity and arbitrator which office drawn from personnel experience or from the society .It is interesting to know that most people campaign to uphold a the view of jurist impressions in the world that isthey live in a world where people generally get what they deserve, Lerner and Millier (1978,p.1030), Haferand Begue(2005). The justice beliefs ar individually associated with mental adjustment and it could be a reflection on objective pass judgmentments of the justice received by other human beings, Sutton et al.(2008)The multifaceted spirit of chronic hurting is preconceived opiniond by woundful sensation beliefs Sloan et al. (2008). McParland and Knussen (2010) describe that a justice belief to a fault has entice in experience of chronic offend and put out behaviors. The people who have justice belief s are motivated to belief that the world operates in a neat and legitimate manner (Sutton et al.2008), and they en organized religion be able to pursuits long-term goals and maintain physical and mental swell up being,( Kathleen and Claudia 2005Laurin et al.2011Dalbert 2002). The human descry immorality when they expose to a situation primarily characterised by violation from human rights or to ch allenge the just world beliefs. Fetchenhauer and Huang(2004).2. Aims of the assignmentThe assignment aimed to explore the available evidence regarding the carry on of justice beliefs in chronic pain sufferers and their reaction to injustice ground on Mrs. Alices Case conceive. The assignment excessively aimed to evaluate the evidences on ethic principles.Case mootMrs. Alice is a 39-year old nurse, mother of two, who has been suffering from low back pain for last two years. The patient has no specific medical history. She attended the general practice in ultimo in intermittent bouts. She was taking analgesics that did not make any difference for her pain. The x-ray was normal. She has been subjected to inexorable suspicions of malingering from doctors and employers, as she has no objective ascertaining. Mrs Alice currently presenting with the statement that everyone misunderstood my pain as moaning entirely I am in pain, might be they didnt understand me properly3. Search S trategyA literature search was done using Science direct, pub med, google scholar, Medline, Ovid for relevant studies done in past 5 years. But this assignment only included one quote from 1978, which is relevant for this review. The key lyric included for the search were justice beliefs, injustice, justice, pain, pain management, chronic pain, unfairness and combination of these words. The search was limited to studies conducted in human beings and published in English. There was wishing of literature regarding chronic back pain to assess the influence of injustice and justice beliefs. Hence searches were extended to other chronic pain conditions. Each of the papers were analysed for validity and rigour according to the framework given by (Rees 1997, cited in Taylor 2009). See appendix 2. The stance of evidence was established using the Hierarchies of evidence framework Dawson (2004). See appendix 1.4. Literature ReviewMcParland and Knussen (2010) conducted a cross sectional qu estionnaire design to find out the impact of general and private beliefs to moderate psychological excruciation in the experience of chronic pain. The product line of operations was conducted in place upright groups, from national chronic pain organisation in Scotland. The recruited participants were from arthritis and fibromyalgia groups and they were asked to smash the questionnaires. The findings from the prove suggests that strong general justice belief is beneficial for psychological well being in the context of chronic pain and it helps cope with pain inspiration and disability. plank1 McParland and Knussen (2010,p. 72)The check employ reliable self-report questionnaires to collect data from en haves. See appendix 5 for questionnaires utilise in the count. The use of reliable tools for the study could the increase the internal validity of the study and maximizes the value of the results. The conducted study was using the samples from National chronic pain organiza tion in Scotland so the beliefs could be influenced by heathenishal and educational factors of the area. The beliefs could differ in different ethnic populations Sloan et al. (2008). As the study was conducted in United estate the results would be more applicable for clinical practice for this country.There are some short points for this study as mentioned the questionnaires wre given to interested patients from the group. This might attract samples that have strong personal and general beliefs into the study. This counsel of sample recruitment might bias the result and adjoin the validity. The sample was collected from community support groups of arthritis and fibromyalgia where they receive personal and tender support from health professionals. This could be argued that these patients might already yarn-dye psychosocial di distort because of their condition. Mcparland and Knussen (2010) that people experience less psychosocial distress when they hold strong personal beliefs. So in that respect could be a chance for bias in sample selection that affects the validity of the study results. The accuracy of the undefiled questionnaires is uncertain as participants might already suffer psychological distress or pain. The self-report questionnaires could