NURS 1008 Professional And Ethical Nursing Practice Considerations

egistered Nurses face ethical challenges on a regular basis and must be able to consider and reflect upon how these issues affect us both personally and professionally. Two articles have been provided to help you formulate your answer.

 

Students must address the following points in their essay:

 

1.  Consider the statement and discuss possible ethical issues using current literature including the two articles provided to support your discussion.

2.Reflect on how this statement may influence your professional nursing practice.

For a very long time now, opioids have been used across the globe as very effective pain treatment and management medications (Buse et al., 2012). The usage of opiates and opioid medications in the management of pain resulting from prolonged medical illnesses such as a migraine is by and large regarded as the standard of cure of the same globally. However, at the same time, the continued usage of opioids for pain management has elicited worldwide controversies leaving most healthcare practitioners with ethical dilemmas on how they are supposed to treat and manage their patients using the same. While scientific research has extensively proven that opiates and opioid medications such as Tramadol to be overly good in the management of chronic migraine, issues related to safety, abuse liability, effectiveness have rocked the medical profession (Maumus, 2015). Some opponents have openly advocated for its restriction while its proponents need it to receive a greater endorsement. This paper will extrapolate on the ethical issues surrounding the use of opiates and opioid medications in the management of chronic migraine besides reflecting on how this may influence my professional nursing practice.

The globe has undergone shifting interfaces of legitimizing opioids and reverting legitimization for fears of opening up doors for abuse and addiction from the same. These interfaces have advanced pain treatment dilemmas across the clinical community resulting in great uncertainties concerning the appropriate role of these drugs in chronic migraine management and treatment. Indeed, opioids undeniably play a critical role of easing patients’ pain (Alemdar, Pekdemir, & Selekler, 2007). This is especially the case when over the counter prescription of opiate-based medications are allowed in the management and treatment of migraines. In the past, deserving instances when these drugs could have been used to treat pain emanating from chronic migraine, cancer, general acute pain, and the end-of-life pain have indeed been denied usage due to addition concerns (Stein, 2013).

Chronic migraine is one of the deserving medical conditions for opiates and opioid medications according to the American Center for Disease and Control (CDC) guidelines (Dowell, Haegerich, & Chou, 2016). This assertion is in accordance with the International Headache Society (2018) description of episodes of chronic migraine. The body describes chronic migraine as instances when a person experiences persistent headache for a period of more than 15 days in a month over a period of 3 consecutive months with at least 8 days of acute migraine pain. The World Health Organization (WHO) has indeed appreciated the impacts and implications of chronic migraine globally categorizing it at a similar level as dementia and acute psychosis (Huang, et al., 2015).

Following these observations, in as much as the usage of opiates and opioid medications in chronic migraine treatment is bound to tag along with abuse and addiction challenges, its usage is indeed a relief to chronic migraine patients. Reuben, et al., (2015) posit that concerns that addiction is a frequent result of opioids may more or less be attributed to confusion over the very terminology and failing to appreciate that chronic pain and addiction are actually of multifactorial etiology. Moreover, ethical dilemmas in its usage may emanate from the failure to accurately define the distinction between physical dependence and addiction. Most opioids administered patients with chronic migraine pain have been established to act differently from those who abuse the same even though pain and addiction are not mutually exclusive.

Behavioral disturbances have been deduced to be comorbid addictive disorder to some patients under opiates and opioid medications. Tepper (2012) observe that the risk of using opioids in the treatment of headache far outweigh its advantages. He insists that though opioids may advance significant pain relief in the short term, the same may not be sustained in the long term posing the risk of overdependence, overdose and subsequently addiction.  Charles (2018) indicated that opioids usage poses the risk of death, addiction, overdose, and other major side effects.

The biggest ethical dilemma facing healthcare practitioners including me lie with figuring out how exactly opiates and opioid medications are supposed to be administered without adversely harming chronic migraine patients. If indeed opioids have the capacity of minimizing chronic migraine pain significantly, then it is not prudent to stop using them just because of an ethical dilemma impacting their usage (Ferrari, Baraldi, and Sternieri, 2015).  Actually, doing so would mean to trade off one crisis (pain crisis) for another (an opioid crisis). Additionally, as a healthcare practitioner, I will be tied up in terms of pain-relieving options that I can suggest and prescribe to my patients.

