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E L N E C Geriatric Curriculum End-of-Life Nursing Education Consortium

E L N E C Geriatric Curriculum End-of-Life Nursing Education Consortium. Session 5 Pain Management: Non-Drug Interventions Fairfield University Quinnipiac University School of Nursing ELDER Project. Objectives: Upon completion of this session, the participant will be able to….

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E L N E C Geriatric Curriculum End-of-Life Nursing Education Consortium

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  1. E L N E C Geriatric CurriculumEnd-of-Life Nursing Education Consortium Session 5 Pain Management: Non-Drug Interventions Fairfield University Quinnipiac University School of Nursing ELDER Project

  2. Objectives: Upon completion of this session, the participant will be able to… 1. List some non-drug therapies used to relieve EOL pain symptoms. 2. Describe special considerations and precautions for using specific non-drug therapies. 3. Develop a toolkit that reflects non-drug interventions used in your facility/agency to manage pain at EOL. Activity

  3. Psychological Distraction Relaxation Meditation Music Art Therapy Comfort Foods Guided Imagery Physical Massage Reflexology Cold Heat Positioning Exercise Aromatherapy Therapeutic Touch Reiki Acupuncture Non-Drug Techniques

  4. Observations Prior to Starting Therapy • Understanding of options • Attitude and comfort • Family interest and availability • Need for education • Ability to participate

  5. Non-Drug Symptom Relief

  6. Massage Decreases pain by soothing the skin and relaxing tense muscles Contraindications include: metatastic bones—massage can cause fractures of theses areas platelet count less than 35,000-40,000---can cause bruising blood clots---can create thrombus formation

  7. Massage Examples • Brief touch such as rubbing someone’s shoulder or handholding • A warm foot soak and rub • Wrapping feet in a warm, moist towel • Massaging a hand with warm lotion Keep in mind the type of pain the person is experiencing, and that certain types of pain may be relieved (arthritis), while others worsen by touch (neuropathic).

  8. Reflexology reduce stress, promote relaxation and sleep, improve circulation, and energize reduce pain, anxiety, nausea and vomiting.

  9. Reflexology

  10. Reflexology

  11. Applications of Cold • Reduces pain by: • numbing nerve endings • reducing muscle spasms • decreasing inflammation • Also decreases the desire to scratch areas that itch! .Avoid areas being treated by radiation, areas with poor circulation, and open wounds.

  12. Cold Examples • An ice pack to the neck and upper shoulders • Ice massage to the knee with a Dixie Cup™ • Ice cloth to the hip opposite the one that hurts Remember that applications of cold require a physician's order; application of heat and cold may be limited to licensed staff. Never use menthol-based products with heat as they can cause burns.

  13. Hot Applications • Relieves pain by reducing inflammation and soreness • Also decreases sensitivity to pain and increases blood flow to the skin Avoid heat if the pain increases. Think “warm” not “hot.” Keep a layer of material (pillowcase, towel) between the heat source and the skin. Remember that moisture increases the effect of both heat and cold.

  14. Heat Examples • Warm washcloth to head • Hot water bottle to abdomen • Jacuzzi™ bath You need a physician order for the use of heat/cold to manage pain. Avoid the use of menthol-containing products with heat as they can cause deeper heat absorption and burns. No Ben-Gay™!

  15. Positioning/Movement • Positioning eases pain by placing the body into postures that maintain or promote normal function of the muscles • Movement helps maintain or restore ease of function in joints, bones, nerves, and ligaments

  16. Positioning/Movement Examples • Use of full-length body pillow • Pillow between knees when lying on either side • Pretend to write the alphabet by using the feet – switch feet every 6 or 8 letters

  17. Lavender ------------- Citrus ----------------- Cypress --------------- Indications Insomnia/anxiety Agitation Depression/grief Transition Breathing difficulties Aromatherapy

  18. Examples of Aromatherapy • Essential oils • Hydrotherapy baths • Massage • Diffuser • Compress • Candles • Atomizer or spritzer • Anointing

  19. Therapeutic Touch • Energy exchange • Rebalancing

  20. Reiki • Hands-on healing art • Balances the biofield • Strengthens the body to heal itself

  21. Acupuncture • Needle placed in designated areas • Releases energy blockages • Licensed acupuncturist

  22. Distraction Used to focus attention on something other than pain. By decreasing concentration on pain, it becomes more bearable.

  23. Distraction Example • Compile a file of pictures • Have resident describe picture by: • Talking about the picture • Pretending they are in the picture • Telling a story about the picture • Choose a new picture as soon as their interest decreases in the current one

  24. Relaxation • Described as freedom from physical and mental tension • Relaxation techniques reduce stress, muscle tension and reduce pain

  25. Relaxation Examples • Put on headphones with a tape of calming music • Breathe in deeply; exhale slowly • Think of a calm setting or peaceful place that you’ve enjoyed visiting

  26. Meditation • Intentional self regulation of attention • Enhances concentration and awareness • Helps relieve physical and emotional pain • Promotes feelings of acceptance, well-being, and inner peace

  27. Music Decreases pain by: • Providing distraction • Reducing anxiety • Prompting recall of pleasant memories • Interrupting the stress response

  28. Art Therapy • Creative expression • Uncover unconscious strengths • Trained professional

  29. Comfort Foods Assists in decreasing pain by: • Providing distraction • Evoking comforting memories • Promoting relaxation and physical calm

  30. Promote relaxation Reduce stress Reduce muscle tension Decrease anxiety Relieve pain & other symptoms Reduce side effects of the disease & treatments Improve sleep Decrease sense of suffering & abandonment Promote safety & trust in caregivers Increase sense of well-being & control regarding matters of daily living & death Goals of Therapy

  31. Activity: Building a Toolkit

  32. We can’t change the course of the illness, but we can help patients through it with a gentle and caring touch.

  33. References City of Hope & the American Association of Colleges of Nursing, 2007; Revised, 2010. TheEnd-of-Life Nursing Education Consortium (ELNEC)- Geriatric Training Program and Curriculum is a project of the City of Hope (Betty R. Ferrell, PhD, FAAN, Principal Investigator) in collaboration with the American Association of Colleges of Nursing (Pam Malloy, RN, MN, OCN, Co-Investigator). Ferrell, B. & Coyle, N, (2010). Oxford Textbook of Palliative Nursing. New York: Oxford University Press, Inc. http://www.hov.org/dementia_programs.aspx (music video) Supported by DHHS/HRSA/BHPR/Division of Nursing Grant # D62HP06858

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