Discussion: 6)           Can the findings be generalized to the public?

Question Answered step-by-step Discussion: 6)           Can the findings be generalized to the public?The implications of the research results are evaluated and interpreted in relation to the research question. There should be a clear statement of support or not of the original research question. Any suggestions for improvements or further research should be included in this section.5)           Is there a discussion of further research that needs to be done?7)           Will the study contribute to nursing knowledge? DISCUSSION In this study we confirmed a disparity in the use of complementary self-management interventions by type of community. A higher proportion of nonrural patients with chronic pain used complementary self-management interventions compared with rural patients with chronic pain. Although this disparity exists, the use of self-management interventions by rural residents may be increasing, given we found a greater percentage of rural residents using self-management interventions compared with previous research (Vallerand et al., 2003). This finding may be a result of an increase in scientific evidence and public knowledge over the last decade regarding the use of complementary self-management interventions for pain management. Even with increased awareness, accessibility of self-management interventions may be limited in the rural setting if the intervention requires a trained clinician for implementation. Our questionnaire focused on interventions that could be implemented independently by the patient. Interventions such as acupuncture, cognitive behavioral therapy, hypnosis, and physical therapy, which require a trained clinician, were only captured if the participant identified them as an ”other” intervention.  Our belief that rural residents were more likely to be taking an opioid-based analgesic for chronic pain management was supported and similar to what has been previously reported (Prunuske et al., 2014). Although not statistically significant, opioids were taken for pain relief more often by rural residents than nonrural residents. However, the proportion of patients on high-dose opioids did not differ between the groups (20%). Patient safety issues increase when opioid doses are greater than 90 morphine equivalent doses per day and require knowledgeable providers who can taper doses in an appropriate manner. The TelePain intervention tested in our primary study educates providers on optimal and safe pain management practices such as opioid dosing and self-management interventions regardless of geographical location (Eaton et al., 2014; Meins et al., 2015). Increased use of telehealth interventions like TelePain may support rural PCPs in decreasing opioid doses by increasing the use of selfmanagement interventions to manage chronic pain.  As recognized by the Chronic Care Model, an essential element for providing high-quality pain care is the identification of key members of the health care team who will be responsible for educating patients about opioid-based analgesics and complementary self-management interventions for chronic pain. Because self-management interventions typically do not require a prescription, nurses are well suited to educate patients with chronic pain about these interventions, whereas PCPs, such as physicians, nurse practitioners, and physician assistants, are better trained for pharmacologic interventions, including opioid-based analgesics. Working together as an informed health care team to provide optimal pain management interventions will lead to better selfmanagement of chronic pain by rural residents.  Implications for Nursing Findings from this study have implications for nursing practice. Nurses can play a vital role in increasing the use of self-management interventions for chronic pain management among rural residents by educating patients and promoting self-management. Nurses who work in primary care should understand the scientific evidence for self-management interventions, the patient’s preferences, and any safety or accessibility issues in using these interventions. For example, yoga may be a self-management intervention that a patient is interested in using, but classes provided by a trained instructor may not be easily accessible in the rural setting. If the patient considers using a yoga DVD, for example, the nurse needs to ensure that the yoga provided by this method is safe and appropriate for the patient.  CONCLUSIONS Complementary self-management interventions are an important part of chronic pain management. The Chronic Care Model identifies essential elements that should be present in the primary care setting to ensure that patients receive optimal pain care that includes selfmanagement interventions. All individuals with chronic pain should be knowledgeable of and have access to these interventions regardless of geographic location. Health Science Science Nursing NUR 354 Share QuestionEmailCopy link Comments (0)