Wednesday, April 28, 2010

How to notice immediately patient with acute condition

If acute changes to the patient and patient's condition is immediately life-threatening, you need to concern to the following of the deteriorating criteria,
  1. Airway ---- threatened / obstructed
  2. Breathing---Respiratory rate kurang 8x/mnt atau lebih dari 30x/menit
  3. O2 Saturation---- kurang dari 90 percent
  4. Circulation---- heart rate kurang dari 45x/menit atau lebih dari 130x/menit
  5. Systolic BP---- less than 90 or more than 200 mmhg
  6. Neurological ---- seizures, decrease level of consciousness
  7. Urine output---- less than 200 mls per 8 hours
  8. BSL---- less than 3
whilst you find patient's condition deteriorates further as above, you require immediately help.
get the doctor in-charge or senior staff to reassess the patient.
All the deteriorating criteria mentioned above can virtually cause the death if respond is unable to stabilise within 1 hours, to prevent death, escalation extremely required.

Written by Riss

Tuesday, April 27, 2010

Do you know what is different among AIN, EEN, RN, CNS, CNC, NE, and NUM

Dear perawat Indonesia,
Some of you, probably do not know apa itu AIN,EEN,RN,CNS,CNC,NE,and NUM? iya kan?
so here I will figure out partly what are their definiton and simply job description on the ward.
  • AIN : Assistant in nursing, they working to assist RN in providing such as showering, toileting, feeding, and more related to basic of nursing to the patient.
  • EEN: Endorse enroll nurse, A Basically they working like RN but they can not administer a sedation medication, and advance nursing skills such as giving IV medication via PICC line or giving a Blood Transfusion as an example of this.
  • RN : Registered Nurse, we call them "comprehensive nurse" because they can give everything and perform everything on the ward like basic care, medication, education, admission, discharging, consultation, referral to others team, etc.job http://www.nets.org.au/PDF/NETS%20Position%20Description%20-%20RN.pdf
  • CNS: Clinical nurse specialist, RN who has a specific studied meaning they had graduated from another course like RN + 1 years of Aged care course, RN + 1 years of oncology course dsb which they were promoted by the hospital in where their work.
  • CNC: Clinical nurse consultant, RN who had promoted by the hospital and has more experience in one specific skill and knowledges like wound care, pain management, stoma care, aged care etc. we can say " the expert " " AHLI " dalam ilmu itu. jadi kalau kita punya masalah di ruangan dan kita tidak tahu dalam menangani masalah tindakan atau perawatan we can ask them to get information.
  • NE : Nurse Educator, RN who had graduated from the management nursing course or has more experience in nursing and also was promoted by the hospital to entitle getting that position. NE is basically the same as CNC on the ward but NE is more general so they can assist you in general nursing skills on the ward. However, if they are unsure with the question that we ask, they normally will refer the problems to CNC for confirmation eventually.
  • NUM : Nursing Unit Manager atau "kepala ruangan". we know what is kepala ruangan ? isn't it?
well, itu hanya pengertian yang sederhana mengenai tugas2 mereka if you would like to know more you can find out on the website, I figured out as per nursing Australian version, regardless of nursing job description among USA, Canada, England, Ireland, Philipine, Singapore etc are the same, it may be Indonesia is the only country that has a different system about the nursing hierarchy possibly...???.

Written by Riss

Monday, April 26, 2010

How to get A visa sambil kerja and earn DOLLAR in Australia for Free,

Teman2 perawat di Indonesia,

Punya keinginan pergi ke Australia? sedikit punya modal buat holiday ke Australia, jangan pesimis karena saat ini mereka sedang menyediakan visa kerja sambil liburan for "FREE" satu tahun!! sudah gitu kamu bisa perpanjang.....visa
lumayan bukan?kita bisa liburan kita juga bisa kerja, pingin tahu caranya?
  1. Of course, your English must be improved first, you can test your english capabilty by IELTS or TOEFL kamu bisa tanya ke staff berapa minimum untuk persyaratan keluar negeri? kalau gak salah recently their change the score, it should be 5 for each brand, if you feel competent enough with your English ability then you can log in or applying to get free working holiday visa.
  2. Your nursing skills must be up to date maksudnya cari info tentang masalah keperawatan in Australia karena between Australia and Indonesia ada perbedaan slightly.
  3. if you have a bit money for deposit you can just get it done go to Australian Immigration in Jakarta and find out an information about the job opportunities. if you don't have enough money? find out the Agency or sponsors which may recruit you as their staff, because siapa tahu kalau kamu sudah fully understand of nursing and fluent in English, they may be impressing on you.
  4. lastly, or go to this website FREE WORKING HOLIDAY http://www.visas-australia.com/visas/free.asp.
  5. By the time you get here don't worry we have a number indonesian community will assisst you to reside or you can contact me.
So, all done...now be ready jangan pesimis don't give up! masa depan di tangan anda if you change your future and improve standard of your life why you just try this simple metode, think about the world - NURSES IS BEING DEMANDED BY THE WORLD

Effects of Hypertension to the patient

Hypertension, defined as blood pressure that is elevated and higher than normal, is one of the most common medical conditions in the world. With several resulting conditions and significant healthcare expenses, the societal impact of hypertension is tremendous. Measures to prevent and treat hypertension have one common goal: to minimize the risk of complications stemming from high blood pressure.

Atherosclerosis

Hypertension is one of the major risk factors of atherosclerosis. In combination with other factors such as high cholesterol and diabetes mellitus, hypertension accelerates the process by which plaques form in the walls of the arteries. Complications result depending on which arteries are affected and, consequently, which organs receive inadequate delivery of blood and oxygen. Of these complications, two are especially common and associated with morbidity and mortality: heart attack and stroke.

Congestive Heart Failure

Hypertension can lead to a heart attack, which can result in congestive heart failure over time because of impaired heart muscle contraction. However, hypertension can also lead to congestive heart failure in a different way. If the blood pressure is consistently high, the heart has to constantly pump against a high level of resistance. This causes the heart muscle of the left ventricle to thicken (left ventricular hypertrophy, or LVH). If it continues, the thickening can be so great that it reduces the space within the ventricle, limiting the amount of blood that gets pumped out.

Kidney Failure

Another effect of untreated high blood pressure is kidney failure. Along with diabetes mellitus, hypertension is a major risk factor for this condition because of damage to the filtering portions of the kidney (glomeruli). Additionally, such kidney disease, in turn, can increase blood pressure. Between 80% and 90% of patients with chronic kidney failure have hypertension.

