Situation of Focus
The opioid epidemic in America has arisen in part as a result of over-prescription of drugs to patients (Brummett et al., 2017). While patients have a right to expect pain relief, the tendency among health care providers to prescribe opioid therapy to opioid naïve patients at an unnecessarily high dosage can have detrimental effects and risks, such as long-term addiction of the patient (Harbaugh et al., 2018), sleep apnea and even depression (Rowsell et al., 2016). Nurses and doctors should be careful, therefore, to use opioid therapy at the lowest doses for effective pain relief, with the goal being pain management at a tolerable level rather than for opioids like oxycodone to be prescribed at high levels so that the patient can experience zero pain.

Problem Statement

The problem is that some patients may expect to be given a strong prescription that will effectively take all their pain away following surgery. The nurse’s job is complicated by the fact that the nurse should seek to provide quality care in every way and assist the patient in the patient’s needs, whatever they may be; but at the same time the nurse has a duty to practice preventive care and to promote the patient’s health literacy by explaining the risks of high-dosage drugs like oxycodone and the potential for long-term habit-formation and addiction, the onset of sleep apnea or depression.

To assist nurses in explaining these risks and encouraging patients to see that pain tolerance (i.e., the lowest effective dosage of opioid therapy) is preferable to total pain relief (i.e., a high dosage), two nursing theories can be applied to this case: the mid-range theory of unpleasant symptoms developed by Lenz, Supee, Gift, Pugh and Milligan (1995) and utilitarian ethical theory, developed by Mill and used to promote nursing ethical principles of beneficence and non-maleficence (Wagner & Dahnke, 2015). The theory of unpleasant symptoms calls for treatment of the whole person and aligns with the holistic care approach by looking at the combination of symptoms for the underlying issue rather than attempting to treat each symptom individually as a separate and unique issue disconnected from what is going on with the whole person. Utilitarian ethical theory focuses on determining what is good for the patient by looking at the outcomes of various options and seeing which one would have the best impact on the patient and everyone else. A third theory could also be applied in terms of a recommending an intervention—the midrange theory of transcultural nursing developed by Leininger (2008). It explains that a nurse should have develop cultural competence so as to be able to address patients’ needs in a culturally sensitive manner that enables the nurse to increase the patient’s understanding of health risks and benefits of types of treatment.

Literature Review

Theory

The mid-range theory of unpleasant symptoms can be useful in this situation because it can allow the nurse to focus on the underlying issue regarding the patient’s pain tolerance. A patient may not realize the risks associated with opioid usage, but the nurse should and therefore it is important for the nurse to explain to the patient why pain tolerance is the most appropriate goal in opioid therapy rather than complete pain elimination. The theory of unpleasant symptoms helps the nurse to see that the pain following surgery may not be the biggest issue (Lenz et al., 1997): other factors in the patient’s life may also be contributing to the patient’s desire for a higher dosage. The patient may fear a lack of support from family at home, or the patient may have problems resting or sleeping in general. The nurse can probe the patient’s feelings by asking questions that will help the nurse to have a better understanding of the patient’s needs so as to provide alternative care solutions that holistically treat the patient instead of simply upping the dosage of opioid therapy and risking a long-term habit formation.

In order to appropriately treat the patient, the nurse must understand the whole, complex, interacting aspects of the patients’s symptoms and more deeply understand the meaning of the patient’s complaint. A patient who may have a low pain tolerance may also lack sufficient ways to distract attention from the pain. This is something that can be discussed in more detail with the patient when the nurse applies this theory. Lenz et al. (1997) explained that nurses have to provide adequate scope and understanding to the patient’s issues in order to treat them effectively.

The utilitarian ethical theory provides additional light on the problem of how to treat a patient that wants something that might neither be the patient’s best long-term interest or in society’s interest (as every opioid addiction effectively places a new burden on society). The basis of this theory is in the idea that the good or right action is determined by the effect of the action. The better the effect is for all, the more one can say that it is good (Wagner & Dahnke, 2015).

Leininger’s (2008) theory of transcultural nursing focuses on the nurse’s need to be culturally competent so as to identify cultural cues that patients signal and to administer nursing care in a way that is culturally appropriate to the patient. The theory is helpful in administering care because it highlights the value of providing personalized care at an individualized level based upon the nurse’s ability to understand cultural differences and how health literacy might be increased through the usage of cultural...…be evidence that the intervention was working were the intervention to be implemented on a nationwide scale. For the purposes of this case, however, the intervention is being measured in a singular instance and so the survey method would be most satisfactory for determining whether the nurse’s intervention achieved the desired outcome of raising the patient’s health literacy (regarding understanding of the need to use opioids to tolerate pain rather than to reduce pain to zero), whether the patient was indeed able to effectively manage pain using the nurse’s recommendations (i.e., whether music therapy helped, whether friends assisted and whether the son was of any comfort), and whether the pain diminished in time without the patient needing to apply for a new dosage. The survey could be personally designed to assess the outcome of this intervention and give the nurse a sense of how effective the intervention was overall. A Likert scale could be used to allow the questions to be answered quantitatively, or the survey could be a simple yes/no survey—so long as the appropriate questions are asked to provide an appropriate measurement of the intervention’s success, the survey may be designed any which way. The instrument could be evaluated by taking the Likert scale scores or the yes/no responses and conducting statistical analysis to find the mean and determining whether the patient’s responses show an average level of effectiveness, below-average or higher-than-average level. Or the survey could be evaluated qualitatively with the nursing staff examining the content of the survey consisting of open-ended responses to find what worked for the patient and what did not and deriving meaning from there.

Conclusion

The opioid crisis is one that needs to be addressed in the U.S. as it has grown into an epidemic. Nurses must be cognizant of the risks associated with over-prescribing opioids in pain management. They must also be able to convey the risks associated with opioid therapy to patients. Some of the ways in which this can be achieved are through the use of utilitarian ethical theory, the theory of unpleasant symptoms, and transcultural theory. Each theory provides a perspective on how the nurse can approach the issue of raising the patient’s health literacy regarding opioids and how the nurse can move the patient to appreciate that pain tolerance when using opioids is a preferable approach to total eradication of pain, which raises the risk of addiction, sleep apnea and depression. Each of these theoretical approaches to nursing can be used effectively in this case and the outcomes can be measured and evaluated using the survey method and statistical or content analysis.