Back pain

All research should be valid in STRICTLY AUSTRALIA.
The purpose of this essay is for students to present a comprehensive discussion and
justification identifying two (2) care priorities within a clinical scenario using the Levett-
Jones’ Clinical Reasoning Cycle.
How to start assignment?
To begin, before you can prioritise your care and implement a specific intervention you (as
in all of your clinical practice as a registered nurse) will first need to perform an
assessment that is relevant, this will add strength to your chosen priority by demonstrating
to the reader why it is that you’ve chosen this priority. You must then explain the priority,
with relevant reference to the chosen client.
This essentially, is the first three components of the clinical reasoning cycle, consider the
patient, collect cues and information and process this information and essentially will end
with you identifying the priority (known as identifying problems/issues). You are then
required to establish goals relevant to the patient and in doing so you must justify why
have you chosen this priority- this is the taking action component of the cycle.
You must support your chosen priority with the most relevant and up to date evidence and
then describe how you will assess the success of your suggested intervention or in other
words you will be required to reflect on the practice you have just suggested.

20 APA refrences not old then 5 years old and only Journals and articles.

Back Pain
Introduction

Back pain is a common and costly disorder in Australia. Hoy et al., (2014) report that
about 25% of Australians suffer from back pain and approximately half of them seek medical
attention. The direct costs for treatment of this condition in Australia have been estimated to be
approximately $ 1 billion with an addition of $ 8 used in indirect costs (Buchbinder et al., 2013).
The condition is also prevalent within the healthcare professionals where nurses have a higher
likelihood of developing back pains unlike individuals from other professions. In South Australia
alone, back injury accounts for over $2 million in every financial year (Lorig et al., 2013).
Surveys of patient self-managing their back pain as well as those managed in primary care have
indicated that usual care is not often evidence based hence hindering provision of best outcomes
to patients. Consequently, there has been a growing demand to address the ramifications of back
pain through changes in health policies, investments, and service delivery. Healthcare providers,

BACK PAIN
are charged with the responsibility of ensuring that patients receive effective prevention and
treatment strategies to curb this menace.
There are a number of activities that a nurse will conduct to examine John’s condition
and the proper intervention that he needs for effective management of his condition. Some of
these activities that the clinician will examine include;
Patient Education

In the initial visit, the nurse will educate John on chronic back pain by highlighting
clearly that the condition may arise due to an injury or diseases on different body structures such
as the muscles, joints, ligaments, or nerves. According to Traeger et al., (2014), the type of pain
varies and can be felt as muscle pain, bone pain, or nerve pain. The nurse will also emphasize
that it is important for patients to seek medical attention the moment they have back pains and
not wait until the disorder worsens to promote effective management of the condition. At this
point, it will be of great significance for the nurse to let John know that he is not the only one
suffering from back pain. He should understand that back pain is a massive problem in Australia
that sends more people to seek medical attention more than any other condition except common
cold (Driscoll et al., 2014).

Nutrition and Weight loss

Normally, patients who are overweight, such as John, and suffer from back pain, may not
be aware their excess weight aggravates their condition (Brady et al., 2016). It is well known that
obese patients are at a greater risk for back pain, muscle strain, and joint pain unlike those that
are not overweight. Moreover, obese patients also complain of fatigue and shortness of breath
which makes them refrain from exercises worsening their back pain (Heuch et al., 2013). When
patients do not get enough exercise for quite some time, the back’s supporting structures become

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weak, stiff, and deconditioned which further increases pain (Silisteanu & Covasa, 2015,
November). It is for these reasons that the clinician will encourage John to have a weight loss
program which may involve gentle low-impact activities such as walking, jogging, or water
therapy. The clinician will also advise John to avoid eating foods with high fat content. He
should also stick to a rational nutrition plan which involves changes in eating habits as a step
toward effective management of his back pain.
During the visit, the healthcare provider will observe John’s posture and position.
Reviewing of John’s curvature of the spine, shoulder symmetry, and the iliac crest will also be of
great importance. The healthcare provider will conduct a physical examination through palpation
of John’s paraspinal muscle to identify any form of tenderness and then initiate proper
interventions as per the findings.

Pain Alleviation

For pain reduction, the healthcare provider will encourage John to take timed bed rests
and adjust his position to improve flexion of the lumbar region. The nurse will teach him to
regulate and adjust the pains that traverse through the respiratory diaphragm. Relaxation can also
help in reducing muscle tension that contributes to back pain. John should also adjust his sitting
position regularly or even engage in other activities such as reading books, watching a movie or
take part in yoga. The nurse will advise John to request his wife, Donna, to gently massage his
back. It has been proven by Kumar, Beaton & Hughes, 2013; Schulz et al., 2014) that massage
aids in reduction of muscle spasms, reducing damming, and improve blood circulation.

