Eloise Carr is Associate Dean Postgraduate Students, School of Health & Social Care, Bournemouth University. She serves on Council for the British Pain Society and Chairs a Special Interest Group in Pain Education. Mandy Layzell is lecturer practitioner, Acute Pain Service, Poole Hospital NHS Foundation Trust, and the School of Health & Social Care, Bournemouth University. Dr Martin Christensen is Senior Lecturer, School of Health & Social Care, Bournemouth University and clinical educator in a general intensive care unit.

• Contributors’ biographies xiForeword 1 - Professor Judy Watt-Watson, University of Toronto, Canada xvForeword 2 - Professor Kim Manley, Head of Practice Development, Royal College of Nursing xviiPreface xixAcknowledgement xxi1 Introduction to advancing practice in pain management 1Eloise Carr and Martin ChristensenIntroduction 1Advanced practice 1The context of pain management: definitions and prevalence 5Advancing practice in pain management 6Bringing together advanced practice and pain management 7Conclusions 82 Nurse-led femoral nerve block service for patients with fractured neck of femur 11Mandy LayzellIntroduction 11Pain control 12Under-treated pain 13Pharmacokinetics 13Pharmacodynamics 13Changes in pain perception 13Assessment of pain 14Analgesic drugs and the elderly 14Femoral nerve block 15Benefits of FNB 15Risks of FNB 16Rationale for a nurse-led service 16Developing the service 17Protocol development and training 17Patient information sheet 18Patient group directions 18Data collection and evaluation of the service 19Training 19Problems encountered with the training 19Challenges in implementing a new service 20Evaluation of the 1-year pilot study 21Service feedback from staff 23Service feedback from patients 23Justifying the advanced nursing contribution 23Conclusions 25Acknowledgements 263 New directions in acute pain management: ketamine 29Gillian ChumbleyIntroduction 29Developing the service 33Challenges in implementing a new service or area of practice development 37Evaluation of using ketamine for pain relief 38Justifying the advanced nursing contribution 40Conclusions 424 Developing a nurse-led clinic for the treatment of neuropathic pain 45Eileen MannIntroduction 45Definitions and causes of neuropathic pain 45Prevalence of neuropathic pain 46A proposal and rationale for a nurse-led clinic for sufferers of neuropathic pain 47Identifying stakeholders 50Developing a business plan 51Assessment tools 52The challenges and reality 54Evaluation of the service 57Justifying the advanced nursing contribution 58Conclusions 58Appendix 1: Original business plan 59Appendix 2: Text of an open letter to all local general practitioners informing them of the proposal to commence a nurse-led clinic for painful diabetic neuropathy 63Appendix 3: Example of a typical letter to a general practitioner, at the time pregabalin was not available for prescription 645 Nurse-led strategies to improve patient safety in acute pain management 71Felicia CoxIntroduction 71Media exposure 72Injectable medicines 72Intravenous opioid PCA 72Epidural analgesia 73Analgesic medicines and risk 74Nursing contribution to medicines management 74New role 74Blurring of roles 75Developing the service 75Oral and PCA analgesia 77Challenges in implementing the changes in practice 84Ongoing evaluation and audit 87Justifying the advanced nursing contribution 88Conclusions 896 Developing an acupuncture service for chronic pain 93Ruth H Heafield, Christine M Haigh, Christine M Barnes and Elaine BeddinghamIntroduction 93Rationale for setting up an acupuncture clinic for pain management 94Staff development: education and maintaining competencies 102Clinical governance 105Conclusions 109Editors’ note 1097 The advanced nurse practitioner: developing alliances 113Ruth Day and Dee BurrowsIntroduction 113Alliances and strategic alliances 113Changing workplaces 114Skill acquisition 114Developing entrepreneurial services in pain management 115The challenge of forming alliances to enable implementation 119The challenge of maintaining