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11 Mar 2024,2:20 PM
My Experience with Chronic Pain Management
Healthcare providers are trusted to provide effective and efficient healthcare. The same can be said of therapeutic practitioners like physical therapists who specialize in restoring movement and function to individuals affected by injury, illness, or disability. These individuals can design a customized exercise program to improve strength, flexibility, and mobility, especially for someone experiencing chronic pain after surgery. Physical therapists may also alleviate pain and improve tissue healing by utilizing manual therapy techniques, such as massage or joint mobilization, during my internship at a non-profit clinic with more than 50 years of experience in healthcare provision. The establishment boasts more than 100 years of healthcare service through providing comprehensive, compassionate care to patients from around the world, using a collaborative approach among healthcare professionals from various specialties to ensure the best possible outcomes for patients. I got to serve JJ, a 35-year-old army veteran with a femoral fracture history. He got the injury after driving over a landmine in one of his missions. JJ had come in seeking an improvement to his movement after an Open Reduction and Internal Fixation (ORIF). As such, my work as a physical therapist intern at a non-profit medical facility displays the expertise expected of a therapeutic practitioner in promoting healthcare delivery. To ensure confidentiality, the patient will be referred to as JJ throughout the paper (Tegegne et al., 2022). As such, this essay will examine the healthcare aspects of JJ, an individual with whom I have had the experience of serving during their stay at my place of work, by examining five components of his healthcare provision: communication, partnership, patient safety, pharmacology, and self-evaluation.
Communication
Communication, exchanging or imparting information via writing, speech, and other mediums like behavior or signals, is critical to protecting patients from harm caused by misunderstandings. While working with JJ, our interactions began with my introduction, where I stated my full name and showed my desire to want to help. I was careful to project myself as a healthcare partner with concern over the social and emotional needs of the patient, as opposed to seeing patients as mere symptoms and tasks. Given JJ's traumatic injury and surgical history, I made sure to provide detailed explanations for every action taken during our sessions. Whether it was examining his affected leg for range of motion or explaining the rationale behind specific exercises, I ensured JJ understood the purpose and expected outcomes. This approach aimed to reassure him and alleviate any concerns or anxieties he may have had.
Despite my efforts to communicate clearly, I noticed that JJ sometimes misinterpreted my messages. He tended to hear only what he wanted and simplified unfavorable information, potentially overlooking important details. To address this, I implemented a teach-back strategy to confirm my communication effectiveness. I could gauge his understanding and clarify any misconceptions by asking JJ to summarize the information I provided. I empathized with JJ by putting myself in his shoes and anticipating his reactions to the information shared (Ali, 2017). Drawing from my knowledge of his case, including his military background and the traumatic nature of his injury, I tailored my communication approach to meet his needs. I imagined how I would communicate with my brother in a similar situation, considering the impact of reassuring words to alleviate unnecessary worry.
Throughout our interactions, I actively contributed to shared decision-making, goal-setting, and planning with JJ, his family, and other healthcare professionals involved in his care. We created a personalized rehabilitation plan that addressed JJ's unique needs and goals by fostering open communication and collaboration. This approach facilitated safe discharge and transitions and empowered JJ to actively participate in his recovery journey.
Partnership
The partnership between the patient and healthcare provider through patient involvement is a valuable aspect of person-centered care (PCC) to increase patients’ sense of responsibility and control, making it another component of JJ’s healthcare condition. While serving JJ, I prioritized building a close relationship with JJ by engaging in open and respectful conversations. I took the time to listen attentively to his concerns and understand his physical, psychological, and social needs. By perceiving JJ holistically, I gained insight into his unique situation and tailored my approach accordingly.
During our interactions, I posed straightforward questions and refrained from making judgments, creating a supportive environment where JJ felt comfortable expressing himself. I provided unharried and immediate support, ensuring he felt valued and heard (Chipidza et al., 2015). We developed a shared understanding of his condition and treatment goals through collaborative discussions. I also actively involved JJ in decision-making, encouraging him to share his needs, wishes, and preferences. We co-created a personalized health plan that addressed his concerns and aligned with his values. By facilitating open dialogue and mutual respect, I empowered JJ to manage his health and well-being actively.
Furthermore, I facilitated JJ's engagement by providing comprehensive information about his diagnosis, treatment options, and care plans. Through ongoing communication and feedback, we iteratively refined our approach to meet JJ's evolving needs and preferences (Wolf et al., 2017). I also encouraged JJ to ask questions, contribute to the care planning process, and take responsibility for his health.