Depression

Depression is the most common emotion linked to chronic back pain. Patients with
chronic back pain have major depression which is said to be four times greater in such patients

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than in the general public in Australia. John is not an exception from this statistics since he
reports that he is depressed because he can no longer take part in activities such as hiking and
cycling that he has always loved. Research has revealed that depression can trigger back pain
(Steffens et al., 2012). It affects the intensity, frequency and the rate of healing of back pain.
Consequently, the nurse will advise John to communicate about the depression. Mostly, many
patients do not talk to their physicians about their depression, anxiety, or stress (Center, 2012).
Individuals that are stressed tend to tense their back muscles which in turn trigger the onset of
low back pain or make it even worse. They believe that the emotions will go away once the
initial pain problem is solved. Therefore, John should regularly keep me updated about his
feelings so that I may provide desirable care to him. The nurse will also recommend John to
interact with other people, for instance, he can occasionally visiting his daughter or son or play
with his grandchild to avoid being lonely and stressed up.
The two activities that the nurse will give priority in the subsequent visits are;
i) Adherence to Medication
Generally, healthcare providers are aware of the considerable increase in rates of opioid
prescribing. Opioids have long been used as pain management agents. However, they are
associated with adverse reactions such as nausea, vomiting, constipation, respiratory depression,
addiction, and even death. The side effects usually limit their use by patients. Therefore, in the
first visit and subsequent visits, this is an issue the nurse will be reviewing. In these visits, the
clinician will assess the effectiveness of the prescribed analgesics and inquire from John on
whether what he feels after taking the drug. The clinician will then initiate appropriate
adjustments according to the patient’s condition for effective pain management. Besides, other

BACK PAIN
pain management therapies such as acupuncture, yoga, chiropractic care, and herbal medicines
such as ginger, capsaicin and feverfew can be used (Ferreira et al., 2014).
ii) Exercise
According to Searle et al., (2015) exercise should be the first treatment choice for a
patient with back problems such as John. This is because exercise matches the fact that
individuals with chronic back pain should be physically active and involve themselves in their
management. Moreover, treatments such as massage, acupuncture, and manipulative therapy are
passive hence the patient is not involved in the therapy. Falla et al., (2014) further highlight that
exercise provides other health benefits beyond back pain management, for instance, in terms of
bone and cardiovascular health. Therefore, the nurse will encourage John to take part in usually
low grade oscillatory exercises such as knees side to side rotation, knee to chest stretches, pelvic
tilts, and press ups. The nurse will also help John to come up with an exercise program which the
nurse will be supervising to ensure he follows it.
There are several forms of exercise and there is no genuine reason of expecting that one
approach would be better than the other (O’Sullivan, 2012; Elden et al, 2013). As a result, the
nurse will give John a list of beneficial exercises he can engage in and enquire from him which
type he would prefer so that it is included in the exercise program. The best form of exercise for
any patient is the one they are enthusiastic about and willing to continue with. For instance, John
says he likes cycling; an activity that has been recorded to have desirable outcomes in patients
with back pains. This can be included in his program. The healthcare provider will advise John
not to take part in heavy physical activities, circular motions, and sways which often worsen the
condition. The nurse will encourage John to switch activities while sitting, lying or walking for a
long time.

BACK PAIN

Conclusion

Back pain is a common health problem in Australia (Cramer et al., 2013). However, its
prevalence can be reduced significantly if patients and clinicians work together. Patients, for
instance, should seek early medical attention and adhere to the prescribed medications and the
recommended activities. On the other hand, physicians should keep a close surveillance on these
patients and ensure that desirable patient outcomes are realized.

References

Brady, S. R., Hussain, S., Brown, W. J., Heritier, S., Billah, B., Wang, Y., & Cicuttini, F. M.
(2016). Relationships between weight, physical activity and back pain in young adult
women. Osteoarthritis and Cartilage, 24, S10-S11.
Buchbinder, R., Blyth, F. M., March, L. M., Brooks, P., Woolf, A. D., & Hoy, D. G. (2013).
Placing the global burden of low back pain in context. Best Practice & Research Clinical
Rheumatology, 27(5), 575-589.
Center, C., Relief, P., Covington, L. A., & Parr, A. T. (2012). Caudal epidural injections in the
management of chronic low back pain: a systematic appraisal of the literature. Pain
Physician, 15, E159-E198.
Cramer, H., Lauche, R., Haller, H., & Dobos, G. (2013). A systematic review and meta-analysis
of yoga for low back pain. The Clinical journal of pain, 29(5), 450-460.