Aortic Dissection

Hypertension can cause aortic dissection in which the layers of the wall of the aorta separate from each other. This generally occurs when the blood pressure remains consistently at a moderate to severe level. Inherent weakness of the aortic wall, as with Marfan's syndrome, may also play a role.




Improve your English to be better

I encourage you to keep studying of English as English is recently a international language, therefore if you have an ambition would like to go overseas you need to improve your English first then you ll be able to compete with the world.

A number of job vacancy is widely available for nurses like in USA, Australia, Canada, Middle East, and Asia like Japan currently offering Indonesia to send more nurses to their country because of shortages of nurse in their country, even in Australia, however, Indonesian nurses is never requested by other countries as a result of language barriers that experienced by Indonesian nurses.
we need to rise our head up from now as era globalization is coming gradually, there was a riot in Batam clash antara indonesian and indian.
indian was insulting us and they were saying we are "stupid" in working, unable to recognize and follow the instruction as by the time the supervisor given a instruction in English, in fact, some indonesian was unable to follow the command. bagaimana reaksi kita menghadapi kasus seperti ini??
Based on my personal experience, Indonesian Nurses who have been working in Overseas for example Australia they have ever experienced the same situation like the incident which I mentioned above, this problems can not be tolerated we need to rise your head up now, encourage your self to be the best both on skills and communication ability.
We can not blame them whose not liable to speak English fluently, it is hard, as English in Indonesia not a compulsory languages but we are as nurses do not ever think to stick our self in Indonesia try to open our mind that we want to compete with others nurse worldwide.

Philipina is now the country called as the king of nurse supplier worldwide, a thousand of nurses they send to other countries constantly every years, because of their English is better than us, I have shared an experience with one of "philipino" they said " you know? why our English is a bit better than others due to English always used everyday".
As a consequently, a number of investor or nursing agency from overseas invest their business in their country to recruit nurses to be employed in their country such as USA, Canada, England, Australia, Middle East, Ireland, Scotland, etc.

Obviously, it is not about skills if we want to go overseas working as a Nurse but it is all about communication ability (English), We believe that Indonesian nurses may be better than others if we are as a nurse are able to show our performance is not only in nursing skills but also communication skill.

Now, we just look forward to the investor hopefully in short period of time, there are investors that look into nursing development in Indonesia and then they will provide us a gate to compete with others nurse worldwide.

Good luck....my Nurses's friend ,

Written and published by Rislan



AGED CARE NURSING IS BEING DEMANDED IN AUSTRALIA

DO YOU WANNA GO TO OVERSEAS THEN WORKING AS A NURSE WITH A MILLION RUPIAH THAT YOU CAN EARN MONTHLY


YOU DO NOT NEED A HIGHLY NURSING SKILLS OR KNOWLEDGES YOU SHOULD BRING WITH.
HOWEVER, YOU MUST BE ABLE TO COMMUNICATE IN ENGLISH AS ONE OF THE REQUIREMENTS.
DO YOU WANT TO KNOW HOW TO BE PART OF AGED CARE NURSES??

  1. IMPROVE YOUR ENGLISH TO BE BETTER, ONE YOU ARE CONFIDENCE ENOUGH WITH YOUR ENGLISH, THEN FIND OUT THE AGENCY/SPONSORS THAT MIGHT ASSIST YOU TO GO TO AUSTRALIA.
  2. A NUMBER OF NURSING AGENCY IS AVAILABLE IN AUSTRALIA WHICH WILL ASSIST YOU TO ALLOCATE YOU IN AGED CARE FACILITIES OR HOSPITAL.
  3. START TO GET MORE MONEY AND BECOME A WEALTH NURSES...

Aged Care Nursing IN AUSTRALIA

"Aged care nurses look after the ageing members of the community, who might need help with day-to-day activities. At present, there is a large demand for nurses in aged care, and in the future, this is likely to dramatically increase further"


Sunday, April 25, 2010

HEART FAILURE AND NURSING MANAGEMENT



The heart pumps out blood that supplies the body with oxygen and nutrients. Heart failure is a condition where the heart cannot pump enough blood to the rest of the body. This results in a reduction in blood supply to the different organs in the body. It can be caused by factors such as

  • rheumatic fever
  • bacterial endocarditis
  • anemia
  • and valvular defects to name a few

Some symptoms of heart failure are: shortness of breath on exertion or with activity, cough, swelling of the feet, stomach area and ankles, tiredness, loss of appetite and frequently urinating at night.

Nursing Diagnoses for Heart Failure

After assessing a patient with heart failure, the nurse may come across one or more symptoms of this disorder such as shortness of breath. The nurse formulates nursing diagnoses based on the symptoms the patient displays. Some nursing diagnoses for heart failure are:

  • decreased cardiac output related to decreased myocardial contractility
  • fatigue due to poor oxygenation
  • altered tissue perfusion related to insufficient blood flow
  • impaired gas exchange related to lung congestion
  • and fluid volume excess related to compensatory mechanisms of heart failure

Nursing Interventions for Decreased Cardiac Output


Decreased cardiac output refers to low blood supply in the body because the heart is not contracting efficiently enough to push blood to the rest of the body. The nurse nurse administers medication that increase the contractility of the heart as ordered by a physician. Some of these medications are digoxin, inotropic agents like dobutamine and dopamine and diuretics. Other nursing interventions for heart failure include administering diuretics and weighing the patient.

Nursing Interventions for Fatigue due to Heart Failure

fatigue occurs when the cells in the body are inadequately oxygenated. This occurs when blood supply through the body is reduced. Nursing interventions for fatigue are:

  • placing items often used by the patient close by so that they dont have to exert themselves to reach such items.
  • using slow progression during the patients daily activity to avoid sudden exertion.
  • teach the patient how to use environmental aids such as hand rails, chairs in the bathroom or bedside commode to avoid getting tired.
  • teach the patient energy conserving practices like sitting down to perform tasks and pushing instead of pulling.

Nursing Interventions for Altered Tissue perfusion and Impaired Gas Exchange

Altered tissue perfusion describes a situation where the cells do not receive enough oxygen therefore the tissues where they are located are oxygen deprived and at risk for injury. Gas exchange occurs in the lungs and in heart failure, the lungs may become congested with blood and this reduces it's ability to absorb oxygen. The nurse can do a few things to address these problems like:

  • administering oxygen as ordered to increase tissue oxygenation
  • elevating the head of the patients bed to alleviate lung congestion
  • inspecting the patients skin for wounds and instituting pressure ulcer precautions
  • raising the side rails of the bed to prevent falls incase the patient gets confused due to hypoxia-- reduced oxygen in the brain.