naturally bias the persons feeling at the time they round the questionnaire as the participants were requested to complete and return the questionnaire by post. It would be better if the researcher asked to complete the questionnaires in a suss outled time and site. This method biases the data collection and could affect the validity and reliability of the result. More over the researcher and assistant met the participants to introduce the study and given tint details. So the study was not blinded. jibe to just world theory the people who has strong belief just world provide be motivated to defend their belief when they encounter any evidence of injustice McParland (2011). They might find a positive ex planation for injustice that is occurred and incrimination themselves. The reviewed study also agreed that justice beliefs in the recruited sample helped to cope with pain saturation and disability. Mrs Alice believed that she would receive a fair advent from health professionals except she see unfairness and injustice with the handling. It is interesting to note that the way she attempt to defend her feeling they didnt understand me properly. The reaction with injustice might not be the same in chronic pain sufferers.The chronic pain sufferer who perceives injustice or unfairness crumb influence their physical and mental health. This is also proposed in Perceived Unfairness Model, Jackson et al. (2006). See appendix 4 for perceived unfairness model. The recurrent episodes of perceiving unfairness (ie. Micro Agressions) arouse be coupled with helplessness, lack of control and compromise to physical health, (Jackson et al. 2006 Zempsky 2009). Sullivan et al. 2008 Sullivan et al.2009 also reported that perceived injustice has an impact on pain callousness in samples later muskuloskeletal injury. Based on hierarchy of evidence the strength of evidence achieved for this is aim 2b. So there is a need for further stronger studies to elucidate the role of justice beliefs in psychological distress, pain variables and disability.McParland et al. (2010) conducted a study to investigate the impact of justice and injustice in context of everyday intent of a chronic pain sufferer. The samples from general practice recognized chronic pain as a major problem in United Kingdom. The participants recruited from different socio-economic areas upper (n=5), middle (=4), lower (n=6) to explore the impact of justice and injustice from different viewpoint. The study examined injustice related concepts same(p) fairness, deservingness and entitlement. The finding from the study is presented in Table 2.Table2The main findings from McParland et al. (2010)-The justice relate d issues in chronic pain sufferer influenced by their social and personnel concerns and needs.-The concepts fairness, deservingness, entitlement of was dominated in participants and reflected in hurt of distri yetive justice principles equality and need.-The middle and lower socio economic class samples presented with egotistic construction of justice in equipment casualty of equality and need.-The chronic pain appeared as a social problem as much as a medical problemThis study was conducted, as a semi-structured interview by the interviewer, which could perceive c ruin feelings of the participants that may not be possible in self-report questionnaire. It is expenditure mentioning that the study carefully examined the mental circumstance of the participants and ensured the appropriateness of samples for interview. The justice beliefs, psychological distress and pain variables are interrelated McParland and Knussen (2010). Choosing the appropriate study sample is essential to ac hieve accurate and trusted study results. The sample size of this study was small (n=15) would affect the validity of the study. More over the recruited sample were mingled with ages 18-65. McParland and Knussen (2010) reported that people get strong personal and general beliefs when they get older. So inclusion of these age groups (18-65) could affect the rigor of the study and validity of result.The study was exploring the ideas of injustice in chronic sufferer based on their socio-economic classes. The chronic pain sufferers from different socio-economic classes evaluated injustice based on their on social concerns and needs. The sample response highlighted that chronic pain sufferers are confront social issues which might ascribable to injustice, that could contributing to their chronic spirit of pain. So chronic pain should guide as a social problem as much as medical problem. Social issues plenty cause chronic pain or chronic pain can cause social issues. The heath care professionals can play a role to minimize the injustice from medical filed and they also can play a role to minimize the chronic pain too.McParland et al. (2010) highlighted that chronic pain sample experienced social issues due to injustice. In Mrs. Alice model she has the right to get appropriate treatment but her self-sufficiency has been removed and felt unfairness. The experience of unfairness and unrelieved pain would make an impact of her family finance and employment. These factors also costs disability care and benefit system. So there is a need to uphold ethic principle, which is the duty of care to protect the patient from harm (Non-maleficence). The appropriate pain management respects the ethic principles, which included autonomy, non-maleficence, fairness