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Depression Goesling, J., Clauw, D. J., & Hassett, A. L. (2013). Pain and depression: an
integrative review of neurobiological and psychological factors. Current psychiatry
reports, 15(12), 1-8.
Driscoll, T., Jacklyn, G., Orchard, J., Passmore, E., Vos, T., Freedman, G., & Punnett, L. (2014).
The global burden of occupationally related low back pain: estimates from the Global
Burden of Disease 2010 study. Annals of the rheumatic diseases, annrheumdis-2013.
Elden, H., Gutke, A., Kjellby-Wendt, G., Fagevik Olsén, M., Stankovic, N., & Östgaard, H. C.
(2013). Back pain in relation to pregnancy: A longitudinal 10-year follow-up of 369
women diagnosed with pelvic girdle pain during pregnancy. In Advances in
multidisciplinary research for better spinal/pelvic care. The 8th Interdiciplinary World
Congress on Low Back & Pelvic Pain, Oct, 2013. Dubai.
Falla, D., Gizzi, L., Tschapek, M., Erlenwein, J., & Petzke, F. (2014). Reduced task-induced
variations in the distribution of activity across back muscle regions in individuals with
low back pain. PAIN®, 155(5), 944-953.
Ferreira, P. H., Ferreira, M. L., Maher, C. G., Refshauge, K. M., Latimer, J., & Adams, R. D.
(2013). The therapeutic alliance between clinicians and patients predicts outcome in
chronic low back pain. Physical therapy, 93(4), 470-478.
Heuch, I., Heuch, I., Hagen, K., & Zwart, J. A. (2013). Body mass index as a risk factor for
developing chronic low back pain: a follow-up in the Nord-Trøndelag Health
Study. Spine, 38(2), 133-139.
Hoy, D., March, L., Brooks, P., Blyth, F., Woolf, A., Bain, C., & Murray, C. (2014). The global
burden of low back pain: estimates from the Global Burden of Disease 2010
study. Annals of the rheumatic diseases, annrheumdis-2013.

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Kumar, S., Beaton, K., & Hughes, T. (2013). The effectiveness of massage therapy for the
treatment of nonspecific low back pain: a systematic review of systematic reviews. Int J
Gen Med, 6, 733-741.
Lorig, K., Ritter, P. L., Plant, K., Laurent, D. D., Kelly, P., & Rowe, S. (2013). The South
Australia health chronic disease self-management Internet trial. Health Education &
Behavior, 40(1), 67-77.
O’Sullivan, P. (2012). It’s time for change with the management of non-specific chronic low back
pain. British journal of sports medicine, 46(4), 224-227.
Schulz, C., Leininger, B., Evans, R., Vavrek, D., Peterson, D., Haas, M., & Bronfort, G. (2014).
Spinal manipulation and exercise for low back pain in adolescents: study protocol for a
randomized controlled trial. Chiropractic & manual therapies, 22(1), 1.
Searle, A., Spink, M., Ho, A., & Chuter, V. (2015). Exercise interventions for the treatment of
chronic low back pain: A systematic review and meta-analysis of randomised controlled
trials. Clinical rehabilitation, 29(12), 1155-1167.
Silisteanu, S. C., & Covasa, M. (2015, November). Reduction of body weight through nutrition
intervention reduces chronic low back pain. In E-Health and Bioengineering Conference
(EHB), 2015 (pp. 1-3). IEEE.
Steffens, D., Ferreira, M. L., Maher, C. G., Latimer, J., Koes, B. W., Blyth, F. M., & Ferreira, P.
H. (2012). Triggers for an episode of sudden onset low back pain: study protocol. BMC
musculoskeletal disorders, 13(1), 7.
Tekur, P., Nagarathna, R., Chametcha, S., Hankey, A., & Nagendra, H. R. (2012). A
comprehensive yoga programs improves pain, anxiety and depression in chronic low

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back pain patients more than exercise: an RCT.Complementary therapies in
medicine, 20(3), 107-118.
Traeger, A. C., Moseley, G. L., Hübscher, M., Lee, H., Skinner, I. W., Nicholas, M. K., & Hush,
J. M. (2014). Pain education to prevent chronic low back pain: a study protocol for a
randomised controlled trial. BMJ open,4(6), e005505.

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