Nusing interventions for the other nursing diagnoses related to heart failure include restricting fluids as ordered by a physician, to prevent or address excess fluid volume in the patient's body. The patient should also be taught to avoid high sodium intake by not eating processed and cooked foods with a lot of salt in them. The expected outcome of the nursing interventions for this condition is that the patient's level of fatigue is reduced therefore, the patient can perform activities of daily living and other lifestyle activities the patient engages in.

References:



Read more at Suite101: Heart Failure and Nursing Management: Nursing Management Of A Congestive Heart Failure Patient http://heart-disease-treatment.suite101.com/article.cfm/heart-failure-and-nursing-management#ixzz0mBQaZKYn

Jobs description of Community Nurses yang sebenarnya!!!

Perawat komunitas atau perawat PUSKESMAS di Indonesia sungguh berbeda dengan negara lain di dalam menjalankan peranya sebagai perawat komunitas, if we refer to literatur or theory that the community nurses's job description is that the following statement below, perawat puskesmas in Indonesia sometime not perform their duty appropriately, is more tend to general nurse jobs otherwise.
Community Nursing includes a full range of Nursing services delivered in-home . These include health screening and assessment, complex personal care, post-acute care, symptom control, medication management, stomal therapy, wound management, palliative care, continence management, mental health and chronic disease management.

Chronic Disease Management

provides a range of services to clients living with a chronic illness such as Diabetes, heart disease, respiratory disease and renal disease. Services include assessment, management, education and referral.

Complex Personal Care

Complex Personal Care is provided to clients who require a high level of assistance with showering, dressing and assistance with daily living

Continence Management

This service provides treatment, information and education to adults and children who are at risk of, or who are experiencing, incontinence. Consultancy, information and education on incontinence are offered to health professionals and the genera...

Health Screening and Assessment

Nurses are qualified to conduct a variety of health screening procedures including physical, social, psychological and environmental home assessments. Nursing staff are competent in the practice of venipuncture, ECG recording, abdominal pain

Medication Management

staff liaise with medical practitioners and pharmacies to provide management and support with medication management.

Palliative Care

This service provides specialist and general Nursing care to clients in the final stages of their lives. Ozcare Nurses ensure clients remain comfortable and with optimal quality of life. Our Nurses specialise in pain control through medicatio...

Stomal Therapy

provides stomal therapy education, support and management for people with a colostomy, ileostomy or urostomy.

Wound Management

Community Nurses and Allied Health staff provide specialist services for wound care, leg ulcers and stomal therapy. Ozcare’s highly qualified staff assess and treat acute or chronic wounds and provide advice on future prevention. ...

NURSING MANAGEMENT ( Indonesia )

Pengertian

Manajemen adalah proses untuk melaksanakan pekerjaan melalui upaya orang lain. Menurut P. Siagian, manajemen berfungsi untuk melakukan semua kegiatan yang perlu dilakukan dalam rangka pencapaian tujuan dalam batas – batas yang telah ditentukan pada tingkat administrasi. Sedangkan Liang Lie mengatakan bahwa manajemen adalah suatu ilmu dan seni perencanaan, pengarahan, pengorganisasian dan pengontrol dari benda dan manusia untuk mencapai tujuan yang ditentukan sebelumnya.

Sedangkan manajemen keperawatan adalah proses pelaksanaan pelayanan keperawatan melalui upaya staf keperawatan untuk memberikan asuhan keperawatan, pengobatan dan rasa aman kepada pasien, keluarga dan masyarakat. (Gillies, 1989).

Kita ketahui disini bahwa manajemen keperawatan adalah suatu tugas khusus yang harus dilaksanakan oleh pengelola keperawatan untuk merencanakan, mengorganisasikan, mengarahkan serta mengawasi sumber – sumber yang ada, baik sumber daya maupun dana sehingga dapat memberikan pelayanan keperawatan yang efektif baik kepada pasien, keluarga dan masyrakat.

Fungsi – Fungsi Manajemen

Secara ringkas fungsi manajemen adalah sebagai berikut :

a. Perenacanaan (planning), perncanaan merupakan :

1) Gambaran apa yang akan dicapai

2) Persiapan pencapaian tujuan

3) Rumusan suatu persoalan untuk dicapai

4) Persiapan tindakan – tindakan

5) Rumusan tujuan tidak harus tertulis dapat hanya dalam benak saja

6) Tiap – tiap organisasi perlu perencanaan

b. Pengorganisasian (organizing), merupakan pengaturan setelah rencana, mengatur dan menentukan apa tugas pekerjaannya, macam, jenis, unit kerja, alat – alat, keuangan dan fasilitas.

c. Penggerak (actuating), menggerakkan orang – orang agar mau / suka bekerja. Ciptakan suasana bekerja bukan hanya karena perintah, tetapi harus dengan kesadaran sendiri, termotivasi secara interval

d. Pengendalian / pengawasan (controling), merupakan fungsi pengawasan agar tujuan dapat tercapai sesuai dengan rencana, apakah orang – orangnya, cara dan waktunya tepat. Pengendalian juga berfungsi agar kesalahan dapat segera diperbaiki.

e. Penilaian (evaluasi), merupakan proses pengukuran dan perbandingan hasil – hasil pekerjaan yang seharusnya dicapai. Hakekat penilaian merupakan fase tertentu setelah selesai kegiatan, sebelum, sebagai korektif dan pengobatan ditujukan pada fungsi organik administrasi dan manajemen.

Adapun unsur yang dikelola sebagai sumber manajemen adalah man, money, material, methode, machine, minute dan market.

Prinsip – Prinsip Manajemen

Prinsip – prinsip manajemen menurut Fayol adalah

a. Division of work (pembagian pekerjaan)

b. Authority dan responsibility (kewenangan dan tanggung jawab)

c. Dicipline (disiplin)

d. Unity of command (kesatuan komando)

e. Unity of direction (kesatuan arah)

f. Sub ordination of individual to generate interest (kepentingan individu tunduk pada kepentingan umum)

g. Renumeration of personal (penghasilan pegawai)

h. Centralization (sentralisasi)

i. Scalar of hierarchy (jenjang hirarki)

j. Order (ketertiban)

k. Stability of tenure of personal (stabilitas jabatan pegawai)

l. Equity (keadilan)

m. Inisiative (prakarsa)

n. Esprit de Corps (kesetiakawanan korps)

Proses Manajemen Keperawatan

Proses manajemen keperawatan sesuai dengan pendekatan sistem terbuka dimana masing – masing komponen saling berhubungan dan berinteraksi dan dipengaruhi oleh lingkungan. Karena merupakan suatu sistem maka akan terdiri dari lima elemen yaitu input, proses, output, kontrol dan mekanisme umpan balik.