and duty of care.McParland and Knussen (2009) presented a research report after conducted a second variant for the above study, which aimed to explore the justice related concept in chronic pain using Q methodolog y. The sample included chronic pain sufferers (n=33), spouses (n=9), health professional lecturers (n=15) and members of normal (n=22). The participants are provided a grid with 47 comments ranging from +5 to -5. See appendix 5 for grid. In Q factor summary eigen values 1 represented participants with akin concepts nearly injustice related to chronic pain. This study analyse six factors with eigen value 1. See slacken 3 for analysed factors. Participants expressed concepts of injustice in related to chronic pain in terms of blame, using and perceive neglect of need after Q factor abridgment.Table3McParland and Knussen (2009,p.1-4)The factors emerged after Q factor analysis1) Pain is normal. Its not almost injustice2) Pain is awful. Its societys fault3) Chronic pain is not your fault, but it is your responsibility to address it4) Its not fair. There should be a cure for pain5) If you are cursed enough to suffer chronic pain, you deserve help6) There is hope that the injustic e of chronic pain will be rectified.There are some good points some this study. The statistical analysis was presented in a clear and meaningful way. The study employ Q methodology, which assess the subjective viewpoints effectively like emotional state experience, stress, satisfaction etc. , Noori (2008). So the Q methodology was an appropriate method to find the participants view about injustice that increases internal validity and maximise the result strength for the study. One of the light(a) points in this study was that the chance of selection bias as the study sample was recruited from primary, secondary care, support group and public from United Kingdom. The method of sample selection might extract data based on nations goal and beliefs. The beliefs could be influence by cultural and educational factors, also differ in different ethnic populations Sloan et al. (2008). Thus recruiting sample from specific population could limit extrapolating the results into general popu lation. But will promote applicability of this study to UK population. The chronic pain sufferer from the study sample expressed concepts regarding injustice as blame development and perceived neglect of need. McParland and Knussen (2009) reported that the sufferers perceived injustice when they perceived something wrong, might be about pain or related to pain management or lack of acceptance from society or influence pain in everyday life. Miler (2001) also reported that people perceives injustice when they go with sufferings that would originate from an undeserved manner. The reflection of this statement could find from Mrs. Alices case when she perceived unfairness in her treatment.The life with chronic pain may lead to significant loss to finance, employment and independence (Harris Barton 2003). These losses can be permanent or temporary, Evans et al. (2001). Its a human tendency that putting blame on others when they feel a discrepancy in their life. The chronic pain suffe rer who blames others for their situation could experience more depression, stress and weak response to treatment, Sullivan et al. (2008). Sullivan et al. (2008) also reported that when chronic pain patients perceive injustice they may boil down on injustice happened rather than their treatment or rehabilitation processes.According to hierarchy of evidence utilise in this assignment, this research report achieved take 2c. This research is still continuing, awaiting more interpretation and analysis related to concepts of injustice among chronic pain sufferers. In coming(prenominal) more evidence-based studies should be considered to revel the complex nature of injustice in chronic pain sufferers.Zempsky (2009) presented an article, which was reinforcing the importance of fostering trust and justice in the treatment of chronic pain conditions. The article discussed a case of a 19-year-old man with sickle cell distemper presented with progressive leg and back pain. The patient app eared in emergency department with pan score 9-10 but appeared in a relax manner. He was using headphone and singing songs. The perceived disbelief by clinical staff sent him into waiting room and received requested dose of morphine with discredit and disdain after several hours. In this case the clinical staff stigmatised the patient as a drug seeker or drug abuser and neglected the intensity of pain. The patient who is in pain expects justice and fairness with their treatment, where they could express their problem. They anticipate that the health care staff will listen, understand, treat with empathy and approach them in a non-judgemental way, Serpell(2011). When patients feel injustice, the situation can link with psychological and physical abnormalities. In case of chronic pain perceived injustice can leads to stress severe pain and disability, Zempsky (2009). This article emphasised that pain is an individual experience, which a person sometimes not able to express as well a s they felt. There are chances for underestimating pain by health professionals even tough patients express the pain as they felt. Patients in chronic pain sometimes dont present with signs autonomic response (changes in ocellus pressure, pulse, sweating