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A learning contract developed to increase understanding of the management of post-operative pain.

A learning contract developed to increase understanding of the management of post-operative pain.

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An essay for the 2011 Undergraduate Awards (Lecturer Nomination) Competition by Emer O'Donovan. It is nominated by Lecturer Maria Bailey of University of Limerick in the category of Nursing & Midwifery
An essay for the 2011 Undergraduate Awards (Lecturer Nomination) Competition by Emer O'Donovan. It is nominated by Lecturer Maria Bailey of University of Limerick in the category of Nursing & Midwifery

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Published by: Undergraduate Awards on Sep 01, 2012
Copyright:Attribution Non-commercial

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10/27/2013

 
A learning contract developed to increase understandingof the management of post-operative pain
 
Abstract
This paper presents a learning contract constructed for an assessment of learning within apain management module. The student identified their learning need, selects appropriatestrategies and tools for learning and then presents evidence of the learning that has occurs. Onconclusion of the contract the student evaluates their learning. This learning contract presentsan exploration of the management of post-operative pain.
Introduction
A learning contract can be defined as an agreement between a learner and an educator thatspecifies in detail the: learning objectives, the resources and strategies required toaccomplish the objectives, the evidence required to demonstrate the objectives have beenaccomplished and the specific criteria for evaluation (Knowles, 1986). This type of learninghelps to facilitate and promote adult learning, and was developed by Knowles (1986). Thisapproach uses problem-solving techniques, which aims to empower the learner (Banning,2005). The use of learning contracts allows the student to develop skills necessary to becomea lifelong learner (Solomon, 1992). It has been suggested that learning contracts increasemotivation and excitement in learning, allow greater flexibility, promote use of a greatervariety of resources and learning strategies and assist in establishing the proper climate forlearning (Tomkins & McGraw, 1988, Knowles, 1986). However, not all student nurses maybe equipped with self directing learning skills (Smedley, 2007), so this is a limitation to thistype of learningExperiencing post operative pain is one of the most common concerns among surgicalpatients. Pain management remains a major challenge for nurses caring for post-operativepatients. Studies report that 50-75% of surgical patients experience moderate to severe post-operative pain (Mac Lellan, 2004). In undertaking this learning contract my aim is to developmy knowledge and understanding of the physiology of pain, the types of pain experienced bythe post operative patients. I also aim to explore pain assessment and consider the differentforms of assessment scales that are used. The pharmacological and non-pharmacologicalmethods of pain management will be evaluated and barriers to effective pain management willbe briefly reviewed.
 
2To undertake my learning contract, I gathered information from a range of sources including,peer reviewed journal articles and books from my local and college library. I searchedwebsites and data bases for example CINHL and Medline. In particular I found the article byChaturvedi and Chaturvedi, (2007) Post-operative pain and its management, to be veryhelpful I arranged a meeting to speak with the Clinical Nurse Specialist in pain managementin the hospital I work in and this was invaluable in assisting me to develop my learning andapply it to practice in post-operative pain management.
Evidence of Accomplishment
Physiology of pain
Pain has been recognised as a highly personal and subjective phenomenon unique to theindividual (MacKintosh, 2007). The most commonly recognised definition of pain is that of the International Association for the Study of Pain (1979) {cited in IASP website 2010}: 'anunpleasant sensory and emotional experience associated with actual or potential damage...
.Nociceptors are the receptors for pain and they are free nerve endings found in every tissue of the body except the brain (Tortora and Derrickson, 2007). These nociceptors can becomeactive due to noxious stimuli of a thermal, chemical or mechanical nature (Figure 1).
Figure 1.
 
 Illustrating the receptor field and nerve fibres involved in perception of nociceptive pain.
There are two types of pain called somatic and visceral pain \these can be identified by theirlocation and by the type of pain that stimulation causes (Table 1).
mechanical A Deltasomatic DorsalHornNociceptive pain thermal CFibresTheSpinalChordvisceralchemical A Beta
 
3
Type of Pain Somatic VisceralIdentification of pain
Easily located Location generalized
Location of pain
Skin, deep tissue Thoracic and abdominal viscera
Symptoms of pain
Dull, aching, throbbing, sore Stretched
Eg of pain
Toothache Tumour or referred pain
Table 1: Properties of somatic and visceral pain
A delta and C Fibres are sensory nerve fibres involved in the perception of pain. (Table 2)
C Fibres A Deltas
Soreness, dull, aching Fast, sharp, pinching, prickingUnmyelinated Myelinated0.5-2 metres/sec 6-120metres/secSmaller diameter Larger diameter
Table 2: Properties of A Delta & C Sensory Nerve Fibres
Both types of sensory nerve fibres meet at the Dorsal Horn of the Spinal Cord at lamina II andV along with A beta sensory nerve fibres.Stimulation of A beta nerve fibres evokes a different sensation i.e rubbing, and confuses thenociceptive pain messages at the dorsal horn of the spinal cord, before travelling to the brain.This theory is described by Melzack and Wall (1965) (Figure 2).
Figure 2: Illustrating the Pain Gate Theory (Melzack and Wall, 1965)
 Pain Gate Theory
A Delta Pinching, fast actingDorsal HornC Fibres Slow, dull, aching of the BrainSpinal Cord (Lamina 2)A Beta Rub
 – 
another sensation (message confusing the painSensation)Neuropathic pain is caused by damage to either the peripheral or central nervous systems.

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