Input dari proses manajemen keperawatan antara lain informasi, personel, peralatan dan fasilitas. Proses dalam manajemen keperawatan adalah kelompok manajer dari tingkat pengelola keperawatan tertinggi sampai ke perawat pelaksana yang mempunyai tugas dan wewenang untuk melakukan perencanaan, pengorganisasian, pengarahan dan pengawasan dalam pelaksanaan pelayanan keperawatan. Output adalah asuhan keperawatan, pengembangan staf dan riset.

Kontrol yang digunakan dalam proses manajemen keperawatan termasuk budget dari bagian keperawatan, evaluasi penampilan kerja perawat, prosedur yang standar dan akreditasi. Mekanisme timbal balik berupa laporan finansial, audit keperawatan, survey kendali mutu dan penampilan kerja perawat.

Prinsip-Prinsip yang Mendasari Manajemen Keperawatan

Prinsip – prinsip yang mendasari manajemen keperawatan adalah :

a. Manajemen keperawatan seyogyanya berlandaskan perencanaan karena melalui fungsi perencanaan, pimpinan dapat menurunkan resiko pengambilan keputusan, pemecahan masalah yang efektif dan terencana.

b. Manajemen keperawatan dilaksanakan melalui penggunaan waktu yang efektif. Manajer keperawatan yang menghargai waktu akan menyusun perencanaan yang terprogram dengan baik dan melaksanakan kegiatan sesuai dengan waktu yang telah ditentukan sebelumnya.

c. Manajemen keperawatan akan melibatkan pengambilan keputusan. Berbagai situasi maupun permasalahan yang terjadi dalam pengelolaan kegiatan keperawatan memerlukan pengambilan keputusan di berbergai tingkat manajerial.

d. Memenuhi kebutuhan asuhan keperawatan pasien merupakan fokus perhatian manajer perawat dengan mempertimbangkan apa yang pasien lihat, fikir, yakini dan ingini. Kepuasan pasien merupakan poin utama dari seluruh tujuan keperawatan.

e. Manajemen keperawatan harus terorganisir. Pengorganisasian dilakukan sesuai dengan kebutuhan organisasi untuk mencapai tujuan.

f. Pengarahan merupakan elemen kegiatan manajemen keperawatan yang meliputi proses pendelegasian, supervisi, koordinasi dan pengendalian pelaksanaan rencana yang telah diorganisasikan.

g. Divisi keperawatan yang baik memotivasi karyawan untuk memperlihatkan penampilan kerja yang baik.

h. Manajemen keperawatan menggunakan komunikasin yang efektif. Komunikasi yang efektif akan mengurangi kesalahpahaman dan memberikan persamaan pandangan, arah dan pengertian diantara pegawai.

i. Pengembangan staf penting untuk dilaksanakan sebagai upaya persiapan perawat – perawat pelaksana menduduki posisi yang lebih tinggi atau upaya manajer untuk meningkatkan pengetahuan karyawan.

j. Pengendalian merupakan elemen manajemen keperawatan yang meliputi penilaian tentang pelaksanaan rencana yang telah dibuat, pemberian instruksi dan menetapkan prinsip – prinsip melalui penetapan standar, membandingkan penampilan dengan standar dan memperbaiki kekurangan.

Berdasarkan prinsip – prinsip diatas maka para manajer dan administrator seyogyanya bekerja bersama – sama dalamperenacanaan danpengorganisasian serta fungsi – fungsi manajemen lainnya untuk mencapai tujuan yang telah ditetapkan sebelumnya.

Lingkup Manajemen Keperawatan

Mempertahankan kesehatan telah menjadi sebuah industri besar yang melibatkan berbagai aspek upaya kesehatan. Pelayanan kesehatan kemudian menjadi hak yang paling mendasar bagi semua orang dan memberikan pelayanan kesehatan yang memadai akan membutuhkan upaya perbaikan menyeluruh sistem yang ada. Pelayanan kesehatan yang memadai ditentukan sebagian besar oleh gambaran pelayanan keperawatan yang terdapat didalamnya.

Keperawatan merupakan disiplin praktek klinis. Manajer keperawatan yang efektif seyogyanya memahami hal ini dan memfasilitasi pekerjaan perawat pelaksana. Kegiatan perawat pelaksana meliputi:

a. Menetapkan penggunakan proses keperawatan

b. Melaksanakan intervensi keperawatan berdasarkan diagnosa

c. Menerima akuntabilitas kegiatan keperawatan yang dilaksanakan oleh perawat

d. Menerima akuntabilitas untuk hasil – hasil keperawatan

e. Mengendalikan lingkungan praktek keperawatan

Seluruh pelaksanaan kegiatan ini senantiasa di inisiasi oleh para manajer keperawatan melalui partisipasi dalam proses manajemen keperawatan dengan melibatkan para perawat pelaksana. Berdasarkan gambaran diatas maka lingkup manajemen keperawatan terdiri dari:

a. Manajemen operasional

Pelayanan keperawatan di rumah sakit dikelola oleh bidang keperawatan yang terdiri dari tiga tingkatan manajerial, yaitu:

1) Manajemen puncak

2) Manajemen menengah

3) Manajemen bawah

Tidak setiap orang memiliki kedudukan dalam manajemen berhasil dalam kegiatannya. Ada beberapa faktor yang perlu dimiliki oleh orang – orang tersebut agar penatalaksanaannya berhasil. Faktor – faktor tersebut adalah

1) Kemampuan menerapkan pengetahuan

2) Ketrampilan kepemimpinan

3) Kemampuan menjalankan peran sebagai pemimpin

4) Kemampuan melaksanakan fungsi manajemen

b. Manajemen asuhan keperawatan

Manajemen asuhan keperawatan merupakan suatu proses keperawatan yang menggunakan konsep – konsep manajemen didalamnya seperti perencanaan, pengorganisasian, pengarahan dan pengendalian atau evaluasi.

Persyaratan Ruangan Menjalankan MPKP

Syarat-syarat Ruangan menjalankan MPKP adalah sebagai berikut:

a. Memiliki fasilitas perawatan yang memadai.

b. Memiliki jumlah perawat minimal sejumlah tempat tidur yang ada.

c. Memiliki perawat pendidikan yang telah terspesialisasi

d. Seluruh perawat telah memiliki kompetensi dalam perawatan primer.

