Вы находитесь на странице: 1из 32

NURSES ROLE IN PAIN

ASSESSMENT & PAIN


MANAGEMENT
AIM

Provide compassionate patient


care centered approach to achieve
pain control which is acceptable to
every patient every time.
OBJECTIVES
At the end of the session, the students will be able to :

Define pain.

State type of pain.

Nurses Role in Pain Assessment

Describe the assessment of pain by using


appropriate pain assessment tools.

Perform comprehensive pain assessment.


OBJECTIVES
At the end of the session, the students will be able to :

Nurses Role in Pain Assessment

Able to state frequency of pain assessment.

Perform the communication skills during assessment.


OBJECTIVES
At the end of the session, the students will be able to :

Nurses Role in Pain Management

Able to be attentive to pain management issues.

Able to manage pain according to pain score


following analgesic ladder.

Able to perform proper pan documentation.


DEFINITION OF PAIN

Pain is an unpleasant sensory and


emotional experience associated with actual
or potential tissue damage or described in
terms of such damage.

Merskey and Bogduk, International Association for the Study of Pain (IASP)
DEFINITION OF PAIN

Pain is whatever patient says it so

(McCaffery,2011)
TYPE OF PAIN
Acute Pain

Pain of recent onset and probable limited duration. It usually has an


identifiable temporal and causal relationship to injury or disease.

Chronic Pain

Commonly persist beyond the time of healing of an injury and frequently


there may not be any clearly identifiable cause.

(Ready & Edwards 1992)


Pain should be assessed by all
healthcare provider
NURSES ROLE IN PAIN ASSESSMENT
WHY NURSES?

Nurses spend more time with patient than other healthcare provider.

Nurses usually the first one to assess pain and to listen to the
response.
(Parker & Bailard, 2010)
NURSES ROLE IN PAIN ASSESSMENT

1. Recognized Pain Assessment Tools

Using appropriate pain scale based on age,


cognitive and patients learning style.
SELF REPORT PAIN
TOOLS
Numerical Rating Scale (NRS)

Wong Baker Faces Grimace Scale (Faces Scale)


SELF REPORT PAIN TOOLS

Visual Analog Scale

Categorical Scale
OBSERVATIONAL PAIN TOOL - ADULT

Critical Care Pain Observation Tool* (CPOT)

*CPOT range = 0 8, CPOT > 3 is significant


OBSERVATIONAL PAIN TOOL - ADULT
Adult Non Verbal Pain Scale
OBSERVATIONAL PAIN TOOL - ADULT
Behavioral Pain Scale (BPS)
OBSERVATIONAL PAIN TOOL - PEDIATRIC

FLACC Scale
Category Score

0 1 2
Face No particular Occasional grimace or Frequent to constant
expression or smile frown, withdrawn, quivering chin,
disinterested clenched jaw
Legs Normal position or Uneasy, restless, tense Kicking or legs drawn
relaxed up
Activity Lying quietly, normal Squirming, shifting back Arched, rigid or
position, moves and forth, tense jerking
easily
Cry No cry (awake or Moans or whimpers; Crying steadily,
asleep) occasional complaint screams or sobs,
frequent complaints
Consolability Content, relaxed Reassured by occasional Difficult to console
touching, hugging or
being talked to
distractible
NURSES ROLE IN PAIN ASSESSMENT

2. Perform comprehensive pain assessment

Pain is always subjective

Self report is gold standard


THE PAIN SCREENING PROCESS
- ADULT

DO YOU HAVE ANY


PAIN?

NO YES

4 HOURLY PAIN
OBSERVATION ACRONYM

Documentation
PAIN Acronym

P= Place/ site/ radiation of pain

A= aggravating/ relieving/ associated factors for the pain

I= Intensity of pain ( using the NRS, WBFGS, Categorical Scale)

N= Nature and duration of pain


NURSES ROLE IN PAIN
ASSESSMENT

3. Adhere to Frequency of Pain Assessment

Nurses have to make decision about changing the frequency of


assessment according to patients condition.

During admission

During routine observation

Whenever patients complaint of pain

After receiving any intervention to relief pain

Before and after any invasive procedure.


NURSES ROLE IN PAIN
ASSESSMENT

4. Communication Skills

Know your patient

Encourage communication from the patient and family.

Use mindful approach let patient guide the conversation

Listen to patients underlying emotion

Being able to consult with other healthcare provider Doctor,


physiotherapy.

Being able to supervise subordinates.


NURSES ROLE IN PAIN MANAGEMENT

1. Attentive to pain management issue

Knows When To Inform The Doctor

When the pain Score is 4/10 using NRS, Faces Scale or FLACC
Scale

When the pain Score is 3/8 using

The CPOT (in CCA)


NURSES ROLE IN PAIN MANAGEMENT

2. Able to manage pain according to analgesic ladder


NURSES ROLE IN PAIN
MANAGEMENT

3. Educate Patient and Family

Frequency of pain assessment

Educate patient to report pain

Compliance with analgesics prescribed

Possible side effects of analgesia and fall prevention


NURSES ROLE IN PAIN MANAGEMENT

4. Perform Proper Documentations

Record and critically analyze patients assessment data.

Document according to changes in patients condition and


relief of pain.
WHERE TO RECORD PAIN?

Patient Medical Record (PMR)

Clinical Chart
Human Body Chart Documentation

P= Place/ site/ radiation of pain.


Place an arrow ( ) to indicate sites pain. Label each
site with date and time

A= Aggravating/ relieving/ associated factors for the pain.


Ask patient to describe the nature of pain and the
aggravating factors. Note them against each site as
identified.

I=Intensity of pain (using the NRS, WBFGS, Categorical


Scale).
Intensity of pain. Use the pain ruler as a guide. Educate
patient to report pain using one consistent measure the
patient is familiar with. Faces/ Numerical/ or Categorical
Scale.

N= Nature and duration of pain. Note the patients tolerance to


activity of daily living and record the finding into the integrated
notes.
WHAT IS IMPORTANT TO
THE PATIENT?
What the patient wants?

Pain relief and comfort

Minimal side effects of pain relief

Improved functions

Need and preferences met

Kindness and empathy

Discontinue or reduce of opioids dosage

BEING HEARD AND BELIEVED