It must be appreciated that even if opiates and opioid medications were not first line, second line or even third line means of treating and managing chronic migraine pain, that does not mean that the same cannot work for anybody. The risks of usage in one person do not mean risk for everybody. To this end, as a professional nurse, my take would be to approach every patient’s pain treatment needs separately and those most deserving of opioids treatment will definitely be prescribed the same. The ethical dilemma surrounding the use of opiates and opioid medications for chronic migraine treatment encourages me to treat every patient independently as opposed to taking a general viewpoint on impact and implications of the same.

Conclusively, the usage of opiates and opioid medications in the management and treatment of chronic migraine will continue to remain controversial and therefore healthcare practitioners will have to bear with medical ethical dilemmas surrounding the same now and in the future. For a long time, opiates and opioid medications has emerged to be first line painkillers for not only chronic pain, but also, for instance, acute pain emanating from various healthcare conditions across the globe (Volkow, & McLellan, 2016). This withstanding, opiates and opioid medications have been blamed for medical induced addiction, dependency, and abuse. While facing ethical dilemmas advanced by these two opposing tenets, healthcare practitioners ought to wisely think of instances they can deservedly prescribe as well as not to prescribe the same to their patients.

References

Alemdar, M., Pekdemir, M., & Selekler, H. (2007). Single-dose intravenous tramadol for acute

migraine pain in adults: a single-blind, prospective, randomized, placebo-controlled clinical trial. Clinical Therapeutics, 29(7), 1441-1447

Buse, D. C., Pearlman, S. H., Reed, M. L., Serrano, D., Ng?Mak, D. S., & Lipton, R. B. (2012).

Opioid use and dependence among persons with migraine: results of the AMPP study. Headache: The Journal of Head and Face Pain, 52(1), 18-36.

Charles, A. (2018). The Migraine Aura. CONTINUUM: Lifelong Learning in Neurology, 24(4), 1009-1022.

Dowell, D., Haegerich, T. M., & Chou, R. (2016). CDC guideline for prescribing opioids for chronic pain—United States, 2016. Jama, 315(15), 1624-1645.

Ferrari, A., Baraldi, C., & Sternieri, E. (2015). Medication overuse and chronic migraine: a critical review according to clinical pharmacology. Expert opinion on drug metabolism & toxicology, 11(7), 1127-1144.

Huang, S. W., Chang, K. H., Escorpizo, R., Hu, C. J., Chi, W. C., Yen, C. F., … & Liou, T. H. (2015). Using the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) for predicting institutionalization of patients with dementia in Taiwan. Medicine, 94(47).

International Headache Society (2018). HIS Classification ICHD-3, Chronic Migraine Accessed from https://www.ichd-3.org/1-migraine/1-3-chronic-migraine/

Maumus, M. (2015). Bioethics in Practice-The Ethics of Opiate Use and Misuse from a Hospitalist’s Perspective. The Ochsner Journal, 15(2), 124-126.

Reuben, D. B., Alvanzo, A. A., Ashikaga, T., Bogat, G. A., Callahan, C. M., Ruffing, V., & Steffens, D. C. (2015). National Institutes of Health Pathways to Prevention Workshop: the role of opioids in the treatment of chronic pain. Annals of internal medicine, 162(4), 295-300.

Stein, C. (2013). Opioids, sensory systems, and chronic pain. European journal of  pharmacology, 716(1-3), 179-187.

Tepper, S. J. (2012). Opioids Should Not Be Used in Migraine. Headache: The Journal Of Head  & Face Pain, 5230-34

Volkow, N. D., & McLellan, A. T. (2016). Opioid abuse in chronic pain—misconceptions and mitigation strategies. New England Journal of Medicine, 374(13), 1253-1263.