Nursing Management's Visionary Leader

The definition of nurse unit manager is that nurse leader who views nursing as both an art and a science by promoting caring and competence as the link between science and human. Therefore, the planning, development, implementation, and evaluation of a sustainable change in the work environment orclinical practice that has resulted in a positive outcome. The manuscript should articulate evidence that addresses the following guidelines:

* Work environment: Significantly influences the work environment through the implementation of creative strategies to improve a professional model of care, nurse satisfaction, or professional development.

* Clinical practice: Active implementation of strategies that support the advancement of nursing science through clarifying, refining, and expanding the nursing knowledge base by influencing patient care delivery.

The entry should address the leader's ability to sustain excellence through insight, inspiration, creativity, and the ability to reproduce results in other organizations.

Friday, April 23, 2010

PAIN MANAGEMENT 2


Pain is the unpleasant feeling common to such experiences as stubbing a toe, burning a finger, putting iodine on a cut and bumping the "funny bone".[1] The International Association for the Study of Pain defines pain as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage".[2]

Pain motivates us to withdraw from damaging or potentially damaging situations, protect the damaged body part while it heals, and avoid those situations in the future.[3] It is initiated by stimulation of nociceptors in the peripheral nervous system, or by damage to or malfunction of the peripheral or central nervous systems.[4] Most pain resolves promptly once the painful stimulus is removed and the body has healed, but sometimes pain persists despite removal of the stimulus and apparent healing of the body; and sometimes pain arises in the absence of any detectable stimulus, damage or pathology.[5] Social support, cultural values, hypnotic suggestion, excitement in sport or war, distraction, and appraisal can all significantly modulatepain's intensity or unpleasantness.[6][7]

Pain is the most common reason for physician consultation in the United States.[8] It is a major symptom in many medical conditions, and can significantly interfere with a person's quality of life and general functioning.[9] Pain medicine is a subspecialty under such medical specialties as anesthesiology, physiatry, neurology, palliative medicine and psychiatry.[10] The study of pain has in recent years attracted many different fields including pharmacology, neurobiology, nursing, dentistry, physiotherapy, and psychology.

Pain
ICD-10R52
ICD-9338
DiseasesDB9503
MedlinePlus002164
MeSHD010146

Etymology : "Pain (n.) 1297, "punishment," especially for a crime; also (c.1300) "condition one feels when hurt, opposite of pleasure," from O.Fr. peine, from L. poena "punishment, penalty" (in L.L. also "torment, hardship, suffering"), from Gk. poine "punishment," from PIE *kwei- "to pay, atone, compensate" (...)."

Contents

[show]

[edit]Classification

[edit]Duration

Pain is usually transitory, lasting only until the noxious stimulus is removed or the underlying damage or pathology has healed, but some painful conditions, such as rheumatoid arthritis, peripheral neuropathy, cancer and idiopathic pain, may persist for years. Pain that lasts a long time is called chronic, and pain that resolves quickly is called acute. Traditionally, the distinction between acuteand chronic pain has relied upon an arbitrary interval of time from onset; the two most commonly used markers being 3 months and 6 months since the onset of pain,[11] though some theorists and researchers have placed the transition from acute to chronic pain at 12 months.[12] Others apply acute to pain that lasts less than 30 days, chronic to pain of more than six months duration, and subacute to pain that lasts from one to six months.[13] A popular alternative definition of chronic pain, involving no arbitrarily fixed durations is "pain that extends beyond the expected period of healing."[11] Chronic pain may be divided into "cancer" and "benign".[13]

[edit]Region and system

Pain can be classed according to its location in the body, as in headache, low back pain and pelvic pain; or according to the body system involved, i.e., myofascial (emanating from skeletal muscles or the fibrous sheath surrounding them), rheumatic (emanating from the joints and surrounding tissue), causalgic ("burning" pain in the skin of the arms or, sometimes, legs; thought to be the product of peripheral nerve damage), neurologic (caused by damage to or malfunction of any part of the nervous system), or vascular (pain from blood vessels).[11]

[edit]Etiology (cause)

The crudest example of classification by etiology simply distinguishes "somatogenic" pain (arising from a perturbation of the body) from "psychogenic" pain (arising from a perturbation of the mind. When a thorough physical exam, imaging, and laboratory tests fail to detect the cause of pain, it is assumed to be the product of psychic conflict or psychopathology).[11]Portenoy divided somatogenic pain into "nociceptive" (caused by activation of nociceptors) and "neuropathic" (caused by damage to or malfunction of the nervous system).[14]

[edit]Nociceptive

Nociceptive pains may be classified according to the mode of noxious stimulation; the most common categories being "thermal" (heat or cold), "mechanical" (crushing, tearing, etc.) and "chemical" (iodine in a cut, chilli powder in the eyes).

Nociceptive pains may also be divided into "superficial" and "deep", and deep pains into "deep somatic" and "visceral". Superficial pains are initiated by activation of nociceptors in the skin or superficial tissues, and are sharp, well-defined, clearly localized pains. Examples of injuries that produce superficial pain include minor wounds and minor (first degree) burns. Deep somatic pains are initiated by stimulation of nociceptors in ligaments, tendons, bones, blood vessels, fasciae and muscles, and are dull, aching, poorly-localized pains; examples includesprains, broken bones and myofascial pain. Visceral pains originate in the viscera (organs) and are usually more aching or cramping than somatic pains. Visceral pains may be well-localized, but often they are extremely difficult to locate, and several visceral regions produce "referred" pain when injured, where the sensation is located in an area completely unrelated to the site of injury.[15]

[edit]Neuropathic

Neuropathic pain is divided into "peripheral" (originating in the peripheral nervous system) and "central" (originiting in the brain or spinal cord).[16] Peripheral neuropathic pain is often described as “burning,” “tingling,” “electrical,” “stabbing,” or “pins and needles.” [17] Bumping the "funny bone" elicits peripheral neuropathic pain.