standards 121Advanced nursing practice and strategic alliances 123Conclusions 124Acknowledgements 1258 An overview of advanced nursing practice in the development of pain clinics in primary care: new ways of working 127Paul BibbyIntroduction 127Background – an overview of the provision of pain services 128Developing the service 129Challenges 132Evaluation 134Conclusions 139Appendix 1: Pain clinic audit 1409 Development of nurse-led pain management programmes: meeting a community need 143Dee BurrowsIntroduction 143Developing the service 145Challenges in implementing the service 150Maintaining standards and evaluating the service 153Justifying the advanced nursing contribution 158Conclusions 159Appendix 1 159Red flags indicative of possible serious spinal pathology 159Psychosocial yellow flags – the beliefs and behaviours which may predict poor outcome and which pain management programmes address 159Acknowledgements 16010 Nurse prescribing in acute and chronic pain management 163Trudy Towell and Martin ChristensenIntroduction 163Acute pain 165Chronic pain 165Rationale for service development 167Evaluation use of audit and CPD 172Justifying the advanced nursing contribution to develop nurse prescribing in pain management 176Conclusions 17711 Nurses leading the development of interprofessional education in pain management 181Ann TaylorIntroduction 181Developing a formal educational qualification in pain 184Challenges in establishing and managing an interprofessional course 187Evaluation and the use of audit 189Justifying the advanced nursing contribution 191Conclusions 19212 New knowledge for advancing practice in pain management 195Martin Christensen and Eloise CarrIntroduction 195Advancing practice in pain management 202Conclusions 204Index 207

Eloise Carr is Associate Dean Postgraduate Students, School of Health & Social Care, Bournemouth University. She serves on Council for the British Pain Society and Chairs a Special Interest Group in Pain Education. Mandy Layzell is lecturer practitioner, Acute Pain Service, Poole Hospital NHS Foundation Trust, and the School of Health & Social Care, Bournemouth University. Dr Martin Christensen is Senior Lecturer, School of Health & Social Care, Bournemouth University and clinical educator in a general intensive care unit.

• Contributors’ biographies xiForeword 1 - Professor Judy Watt-Watson, University of Toronto, Canada xvForeword 2 - Professor Kim Manley, Head of Practice Development, Royal College of Nursing xviiPreface xixAcknowledgement xxi1 Introduction to advancing practice in pain management 1Eloise Carr and Martin ChristensenIntroduction 1Advanced practice 1The context of pain management: definitions and prevalence 5Advancing practice in pain management 6Bringing together advanced practice and pain management 7Conclusions 82 Nurse-led femoral nerve block service for patients with fractured neck of femur 11Mandy LayzellIntroduction 11Pain control 12Under-treated pain 13Pharmacokinetics 13Pharmacodynamics 13Changes in pain perception 13Assessment of pain 14Analgesic drugs and the elderly 14Femoral nerve block 15Benefits of FNB 15Risks of FNB 16Rationale for a nurse-led service 16Developing the service 17Protocol development and training 17Patient information sheet 18Patient group directions 18Data collection and evaluation of the service 19Training 19Problems encountered with the training 19Challenges in implementing a new service 20Evaluation of the 1-year pilot study 21Service feedback from staff 23Service feedback from patients 23Justifying the advanced nursing contribution 23Conclusions 25Acknowledgements 263 New directions in acute pain management: ketamine 29Gillian ChumbleyIntroduction 29Developing the service 33Challenges in implementing a new service or area of practice development 37Evaluation of using ketamine for pain relief 38Justifying the advanced nursing contribution 40Conclusions 424 Developing a nurse-led clinic for the treatment of neuropathic pain 45Eileen MannIntroduction 45Definitions and causes of neuropathic pain 45Prevalence of