Patient Safety
Patient safety is the move to ensure that patients are protected from any preventable and avoidable harm. According to the World Health Organization (2023), patient safety is the absence of preventable harm and the reduced risk of unnecessary harm to a minimum. For JJ, patient safety involved the utilization of smart electronic health records, broader tool adoption, minimizing unnecessary movements, and broader adoption of nonpharmacological interventions. As his physical therapist intern, I employed EHR to track JJ's past medications, including those that have caused problems in the past. This deployment enabled me to make more informed decisions regarding his current and future treatment plans, minimizing the risk of adverse drug events and potential medication errors. By having access to JJ's comprehensive medical history and medication profile at my fingertips, I could tailor more robust choices in managing his condition and minimizing the risk of adverse drug events.
Telemedicine played a crucial role in ensuring JJ's safety and convenience in our interaction. I provided JJ with an online schedule for communication, allowing for remote monitoring of his condition and progress. This approach minimized unnecessary movements from his residence to the healthcare facility, reducing the risk of adverse events associated with travel and unfamiliar environments (Bates & Zebrowski, 2022). By leveraging telemedicine, JJ could receive timely support and guidance without needing frequent in-person visits, thus improving his overall quality of life. Recognizing the importance of minimizing unnecessary movements for JJ's safety, we agreed to avoid unnecessary commutes as a means of reducing the risk of adverse drug events. By limiting JJ's exposure to unfamiliar environments and reducing unnecessary travel, we aimed to optimize his safety and well-being.
To further protect JJ from avoidable medication errors and adverse events, I recommended nonpharmacological interventions for managing his condition. These interventions, such as exercise therapy, manual therapy, and psychological support, aim to address JJ's pain and functional limitations without solely relying on pain medication. By adopting a holistic approach to care, we aimed to reduce JJ's dependence on pharmacological interventions while promoting his overall health and well-being.
Pharmacology
Pharmacology is the study of drug effects on living system functions to understand the pharmacodynamics and pharmacokinetics of drugs and how their influence can be implemented in treating various healthcare conditions. In JJ's case, pharmacology involves the assessment of drugs used by JJ and their potential benefits or hindrance to his health. After his surgical procedure, JJ was prescribed morphine per WHO's analgesic ladder, which advises the most suitable analgesic following the pain severity (Anekar et al., 2023). Morphine, with an affinity for delta, kappa, and mu-opioid receptors, can bind to the central and peripheral nervous systems' mu-opioid receptors. As a result, the nociceptive transmission is reduced through morphine’s activation of descending inhibitory pathways of the central nervous system (CNS) and inhibition of the nociceptive afferent neurons of the peripheral nervous system (PNS). Nonetheless, extensive research reveals adverse effects of its use, like constipation, central nervous system depression, nausea, vomiting, and urinary retention, to name a few.
In JJ’s case, he reported feeling constipated, which is a result of the slowing of the movement of the gastrointestinal tract, leading to difficulty passing stools. He also shared feeling drowsy and sedated, which made it difficult for him to concentrate and perform activities requiring mental alertness (Murphy et al., 2023). From this description, I illuminated the potential of morphine to result in unwarranted health outcomes. I also communicated that his history of substance abuse put him at risk of addiction to morphine. In the end, we were able to come up with a mix of exercise and manual therapy as an alternative form of pain management (Coronado, 2017). These exercises were meant to prescribe exercise programs and manual therapy techniques like massage to alleviate his pain.
Self-evaluation
Throughout my interaction with JJ, I improved the patient-professional relationship by addressing his information needs, viewing him as a whole individual, and promoting concordance on par with the provision of patient-centered care. As such, I was able to achieve patient-centered care through an examination of my personal traits, especially my emotional intelligence (EI), which has increasingly been linked to influencing healthcare provision to provide an effective practice. According to Birks & Watt (2007), EI is a set of verbal and non-verbal abilities that promotes the generation, recognition, expression, and understanding of emotions for the provision of thinking and action guidance and ensures a successful coping mechanism with the pressures and demands of the environment.
Therefore, as a physical therapist with high emotional intelligence, I was adept at assessing and understanding the emotions of JJ’s chronic pain. I recognized that chronic pain not only affects the physical well-being of the patient but also their emotional and psychological state. I established a trusting and supportive therapeutic relationship by actively listening to JJ's concerns, validating his experiences, and empathizing with his struggles. My emotional intelligence also made it possible to recognize that different patients may respond differently to treatment modalities and interventions based on their emotional reactions and personal preferences. For example, I could ascertain that JJ was more receptive to certain exercises, manual therapies, relaxation techniques, or mindfulness-based interventions. By understanding JJ's emotional responses to treatment, I was also able to tailor an approach that better meet his individual needs and preferences.