[edit]IASP Multiaxial classification system

The International Association for the Study of Pain (IASP) synthesizes much of the above and recommends describing pains according to five categories, or axes: its anatomical location (neck, lower back, etc.), the body system involved (gastrointestinal, nervous, etc.), temporal characteristics (intermittent, constant, etc.), intensity and time since onset, and etiology(cause).[18] This IASP system has been criticized by Woolf and others as inadequate for guiding research and treatment.[19] They propose the development of an additional category based, not on symptoms or underlying conditions, but on the type of neurochemical mechanism generating the pain.[11]

[edit]MPI

Using the Multidimensional Pain Inventory (MPI), a questionnare designed to assess the chronic pain patient's psychosocial state, Turk and Rudy[20] found three types of chronic pain patient: "(a) dysfunctional, patients who perceived the severity of their pain to be high, reported that pain interfered with much of their lives, reported a higher degree of psychological distress caused by pain, and reported low levels of activity; (b) interpersonally distressed, patients with a common perception that significant others were not very supportive of their pain problems; and (c) adaptive copers, patients who reported high levels of social support, relatively low levels of pain and perceived interference, and relatively high levels of activity."[11] Turk and Okifuji recommend combining MPI characterization of the patient with the IASP multiaxial profile of their pain to arrive at the most useful case description.[11]

[edit]In health care

[edit]As an aid to diagnosis

Pain is a symptom of many medical conditions. Knowing the time of onset, location, intensity, pattern of occurrence (continuous, intermittent, etc.), exacerbating and relieving factors, and quality (burning, sharp, etc.) of the pain will help the examining physician to accurately diagnose the underlying trauma or pathology. For example, chest pain described as extreme heaviness may indicate myocardial infarction, while chest pain described as tearing may indicate aortic dissection.[21][22]

Patient report is the most reliable measure of these factors; health professionals tend to underestimate pain.[23] A definition of pain widely employed in nursing, emphasizing its subjective nature and the importance of believing patient reports, was introduced by Margo McCaffery in 1968: "Pain is whatever the experiencing person says it is, existing whenever he says it does".[24][25] To assess intensity, the patient may be asked to locate their pain on a scale of 0 to 10, with 0 being no pain at all, and 10 the worst pain they have ever felt. Quality can be established by having the patient complete the McGill Pain Questionnaire indicating which words best describe their pain.[9]

[edit]Assessment in nonverbal patients

See also: Pain and dementia and Pain in babies

When a patient is non-verbal and cannot self report pain, observation becomes critical, and specific behaviors can be monitored as pain indicators. Behaviors such as facial grimacing and guarding indicate pain, as well as an increase or decrease in vocalizations, changes in routine behavior patterns and mental status changes. Patients experiencing pain may exhibit withdrawn social behavior and possibly experience a decreased appetite and decreased nutritional intake. A change in condition that deviates from baseline such as moaning with movement or when manipulating a body part, and limited range of motion are also potential pain indicators. In patients that are vocal but incapable of expressing themselves effectively, such as those with a dementia related diagnosis, an increase in confusion or display of aggressive behaviors, including agitation, may signal that discomfort exists, and further assessment is necessary.

Infants feel pain. Pre-term babies are more sensitive to painful stimuli than full term babies. They lack the verbal skills needed to report pain, so communicate distress by crying. A non-verbal pain assessment should be conducted which should involve the parents, who will notice changes in the infant not obvious to the health care provider.[26]

[edit]Other barriers to reporting

An aging adult may not respond to pain in the way that a younger person would. Their ability to recognize pain may be blunted by illness or the use of multiple prescription drugs. Depression may also keep the older adult from reporting they are in pain. The older adult may also quit doing activities they love because it hurts too much. Decline in self-care activities (dressing, grooming, walking, etc.) may also be indicators that the older adult is experiencing pain. The older adult may refrain from reporting pain because they are afraid they will have to have surgery or will be put on a drug they become addicted to. They may not want others to see them as weak, or may feel there is something impolite or shameful in complaining about pain, or they may feel the pain is deserved punishment for past transgressions.[27]

Cultural barriers can also keep a person from telling someone they are in pain. Religious beliefs may prevent the individual from seeking help. They may feel certain pain treatment is against their religion. They may not report pain because they feel it is a sign that death is near. Many people fear the stigma of addiction and avoid pain treatment so as not to be prescribed addicting drugs. Many Asians do not want to lose respect in society by admitting they are in pain and need help, believing the pain should be borne in silence, while other cultures feel they should report pain right away and get immediate relief.[26] Gender can also be a factor in reporting pain. Gender differences are usually the result of social and cultural expectations, with women expected to be emotional and show pain and men stoic, keeping pain to themselves.[26]

[edit]Medical treatment and management

Medicine treats injury and pathology to promote healing; and addresses distressing symptoms such as pain to relieve suffering during treatment and healing. When a painful injury or pathology is resistant to treatment and persists, when pain persists after the injury or pathology has healed, and when medical science cannot identify the cause of pain, the job of the physician is to relieve suffering. Transitory pain is usually managed by one practitioner with drugs such as anesthetics, analgesics and (occasionally) anxiolytics. The effective management of long term pain, however, frequently requires the coordinated efforts of a pain management team. The typical pain management team includes a medical practitioner, a clinical psychologist, a physiotherapist, an occupational therapist, and a nurse practitioner.[28]

Inadequate treatment of pain is widespread throughout surgical wards, intensive care units, accident and emergency departments, in general practice, in the management of all forms of chronic pain including cancer pain, and in end of life care.[29][30][31][32][33][34][35][36] This neglect is extended to all ages, from neonates to the frail elderly.[37][38][39] African and Hispanic Americans are more likely to suffer needlessly in the hands of a physician than whites;[40][41] and women's pain is more likely to be undertreated than men's.[42]

Failure to provide adequate pain relief may be due to physicians' fear of being accused of over-prescribing (See the cases of Drs William E. Hurwitz and Richard Paey), despite the rarity of such prosecutions; physicians' poor understanding of the risks attached to opioid prescription;[43] or physicians' adherance to the biomedical model of disease which focuses onpathophysiology rather than quality of life, marginalizing pain management.[44] As a result of two recent cases in California though, where physicians who failed to provide adequate pain relief were successfully sued for elder abuse, the North American medical and health care communities appear to be undergoing a shift in perspective. The California Medical Board publicly reprimanded the physician in the second case; the federal Center for Medicare and Medicaid Services has declared a willingness to charge with fraud health care providers who accept payment for providing adequate pain relief while failing to do so; and clinical practice guidelines and standards are evolving into clear, unambiguous statements on acceptable pain management, so health care providers can no longer avoid culpability by claiming that poor or no pain relief meets community standards[43]