etc.) or behavioral features (moaning, wincing), Serpell (2011). The healthcare professionals should understand that severe pain with absence of physiological and behavioural changes is common in chronic pain conditions, Zempsky (2009).When we consider the case of Mrs Alice the physician might not make the pain appropriately. According to Notcutt (2011) there is lack of formal and day-and-night education regarding the pain and its management among health professionals. The American academy of code of ethics for pain management mentioned that the practitioners are responsible for maintain their professional competence and they are obligated to reveal their education, training, experience and continuous education to public. The pa in management field is fast growing and moving towards more effective treatment modalities. So it emphasis the importance of continuous education for all who works in this field. The practitioners who abstain from continuous education may cause harm to the patient ( maleficence), which is against the ethic principles. Mrs Alice might be poorly managed or abandoned due to lack of fellowship of chronic pain management among health professionals. The principles of ethics emphasize that the patients in chronic pain are entitled to get fairness in their treatment, which is beneficial for the patient by minimising harm (non-maleficence).The pain management practitioner or all working in for pain management should keep good apprehension of ethical framework regarding pain management. Notcutt (2011), presented structured criteria to face with clinical ethics situation. See appendix 7 for criteria. It is not always easy to deal with situation because of many reasons. The proper pinch of b asic principles will tackle the situation appropriately. Lauris et al (2005) presented an approach for ethical reasoning and a comparison of clinical and ethical reasoning. See appendix 8 9. According to hierarchy of evidence reviewed in this assignment this article achieved level 5. So there is a need for clinical experimental studies to reinforce these findings.Sullivan et al. (2009) conducted a study to evaluate the role of pain and perceived injustice in posttraumatic stress. The samples were 112 individuals who attended rehabilitation clinics after whiplash injuries. In logistic examination the perceived injustice appeared as a unique predictor for persistence of posttraumatic symptoms. The study emphasise the importance of effective interventions which is intending to manage perception of injustice in case of posttraumatic stress after whiplash injuries. See the results in table 4.Table4Sullivan et al. (2009,p.329)There are some weak points for this study. The sample recruit ed from rehabilitation clinics where they provide multidisciplinary rehabilitation programme for patients after whiplash injuries. It could be argued that these patients might already influence by the rehabilitation programme. So the sample might not represent a generalization of the study that result into a general population. The sampling also biased the inclusion of more young-bearing(prenominal) participants (76 women, 36 men), according to Sullivan et al. (2008) the men perceive more injustice than women. This would affect the internal validity of the result. The participants were asked to complete questionnaires to assess physical, cognitive and affective variables related to their posttraumatic stress. This would have been done better if the data collected based on structured interview as self-report questionnaires could naturally biased by peoples feelings at the time they complete it. Hence the method of data collection might bias the result and affect the result validity . The appellation of problems related to perception of injustice helps to identify the reason for suffering among chronic pain sufferers. Mrs. Alice perceived injustice might be due to poor interaction from practitioners or due to the attitude of negativity from practitioners. The interaction between practitioners and patients is imperative in management of chronic pain. all(prenominal) health care professionals should understand as part of patient treatment we have a duty of care to work towards their beneficence. The other issue might happen because of the attitude of negativity towards the patient from health care professionals. The negativity could develop due to patients appearance (eg. Obesity) or due to behaviour. The health care provider should understand listen and provide them justice in their treatment and uphold the principle of duty of care. Based on hierarchy of evidence used in this assignment, the strength of evidence achieved for this study is level 2b. Further st udies should be considered based on weak points of the present study.ConclusionThe people who believes in just world uphold the concept that they live in a world where people generally get what they deserve. Lerner and Millier (1978,p1030). The people who have justice beliefs could be able to pursuits long-term goals and maintain physical and psychological well being, (Kathleen and Claudia 2005 Laurin et al. 2011 Dalbert 2002). McParland and Knussen (2010) conducted a cross sectional study and reported that justice beliefs have influence in experience of chronic pain and pain behaviours. The study turn up that strong justice beliefs are beneficial for psychological well being and helped to cope with pain intensity and