Asking patient about the extent of pain and assessing systematically.
Believing that the degree of pain the patient reports is accurate.
Choosing the appropriate method of pain control for the patient and circumstances.
Delivering pain interventions appropriately and in a timely, logical manner.
Empowering patients and family by helping them to have control of the course of treatment.
The 5 key elements of pain assessment include:
- Words: use to describ pain, such as burning, stabbing, deep, shooting, and sharp. Some may complain of pressure, squeezing, and discomfort rather than pain.
- Intensity: use the appropriate scale to quantify the degree of pain.
- Location: where patient indicates pain.
- Duration: constant or comes and goes, breakthrough pain.
- Aggravating/ alleviating factors: those things that increase the intensity of pain and those that relieve the pain.
The best assessment of the patient’s pain is his own report. All other information is assessed as supporting this support. However, when this method is restricted or unavailable, physical signs and symptoms can help the nurse’s assessment capabilities. It is important to be familiar with the patient’s baseline or resting information to give a clear picture of the body changes may go through when experiencing significant pain. Systolic blood pressure, heart rate, and respiration may all increase above the patient’s normal parameters. Tightness or tension may be felt in major muscle groups. Posturing can also occur: the patient may guard areas of the body, curl around themselves in a “fetal” position or hold certain body portions rigid. Calling out, increased volume in speech, and moaning can also be indicators. Facial expressions such as flat affect or grimacing and distraction from their surroundings also indicate a significant increase in the stressful stimulus.
Barriers to Optimal Pain Assessment:
- Healthcare providers may lack knowledge about pain assessment and management of different patient populations or may carry out assessments based on personal perceptions rather than validated pain assessment instrucments. Some may be concerned about managing adverse effects or the patient’s development of tolerance or addition.
- Healthcare providers may lack empathy for patient’s suffering. Lack cultural awareness may affect interpretation of pain. For examples, patients in cultures that encourage expression of pain may be assessed as having more pain that patients from culture that value stoicism.
- System: The organization may lack clear policies regarding pain assessment and management and may not have established clear guidelines for consistent use of pain assessment instruments. Additionally, supervision and accountability may be inadequate, and the organization may be concerned about costs and reimbursement for treatment.
- For personal or cultural reasons, patients may minimize or overstate the degree of effects of drugs on cognition (confusion, disorientation, lethargy) or other side effects (constipation, nausea, itching). Some may want to protect family from knowing the extrent of pain.
- Gender can affect pain sensitivity, tolerance, distress, and exaggeration of pain, and the patient’s willingness to report pain, as well as displayed nonverbal cues concerning the patient experience. However, nurses need to be carefull that biases concerning gender experiences with pain do not skew their assessments of pain. They need to be aware that pain experiences are always individual and may differ between the sexes.
- Family: Cultural biases may influence how the family responds to a patient’s pain, and this can influence the patient’s response as well. Families may lack understanding of the role of pain assessment and management. Some lack understanding about the differentce between addiction and pain control at the end of life. (belows are cultural considerations for pain management):
- American Indian and Alaskan natives are unwilling to show pain or request medications. Pain is a difficulty that must be endured rather than treated.
- Asian and Pacific Islanders do not vocalize pain and may have an interest in pursuing nontraditional and nonpharmacological treatments, such as acupuncture, to help relieve pain.
- Black and African American cultures tend to openly express their pain but still believe that it is to be endured. They may avoid medication because of personal fears of addition or cultural stigmatism.
- Hispanic culture value the ability to endure pain and suffering as a personal quality of strength. Expression of pain, especially for a male, is considered a sign of weakness. They may feel that pain is a form of godly punishment or trial.
- Society: Concerns about drug abuse and addiction often permeate society and influence society attitudes toward pain control and appropriate drugs to use. Laws and regulation may make access to certain drugs, such as those derived from marijuana, difficult or impossible to obtain.