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As one of the three Nurse Practitioners in the Acute Pain Service providing care to post-surgical patients at TGH, Salima Ladak is a champion of pain management, relaying multiple statistics on pain with compassion and concern.
These Nurse Practitioners see anywhere from 20 to 65 patients with pain issues per day. "We're so busy, we're on roller skates most of the time," she says.
Pain after some of the most common surgical procedures – breast and thoracic surgery, hip and knee replacements - is followed by persistent pain in 10 per cent to 50 per cent of surgical patients.
Pain is the most common reason for seeking health care and accounts for up to 70 per cent of visits to Emergency. One in five Canadian adults suffer from chronic pain.
"We live in a society where pain remains unrecognized," she says, "yet we know that pain management is a key factor in the successful recovery of patients from surgery. It can affect their daily function, length of stay, and it could become a persistent problem after discharge."
This recognition of Ladak's extensive clinical work, strong interprofessional approach to improve pain practice and education and mentorship of nursing students has earned Ladak the 2014 Nursing Excellence in Pain Management Award from the prestigious Canadian Pain Society.
Three colleagues nominated Ladak for her leadership in pain improvement strategies, mentoring of nurses to improve pain-related outcomes, and research into pain.
"In the last 10 years, Salima has consistently raised the bar for the quality of service that we provide to our patients on the Acute Pain Service," wrote Nurse Practitioner Jiao Jiang. Ladak is the Coordinator of the UHN Pain Advanced Practices Network, who helps other nurse champions to implement pain best practices and projects in the units.
"Her natural talent to work collaboratively with individuals of varied health disciplines, achievement of concrete patient and organizational outcomes and strong clinical acumen rendered her the most appropriate Nurse Practitioner …to assist in the international partnership UHN has with the Kuwait Cancer Care Ontario," added Dr. Hance Clarke, Medical Director of the Pain Research Unit at TGH in his nominating letter.
As Co-Chair of the UHN Corporate Pain Committee, Ladak has worked tirelessly with interprofessional groups to introduce a scale from 0 to 10 that can be used by all patients to describe their pain level. "As my colleagues point out, pain is what our patients say it is, and it occurs when the patients say it does," she says, "The simpler the tool the easier it is for patients to work with us to help them."
With her colleagues, Ladak also helped to introduce monitoring pain as the fifth vital sign in patients' charts. Staff now assess pain at rest and upon movement, giving it as much importance as measuring heart and respiratory rates, and patients' blood pressure.
For Ladak, managing pain can also include complementary therapies, such as massage, music or the relief an ice pack can bring to a patient with lower back or shoulder pain. "We understand the latest methods of analgesia techniques," she says, "but we also include other simple therapies in a focused way. We try and understand the whole person, and provide the patient with what works best for him or her."