disability. The also reported that older people uphold stronger justice beliefs and experience less pain. Human beings perceive injustice normally when they expose to a situation primarily characterised by violation from human rights or to challenge just world beliefs , Fetchenhauer and Huang (2004). According to just world theory the people who has strong belief in just world motivated to defend their belief when they encounter any evidence of injustice, McParland (2011). The chronic pain sufferers who perceive injustice or unfairness can influence the physical and mental health (Jackson et al.2006 Sullivan et al.2008 Sullivan et al.2009 zempsky2009). Mc Parland et al. (2010) reported that justice related issues in chronic pain sufferers influenced by their own social and personal concerns and needs. McParland and Knussen (2009) reported that the participants expressed concepts regarding injustice related to chronic pain in terms of blame, victimisation and perceived neglect of need.The case of Mrs. Alice highlighted that she perceived unfairness in her treatment. The reason for perceived unfairness could be the attitude of health professionals. It is essential to analyse the route cause of this attitude in order to put on efficient pain manage ment among chronic pain sufferers. Some of the problems could be poor interaction between practitioners and patients or could be a attitude of negativity towards the patient from health care professionals or lack of individualised care plan for pain management or lack of knowledge to manage the pain, Notcutt (2011). According to Notcutt (2011) there is lack of formal and continuous education regarding pain and its management among health professionals. The appropriate pain management respects the ethic principles which includes autonomy, non-maleficence , fairness and duty of care. The reviewed studies proved that justice beliefs and perceived injustice are relevant among chronic pain sufferers. So it would be necessary to conduct more experimental studies to find more about role of perceived injustice and justice beliefsamong chronic pain sufferers. The proper understanding of these subjects would be morehelpful for efficient management plan for chronic pain sufferers.6 ReferencesD albert,C. 2002 Beliefs in a Just World as a Buffer Against Anger. Social Justice Research, 15(2), pp.123-145.Dawson A 2004 asthma in the Australian indigenous population a review of the evidence. The international electronic journal of rural and remote health research. cited 18th November 2009 Available from internet Evans, T. H., Mayer, T. G. and Gatchel, R. J. 2001 Recurrent disabling work-related spinal disorders after anterior injury claims in a chronic low back pain population. Spine, 1(3), pp.183-189.Fetchenhauer, D. and Xu, H. 2004 Justice sensitivity and diffusing(prenominal) decisions in experimental games. Personality and Individual Differences, 36(5), pp.1015-1029.Hafer, C. 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AppendicesAppendix 1Hierarchy of evidenceHierarchy of evidencelevel of EvidenceDescription1a domineering review of randomised, controlled clinical trials (RCT)1bIndividual randomised controlled clinical trial1cAll or none2aSystematic review of cohort studies2bIndividual cohort study (including low-quality RCT)2cOutcomes research3aSystematic review of case-control studies3bIndividual case-control study4Case series, poor quality cohort and case-control studies and reviews5 in force(p) opinion without explicit critical appraisalAppendix 2 Framework for critiquing quantitative research (after Rees 1997) center onIn broad terms what is the theme of the article? What are the key word s you would file this under? Are the key words in the title a clue to the direction? How important is this focus for clinical practice?BackgroundWhat argument or evidence does the researcher provide that suggests this topic is worth exploring? Is there a critical review of previous research on the subject? Are the gaps in the literature or inadequacies with previous methods highlighted? Are local problems or changes that justify the study presented? Is there a trigger that answers the question why did they do it then?Terms of referenceDoes the researcher state terms of reference? This will usually start with the word to e.g. the aim of this research was to examine/determine/ oppose/establish/etc. In the case of clinical research there may only be a statement of the hypothesis or hypotheses that the researcher(s) wished to test. Is it possible to identify dependent and independent variables Remember level 1 questions will not have both, neither will a correlation study. Are there con cept and operational definitions?Study designWhat is the broad research approach? Is it experimental? Descriptive? save research or audit? Is it quantitative or qualitative? Is the study design appropriate to the terms of reference/hypothesis/research question?Data collection methodsWhat tool of data collection has been used? Has a single method been used, or triangulation? Has the author addressed the issues of reliability and validity? Has a pilot burner study been conducted? Have strengths and limitations been recognised by the author?Ethical considerationsWere the issues of informed consent and confidentiality addressed? Was any harm or discomfort to individuals balanced against benefits? Did a local ethics committee consider the study?