[edit]Complementary and alternative medicine

Pain is the most common reason that people use complementary and alternative medicine.[45][46] Traditional Chinese medicine views pain as a 'blocked' qi, akin to electrical resistance, with treatments such as acupuncture claimed as more effective for nontraumatic pain than traumatic pain. Although the mechanism is not fully understood, acupuncture may stimulate the release of large quantities of endogenous opioids.[47] There is interest in the relationship between vitamin D and pain, but the evidence from controlled trials for such a relationship, other than in osteomalacia, is unconvincing.[48] A 2007 review of 13 studies found evidence for the efficacy of hypnosis in the reduction of pain in some conditions, though the number of patients enrolled in the studies was low, bringing up issues of power to detect group differences, and most lacked credible controls for placebo and/or expectation. The authors concluded that "although the findings provide support for the general applicability of hypnosis in the treatment of chronic pain, considerably more research will be needed to fully determine the effects of hypnosis for different chronic-pain conditions." (p. 283)[49] Physical manipulation and exercise are showing interesting results in some pain conditions.[50]

[edit]Evolutionary and behavioral role

Pain is part of the body's defense system, producing a reflexive retraction from the painful stimulus, and tendencies to protect the affected body part while it heals, and avoid that harmful situation in the future.[3][51] It is an important part of animal life, vital to healthy survival. People with congenital insensitivity to pain have reduced life expectancy.[52] Idiopathic pain (pain that persists after the trauma or pathology has healed, or that arises without any apparent cause), may be an exception to the idea that pain is helpful to survival, although John Sarno argues that such pain is psychogenic, enlisted as a protective distraction to keep dangerous emotions unconscious.[53] It is not clear what the survival benefit of some extreme forms of pain (e.g.toothache) might be, and the intensity of some forms of pain (for example as a result of injury to fingernails or toenails) seems to be out of all proportion to any survival benefits.

[edit]Theory

[edit]Specificity

Descartes' pain pathway.

In his 1664 Treatise of Man, René Descartes traced a pain pathway. "Particles of heat" (A) activate a spot of skin (B) attached by a fine thread (cc) to a valve in the brain (de) where this activity opens the valve, allowing the animal spirits to flow from a cavity (F) into the muscles that then flinch from the stimulus, turn the head and eyes toward the affected body part, and move the hand and turn the body protectively. The underlying premise of this model - that pain is the direct product of a noxious stimulus activating a dedicated pain pathway, from a receptor in the skin, along a thread or chain of nerve fibers to the pain center in the brain, to a mechanical behavioral response - remained the dominant perspective on pain until the mid-nineteen sixties.[54]

[edit]Pattern

Specificity theory (dedicated pain receptor and pathway) has been challenged by the theory, proposed initially in 1874 by Wilhelm Erb, that a pain signal can be generated by stimulation of any sensory receptor, provided the stimulation is intense enough: the pattern of stimulation (intensity over time and area), not the receptor type, determines whether nociception occurs. Alfred Goldscheider (1894) proposed that over time, activity from many sensory fibers might accumulate in the dorsal horns of the spinal cord and begin to signal pain once a certain threshold of accumulated stimulation has been crossed. In 1953, Willem Noordenbos observed that a signal carried from the area of injury along large diameter "touch, pressure or vibration" fibers may inhibit the signal carried by the thinner "pain" fibers - the ratio of large fiber signal to thin fiber signal determining pain intensity; hence, we rub a smack. This was taken as a demonstration that pattern of stimulation (of large versus thin fibers in this instance) modulates pain intensity.[55]

[edit]Gate Control

This all set the scene for Melzack and Wall's classic 1965 Science article "Pain Mechanisms: A New Theory".[56] Here the authors proposed that the large diameter ("touch, pressure, vibration") and thin ("pain") fibers meet at two places in the dorsal horn of the spinal cord: the "transmission" (T) cells, and the "inhibitory" cells. Both large fiber signals and thin fiber signals excite the T cells, and when the output of the T cells exceeds a critical level, pain begins. The job of the inhibitory cells is to inhibit activation of the T cells. The T cells are the gate on pain, and inhibitory cells can shut the gate. If your large diameter and thin fibers have been activated by a noxious event, they will be exciting T cells (opening the pain gate). At the same time, the large diameter fibers will be exciting the inhibitory cells (tending to close the gate), while the thin fibers will be impeding the inhibitory cells (tending to leave the gate open). So, the more large fiber activity relative to thin fiber activity, the less pain you will feel. They had conceived a neural "circuit diagram" to explain why we rub a smack.[54]

The authors then added the most enduring and influential element of their theory: a pain modulating signal coming down from the brain to the dorsal horn. They pictured the large fiber signals traveling, not only from the site of injury to the inhibitory and T cells in the dorsal horn, but also up to the brain where, depending on the state of the brain, they may trigger a signal back down to the dorsal horn to further modulate T cell activity and so pain intensity. This model provided a neuroscientific rationale for taking seriously the effect of motivation and cognition on pain.[54]

[edit]Dimensions

In 1968 Melzack and Casey described pain in terms of its three dimensions: "Sensory-discriminative" (sense of the intensity, location, quality and duration of the pain), "Affective-motivational" (unpleasantness and urge to escape the unpleasantness), and "Cognitive-evaluative" (cognitions such as appraisal, cultural values, distraction and hypnotic suggestion).[7]They theorized that pain intensity (the sensory discriminative dimension) and unpleasantness (the affective-motivational dimension) are not simply determined by the magnitude of the painful stimulus, but “higher” cognitive activities (the cognitive-evaluative dimension) can influence perceived intensity and unpleasantness. Cognitive activities "may affect both sensory and affective experience or they may modify primarily the affective-motivational dimension. Thus, excitement in games or war appears to block both dimensions of pain, while suggestion and placebos may modulate the affective-motivational dimension and leave the sensory-discriminative dimension relatively undisturbed." (p. 432) The paper ended with a call to action: "Pain can be treated not only by trying to cut down the sensory input by anesthetic block, surgical intervention and the like, but also by influencing the motivational-affective and cognitive factors as well." (p. 435)

[edit]Theory today

Regions of the cerebral cortex associated with pain.