Since effective communication is essential for building rapport with patients and facilitating shared decision-making in the management of chronic pain, I was able to impose skilled, compassionate, empathetic, and non-judgmental communication with JJ. I was also able to actively listen to his concerns, provide clear explanations of treatment options, and involve him in the decision-making process. By fostering open and honest communication, I helped empower JJ to take an active role in his own care and improve treatment adherence. As a result, I learned to reflect on my emotional intelligence and how it impacts my patient interactions. I recognized areas for improvement, such as developing better self-awareness, regulating their own emotions during challenging patient encounters, or enhancing my ability to empathize with patients' experiences. By engaging in ongoing self-reflection and professional development, I will continue enhancing my emotional intelligence and improving the quality of care I can provide patients.
In conclusion, my supervision of JJ's chronic pain management during his visit to my place of work by examining five components of his healthcare provision: communication, partnership, patient safety, pharmacology, and self-evaluation, reveals valuable insights into the challenges and complexities of caring for such patients. As such, I was able to illuminate the significance of actively listening to patients, demonstrate a commitment to patient-centered principles and partnership, and highlight the importance of prioritizing patient safety, particularly in individuals with complex healthcare needs. I also demonstrated the importance of understanding the potential benefits and risks associated with medication use and revealed the importance of self-awareness, empathy, and self-regulation in providing compassionate and patient-centered care.
References
Ali, M., 2017. Communication skills 1: benefits of effective communication for patients. Nursing Times [online]; 113: 12, 18-19. https://www.nursingtimes.net/clinical-archive/assessment-skills/communication-skills-1-benefits-of-effective-communication-for-patients-20-11-2017/
Anekar, A.A., Hendrix, J.M. and Cascella, M., 2023. WHO analgesic ladder. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK554435/
Bates, D.W. and Zebrowski, J., 2022. Medication safety in nursing home patients. BMJ Quality & Safety, 31(12), pp.849-852. https://qualitysafety.bmj.com/content/qhc/31/12/849.full.pdf
Birks, Y.F. and Watt, I.S., 2007. Emotional intelligence and patient-centred care. Journal of the Royal society of medicine, 100(8), pp.368-374. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1939962/
Coronado, R.A. and Bialosky, J.E., 2017. Manual physical therapy for chronic pain: the complex whole is greater than the sum of its parts. Journal of Manual & Manipulative Therapy, 25(3), pp.115-117. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5498791/pdf/yjmt-25-115.pdf
Chipidza, F.E., Wallwork, R.S. and Stern, T.A., 2015. Impact of the doctor-patient relationship. The primary care companion for CNS disorders, 17(5), p.27354. https://legacy.psychiatrist.com/read-pdf/27354
Murphy, P.B., Bechmann, S. and Barrett, M.J., 2018. Morphine. https://www.ncbi.nlm.nih.gov/books/NBK526115/
Tegegne, M.D., Melaku, M.S., Shimie, A.W., Hunegnaw, D.D., Legese, M.G., Ejigu, T.A., Mengestie, N.D., Zemene, W., Zeleke, T. and Chanie, A.F., 2022. Health professionals' knowledge and attitude towards patient confidentiality and associated factors in a resource-limited setting: a cross-sectional study. BMC medical ethics, 23(1), p.26. https://bmcmedethics.biomedcentral.com/counter/pdf/10.1186/s12910-022-00765-0.pdf
Wolf, A., Moore, L., Lydahl, D., Naldemirci, Ö., Elam, M. and Britten, N., 2017. The realities of partnership in person-centred care: a qualitative interview study with patients and professionals. BMJ open, 7(7), p.e016491. https://scholar.google.com/scholar_url?url=https://bmjopen.bmj.com/content/bmjopen/7/7/e016491.full.pdf&hl=en&sa=T&oi=ucasa&ct=ufr&ei=Dp7rZbfjMJuZ6rQPuu6AiAo&scisig=AFWwaebp5x1c-zC8l-69RIf1M4st
World Health Organization. (2023). Patient safety. Who.int; World Health Organization: WHO. https://www.who.int/news-room/fact-sheets/detail/patient-safety