neuropathic pain 46A proposal and rationale for a nurse-led clinic for sufferers of neuropathic pain 47Identifying stakeholders 50Developing a business plan 51Assessment tools 52The challenges and reality 54Evaluation of the service 57Justifying the advanced nursing contribution 58Conclusions 58Appendix 1: Original business plan 59Appendix 2: Text of an open letter to all local general practitioners informing them of the proposal to commence a nurse-led clinic for painful diabetic neuropathy 63Appendix 3: Example of a typical letter to a general practitioner, at the time pregabalin was not available for prescription 645 Nurse-led strategies to improve patient safety in acute pain management 71Felicia CoxIntroduction 71Media exposure 72Injectable medicines 72Intravenous opioid PCA 72Epidural analgesia 73Analgesic medicines and risk 74Nursing contribution to medicines management 74New role 74Blurring of roles 75Developing the service 75Oral and PCA analgesia 77Challenges in implementing the changes in practice 84Ongoing evaluation and audit 87Justifying the advanced nursing contribution 88Conclusions 896 Developing an acupuncture service for chronic pain 93Ruth H Heafield, Christine M Haigh, Christine M Barnes and Elaine BeddinghamIntroduction 93Rationale for setting up an acupuncture clinic for pain management 94Staff development: education and maintaining competencies 102Clinical governance 105Conclusions 109Editors’ note 1097 The advanced nurse practitioner: developing alliances 113Ruth Day and Dee BurrowsIntroduction 113Alliances and strategic alliances 113Changing workplaces 114Skill acquisition 114Developing entrepreneurial services in pain management 115The challenge of forming alliances to enable implementation 119The challenge of maintaining standards 121Advanced nursing practice and strategic alliances 123Conclusions 124Acknowledgements 1258 An overview of advanced nursing practice in the development of pain clinics in primary care: new ways of working 127Paul BibbyIntroduction 127Background – an overview of the provision of pain services 128Developing the service 129Challenges 132Evaluation 134Conclusions 139Appendix 1: Pain clinic audit 1409 Development of nurse-led pain management programmes: meeting a community need 143Dee BurrowsIntroduction 143Developing the service 145Challenges in implementing the service 150Maintaining standards and evaluating the service 153Justifying the advanced nursing contribution 158Conclusions 159Appendix 1 159Red flags indicative of possible serious spinal pathology 159Psychosocial yellow flags – the beliefs and behaviours which may predict poor outcome and which pain management programmes address 159Acknowledgements 16010 Nurse prescribing in acute and chronic pain management 163Trudy Towell and Martin ChristensenIntroduction 163Acute pain 165Chronic pain 165Rationale for service development 167Evaluation use of audit and CPD 172Justifying the advanced nursing contribution to develop nurse prescribing in pain management 176Conclusions 17711 Nurses leading the development of interprofessional education in pain management 181Ann TaylorIntroduction 181Developing a formal educational qualification in pain 184Challenges in establishing and managing an interprofessional course 187Evaluation and the use of audit 189Justifying the advanced nursing contribution 191Conclusions 19212 New knowledge for advancing practice in pain management 195Martin Christensen and Eloise CarrIntroduction 195Advancing practice in pain management 202Conclusions 204Index 207

Eloise Carr is Associate Dean Postgraduate Students, School of Health & Social Care, Bournemouth University. She serves on Council for the British Pain Society and Chairs a Special Interest Group in Pain Education. Mandy Layzell is lecturer practitioner, Acute Pain Service, Poole Hospital NHS Foundation Trust, and the School of Health & Social Care, Bournemouth University. Dr Martin Christensen is Senior Lecturer, School of Health & Social Care, Bournemouth University and clinical educator in a general intensive care unit.

