Mahfudh Salma Said
Obstetric and Pain Management Certificates, PO Box 9, Code 116, Mina Al Fahal, Sultanate of Oman.
J Pediatr Hematol Oncol. 2011 Oct;33 Suppl 2:S146-8. doi: 10.1097/MPH.0b013e318230dfd8.
Nurses spend more time with patients than any other member of the healthcare team. They play a critical, active and very important part in controlling cancer patients' pain and alleviating suffering. In controlling cancer pain the nurse needs to understand the psychological state of the cancer patient, cancer pain, cancer pain treatment, deleterious effects of unrelieved cancer pain and patient's socio cultural background. She needs to understand that there are two types of pain, nociceptive and neuropathic pains and that 80% of the cancer patients in pain could have 2 or more than 4 different pains at the same time. Nurses' role in controlling cancer pain include believing the patient, assessing pain, identifying the root of the problem, planning the care, administering medication, evaluating effectiveness, ensuring good pain control and individualizing treatment. It also includes nursing interventions such as giving tender nursing care, preventing pain, educating, advocating, communicating, comforting, supporting, and counseling the patient. The nurse must use both pharmacological and non pharmacological treatments to individualize treatment, know all the drugs that are used for the treatment of Cancer Pain, how these drugs relieve pain and what their side effects are. She must use the WHO guidelines to treat pain and must choose the right drug, right dose, given at the right times, with the right intervals and to the right patient. She must evaluate effectiveness of treatment, give PRN doses for breakthrough pain and recommend for specific changes. The role of the nurse is to anticipate the patient's pain needs, advocate for the patient for what feels appropriate for him within his cultural context and incorporate the patient's belief. The nurse can physically relieve pain by promoting comfort, support painful area, gentleness in handling the patient and use nursing treatments. The nurse can recommend physiotherapy, (TENS)/Acupuncture, Occupational therapy, spiritual support, social worker, psychologist, and psychiatrist to address different types of pain. She must relieve both pain and other symptoms. and ensure that the patient has good sleep. She must show kindness, compassion and empathize with him. Each patient is unique the process of controlling cancer pain develops differently each time. The nurse's role is challenging, she must demonstrate that she is not only clinically proficient but culturally competent. She has to use creative assessment skills, clinical judgment, psychological support, advocacy and good communication skills in such a way that the contribution of drugs, nursing care, nursing and other non pharmacological treatments are maximized to the patient's benefit. When evaluating the overall care the nurse must find out what is the total effect of all approaches taken to relieve pain. Nurses can make a difference between a patient who suffers until the last breath of his/her life and a patient who is comfortable and dies pain free and in dignity.
护士与患者相处的时间比医疗团队中的其他任何成员都要长。他们在控制癌症患者的疼痛和减轻痛苦方面发挥着关键、积极且非常重要的作用。在控制癌症疼痛方面，护士需要了解癌症患者的心理状态、癌症疼痛、癌症疼痛治疗、未缓解的癌症疼痛的有害影响以及患者的社会文化背景。她需要明白有两种类型的疼痛，即伤害性疼痛和神经性疼痛，并且80%的疼痛癌症患者可能同时有两种或四种以上不同的疼痛。护士在控制癌症疼痛中的作用包括相信患者、评估疼痛、找出问题根源、制定护理计划、给药、评估效果、确保良好的疼痛控制以及个性化治疗。这还包括护理干预措施，如给予体贴的护理、预防疼痛、教育、倡导、沟通、安慰、支持和为患者提供咨询。护士必须使用药物和非药物治疗方法进行个性化治疗，了解所有用于治疗癌症疼痛的药物、这些药物如何缓解疼痛以及它们的副作用是什么。她必须遵循世界卫生组织的疼痛治疗指南，必须选择正确的药物、正确的剂量、在正确的时间、以正确的间隔给予正确的患者。她必须评估治疗效果，为突破性疼痛给予必要时的剂量，并建议进行具体的调整。护士的职责是预测患者的疼痛需求，在患者的文化背景下为其争取适合他的东西，并融入患者的信念。护士可以通过促进舒适、支撑疼痛部位、轻柔地护理患者以及采用护理治疗方法来从身体上缓解疼痛。护士可以推荐物理治疗、（经皮电刺激神经疗法）/针灸、职业治疗、精神支持、社会工作者、心理学家和精神科医生来应对不同类型的疼痛。她必须缓解疼痛和其他症状，并确保患者有良好的睡眠。她必须表现出友善、同情并与患者产生共鸣。每个患者都是独特的，每次控制癌症疼痛的过程发展也不同。护士的角色具有挑战性，她必须证明自己不仅在临床方面精通，而且在文化方面也有能力。她必须运用创造性的评估技能、临床判断力、心理支持、倡导和良好的沟通技巧，以使药物、护理、护理和其他非药物治疗对患者的益处最大化。在评估整体护理时，护士必须弄清楚缓解疼痛所采取的所有方法的总体效果是什么。护士可以让患者在生命的最后一刻仍遭受痛苦与让患者舒适、无痛且有尊严地离世之间产生差别。
