Transcript Slide 1

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Geriatric Curriculum
End-of-Life Nursing Education Consortium
Session 5
Pain Management:
Non-Drug Interventions
Fairfield University
Quinnipiac University
School of Nursing ELDER Project
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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
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Non-Drug Techniques
Physical
• Massage
• Reflexology
• Cold
• Heat
• Positioning
• Exercise
• Aromatherapy
• Therapeutic Touch
• Reiki
• Acupuncture
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Psychological
• Distraction
• Relaxation
• Meditation
• Music
• Art Therapy
• Comfort Foods
• Guided Imagery
Observations Prior to Starting
Therapy
• Understanding of options
• Attitude and comfort
• Family interest and
availability
• Need for education
• Ability to participate
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Non-Drug Symptom Relief
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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
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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).
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Reflexology
1. reduce stress,
2. promote relaxation
and sleep,
3. improve
circulation, and
energize
4. reduce pain,
anxiety, nausea
and vomiting.
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Reflexology
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Reflexology
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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.
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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.
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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.
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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™!
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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
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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
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Aromatherapy
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Lavender -------------
Indications
• Insomnia/anxiety
• Agitation
Citrus -----------------
• Depression/grief
Cypress ---------------
• Transition
• Breathing difficulties
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Examples of Aromatherapy
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Essential oils
Hydrotherapy baths
Massage
Diffuser
Compress
Candles
Atomizer or spritzer
Anointing
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Therapeutic Touch
• Energy exchange
• Rebalancing
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Reiki
• Hands-on healing art
• Balances the biofield
• Strengthens the body to heal itself
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Acupuncture
• Needle placed in designated areas
• Releases energy blockages
• Licensed acupuncturist
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Distraction
Used to focus attention on
something other than pain. By
decreasing concentration on pain,
it becomes more bearable.
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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
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Relaxation
• Described as freedom from
physical and mental tension
• Relaxation techniques reduce
stress, muscle tension and
reduce pain
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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
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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
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Music
Decreases pain by:
• Providing distraction
• Reducing anxiety
• Prompting recall of pleasant
memories
• Interrupting the stress response
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Art Therapy
• Creative expression
• Uncover unconscious strengths
• Trained professional
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Comfort Foods
Assists in decreasing pain by:
• Providing distraction
• Evoking comforting memories
• Promoting relaxation and physical
calm
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Goals of Therapy
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Promote relaxation
Reduce stress
Reduce muscle tension
Decrease anxiety
Relieve pain & other
symptoms
• Reduce side effects of
the disease &
treatments
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• Improve sleep
• Decrease sense of
suffering &
abandonment
• Promote safety & trust
in caregivers
• Increase sense of wellbeing & control
regarding matters of
daily living & death
Activity: Building a Toolkit
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We can’t change the course of the illness, but
we can help patients through it with a gentle
and caring touch.
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References
City of Hope & the American Association of Colleges of Nursing, 2007; Revised,
2010. The End-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, CoInvestigator).
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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