Specificity, the theory that pain is transmitted from specific pain receptors along dedicated pain fibers to a pain center in the brain, has withstood the challenge from pattern theory, though the "pain center" in the brain has become an elaborate neural network. Wilhelm Erb's (1874) early pattern theory hypothesis, that a pain signal can be generated by intense enough stimulation of any sensory receptor, has been soundly disproved.[57] A-delta and C peripheral nerve fibers carry information regarding the state of the body to the dorsal horn of the spinal cord.[58] Some of these A-delta and C fibers (nociceptors) respond only to painfully intense stimuli, while others do not differentiate noxious from non-noxious stimuli.[57] A.D.Craig and colleagues have identified fibers dedicated to carrying A-delta fiber pain signals, and others dedicated to carrying C fiber pain signals up the spinal cord to the thalamus in the brain.[59] There is a specific pain pathway from nociceptor to brain. Pain-related activity in the thalamus spreads to the insular cortex (thought to embody, among other things, the feeling that distinguishes pain from other homeostatic emotions such as itch and nausea) and anterior cingulate cortex (thought to embody, among other things, the motivational element of pain);[58]and pain that is distinctly located also activates the primary and secondary somatosensory cortices.[60][61]

The gate control theory has not fared well. Most of the dorsal horn interneurons identified by Melzack and Wall as inhibitory are in fact excitatory,[57] and Koji Inui and colleagues have recently shown that pain reduction due to non-noxious touch or vibration can result from activity within the cerebral cortex, with minimal contribution at the spinal level.[62] Melzack and Casey's 1968 picture of the dimensions of pain is as influential today as ever, firmly framing theory and guiding research in the functional neuroanatomy and psychology of pain.

[edit]Special cases

[edit]Phantom pain

Phantom pain is the sensation of pain from a limb or organ that has been lost or from which a person no longer receives physical signals. Phantom limb pain is an experience almost universally reported by amputees and quadriplegics. Phantom pain is a type of neuropathic pain.

[edit]Pain asymbolia

Pain science acknowledges, in a puzzling challenge to IASP definition,[2] that pain may be experienced as a sensation devoid of any unpleasantness: this happens in a syndrome calledpain asymbolia or pain dissociation, caused by conditions like lobotomy, cingulotomy or morphine analgesia. Typically, such patients report that they have pain but are not bothered by it, they recognize the sensation of pain but are mostly or completely immune to suffering from it.[63]

[edit]Insensitivity to pain

The ability to experience pain is essential for protection from injury, and recognition of the presence of injury. Insensitivity to pain may occur in special circumstances, such as for an athlete in the heat of the action, or for an injured soldier happy to leave the battleground. This phenomenon is now explained by the gate control theory. However, insensitivity to pain may also be an acquired impairment following conditions such as spinal cord injury, diabetes mellitus, or more rarely Hansen's Disease (leprosy).[64] A few people can also suffer from congenital insensitivity to pain, or congenital analgesia, a rare genetic defect that puts these individuals at constant risk from the consequences of unrecognized injury or illness. Children with this condition suffer carelessly repeated damages to their tongue, eyes, bones, skin, muscles. They may attain adulthood, but they have a shortened life expectancy.

[edit]Psychogenic pain

Psychogenic pain, also called psychalgia or somatoform pain, is physical pain that is caused, increased, or prolonged by mental, emotional, or behavioral factors.[65][66] Psychogenic pain commonly manifests as headache, back pain, or stomach pain.[65] Sufferers are often stigmatized, because both medical professionals and the general public tend to think that pain from a psychological source is not "real". However, specialists consider that it is no less actual or hurtful than pain from other sources.

[edit]Society and culture

The okipa ceremony as witnessed byGeorge Catlin, circa 1835.

Physical pain has been diversely understood or defined from antiquity to modern times.[67] Philosophy of pain is a branch of philosophy of mindthat deals essentially with physical pain. Identity theorists assert that the mental state of pain is completely identical with some physiological state. Functionalists consider pain only with regard to its causal relation to other mental states, sensory inputs, and behavioral outputs. Religious or secular traditions usually define the nature or meaning of physical pain in every society.[68] Sometimes, extreme practices are highly regarded:mortification of the flesh, painful rites of passage, walking on hot coals, etc. Variations in pain threshold or in pain tolerance occur between individuals for various reasons including genetics, cultural background, ethnicity and sex.

Physical pain is an important political topic in relation to various issues, including distribution of resources for pain management, drug control,animal rights, torture, pain compliance (see also pain beam, pain maker, pain ray). Corporal punishment is the deliberate infliction of pain intended to punish a person or change his behavior. More generally, it is rather as a part of pain in the broad sense, i.e., suffering, that physical pain is dealt with in cultural, religious, philosophical, or social issues.

[edit]In animals

Portrait of René Descartes by Jan Baptist Weenix 1647-1649

The most reliable method for assessing pain in most humans is by asking a question: a person may report pain that cannot be detected by any known physiological measure. However, like infants (Latin infans meaning "unable to speak"), non-human animals cannot answer questions about whether they feel pain; thus the defining criterion for pain in humans cannot be applied to them. Philosophers and scientists have responded to this difficulty in a variety of ways. René Descartes for example argued that animals lack consciousness and therefore do not experience pain and suffering in the way that humans do.[69][70] Bernard Rollin of Colorado State University, the principal author of two U.S. federal laws regulating pain relief for animals,[71] writes that researchers remained unsure into the 1980s as to whether animals experience pain, and that veterinarians trained in the U.S. before 1989 were simply taught to ignore animal pain.[72] In his interactions with scientists and other veterinarians, he was regularly asked to "prove" that animals are conscious, and to provide "scientifically acceptable" grounds for claiming that they feel pain.[72] Carbone writes that the view that animals feel pain differently is now a minority view. Academic reviews of the topic are more equivocal, noting that although the argument that animals have at least simple conscious thoughts and feelings has strong support,[73] some critics continue to question how reliably animal mental states can be determined.[70][74] The ability of invertebrate species of animals, such as insects, to feel pain and suffering is also unclear.[75][76]

The presence of pain in an animal cannot be known for certain, but it can be inferred through physical and behavioral reactions.[77] Specialists currently believe that all vertebrates can feel pain, and that certain invertebrates, like the octopus, might too.[78][79] As for other animals, plants, or other entities, their ability to feel physical pain is at present a question beyond scientific reach, since no mechanism is known by which they could have such a feeling. In particular, there are no known nociceptors in groups such as plants, fungi, and most insects,[80] except for instance in fruit flies.[81]

In vertebrates, endogenous opioids are neurochemicals that moderate pain by interacting with opiate receptors. Opioids and opiate receptors occur naturally in crustaceans and, although at present no certain conclusion can be drawn,[82] their presence indicates that lobsters may be able to experience pain.[82][83] Opioids may mediate their pain in the same way as in vertebrates.[83] Veterinary medicine uses, for actual or potential animal pain, the same analgesics and anesthetics as used in humans.[84]