• Contributors’ biographies xiForeword 1 - Professor Judy Watt-Watson, University of Toronto, Canada xvForeword 2 - Professor Kim Manley, Head of Practice Development, Royal College of Nursing xviiPreface xixAcknowledgement xxi1 Introduction to advancing practice in pain management 1Eloise Carr and Martin ChristensenIntroduction 1Advanced practice 1The context of pain management: definitions and prevalence 5Advancing practice in pain management 6Bringing together advanced practice and pain management 7Conclusions 82 Nurse-led femoral nerve block service for patients with fractured neck of femur 11Mandy LayzellIntroduction 11Pain control 12Under-treated pain 13Pharmacokinetics 13Pharmacodynamics 13Changes in pain perception 13Assessment of pain 14Analgesic drugs and the elderly 14Femoral nerve block 15Benefits of FNB 15Risks of FNB 16Rationale for a nurse-led service 16Developing the service 17Protocol development and training 17Patient information sheet 18Patient group directions 18Data collection and evaluation of the service 19Training 19Problems encountered with the training 19Challenges in implementing a new service 20Evaluation of the 1-year pilot study 21Service feedback from staff 23Service feedback from patients 23Justifying the advanced nursing contribution 23Conclusions 25Acknowledgements 263 New directions in acute pain management: ketamine 29Gillian ChumbleyIntroduction 29Developing the service 33Challenges in implementing a new service or area of practice development 37Evaluation of using ketamine for pain relief 38Justifying the advanced nursing contribution 40Conclusions 424 Developing a nurse-led clinic for the treatment of neuropathic pain 45Eileen MannIntroduction 45Definitions and causes of neuropathic pain 45Prevalence of neuropathic pain 46A proposal and rationale for a nurse-led clinic for sufferers of neuropathic pain 47Identifying stakeholders 50Developing a business plan 51Assessment tools 52The challenges and reality 54Evaluation of the service 57Justifying the advanced nursing contribution 58Conclusions 58Appendix 1: Original business plan 59Appendix 2: Text of an open letter to all local general practitioners informing them of the proposal to commence a nurse-led clinic for painful diabetic neuropathy 63Appendix 3: Example of a typical letter to a general practitioner, at the time pregabalin was not available for prescription 645 Nurse-led strategies to improve patient safety in acute pain management 71Felicia CoxIntroduction 71Media exposure 72Injectable medicines 72Intravenous opioid PCA 72Epidural analgesia 73Analgesic medicines and risk 74Nursing contribution to medicines management 74New role 74Blurring of roles 75Developing the service 75Oral and PCA analgesia 77Challenges in implementing the changes in practice 84Ongoing evaluation and audit 87Justifying the advanced nursing contribution 88Conclusions 896 Developing an acupuncture service for chronic pain 93Ruth H Heafield, Christine M Haigh, Christine M Barnes and Elaine BeddinghamIntroduction 93Rationale for setting up an acupuncture clinic for pain management 94Staff development: education and maintaining competencies 102Clinical governance 105Conclusions 109Editors’ note 1097 The advanced nurse practitioner: developing alliances 113Ruth Day and Dee BurrowsIntroduction 113Alliances and strategic alliances 113Changing workplaces 114Skill acquisition 114Developing entrepreneurial services in pain management 115The challenge of forming alliances to enable implementation 119The challenge of maintaining standards 121Advanced nursing practice and strategic alliances 123Conclusions 124Acknowledgements 1258 An overview of advanced nursing practice in the development of pain clinics in primary care: new ways of working 127Paul BibbyIntroduction 127Background – an overview of the provision of pain services 128Developing the service 129Challenges 132Evaluation 134Conclusions 139Appendix 1: Pain clinic audit 1409 Development of nurse-led pain management programmes: meeting a community need 143Dee BurrowsIntroduction 143Developing the service 145Challenges in implementing the service 150Maintaining standards and evaluating the service 153Justifying the advanced nursing contribution 158Conclusions 159Appendix 1 159Red flags indicative of possible serious spinal pathology 159Psychosocial yellow flags – the beliefs and behaviours which may predict poor outcome and which pain management programmes address 159Acknowledgements 16010 Nurse prescribing in acute and chronic pain management 163Trudy Towell and Martin ChristensenIntroduction 163Acute pain 165Chronic pain 165Rationale for service development 167Evaluation use of audit and CPD 172Justifying the advanced nursing contribution to develop nurse prescribing in pain management 176Conclusions 17711 Nurses leading the development of interprofessional education in pain management 181Ann TaylorIntroduction 181Developing a formal educational qualification in pain 184Challenges in establishing and managing an interprofessional course 187Evaluation and the use of audit 189Justifying the advanced nursing contribution 191Conclusions 19212 New knowledge for advancing practice in pain management 195Martin Christensen and Eloise CarrIntroduction 195Advancing practice in pain management 202Conclusions 204Index 207