Sample Nursing Essays on Pain Assessment Procedures

Pain Assessment Procedures

Introduction

Pain is a very subjective phenomenon, and accurate assessment depends solely on the words of the reporter. Pain is described as exactly what the patient says it is and also in terms of what it does to the patient. The only relatively comparative way for pain assessment would thus depend on consideration of the pain characteristics and its description as the fifth vital sign. While most pain is individual, understanding the pain from the patient’s perspective is necessary for effective pain management. Assessment can be based on a variety of pain management theories including specificity, open gates, intensity, and patterns theories. All these theories address different characteristics of pain and can be used as the grounding theory for the assessment of pain in any patient.

Pain Assessment Theories

The pain assessment procedure described in the ensuing paper is founded on a combination of intensity and pattern theories. The pattern theory, as explained by Moayedi and Davis (2013), asserts that pain patterns are based on the intensity and the type of pain stimuli and that each pain is distinct in the path it follows in the body. The pattern theory is useful when the intent is to understand the progress of the pain and its relationship to other parts of the body. The intensity theory, on the other hand, describes pain as an emotional effect which arises when one is subjected to a stimulus that is much stronger than normal. This means that pain may exist when one is subjected to a specific stimulus to which they are used but at a higher intensity. The intensity and frequency of exposure result in different degrees of pain as described by Moayedi and Davis (2013). As the frequency of exposure to unexpected stimulus increases, the intensity of the pain caused also increases, eventually graduating to what is described as unbearable pain. In the healthcare setting, the nurse has to consider the patient’s self-reports and determine whether their pain was unbearable or not. Pain management practices depend on the degree of pain felt and the intensity of stimuli.

The nursing process entails activities that depend on the interactions between the nurse and the patient. Understanding the origin of pain can also be the starting point of more holistic healing processes in the healthcare setting, as well as more sustainable patient well-being. The Pattern theory can help a nurse to assess pain satisfactorily and understand the causes of the pain before treating the symptoms. By first understanding the origin of pain, healthcare providers can go to the causes of the problems and thus determine the most effective approaches to management. The Intensity theory, on the other hand, can be applied as the foundation of evaluating the progress of pain. One of the areas under which this could find optimum application is in labor management. Healthcare practitioners ought to consider the patients’ self- reports and to use them rather than assumptions as the bases for decision making. The intensity and patterns of pain in such instances are indicators of progress into labor and can be instrumental in guiding patient placement in the labor ward. Similarly, other areas such as palliative care units and pediatric orthopedic treatment departments require the application of intensity theories as the basis for pain management and comprehension.

Rationale for Pain Assessment

In any healthcare setting, pain assessment is considered to be one of the vital practices in the casualty as well as other general healthcare departments. In emergency cases, pain assessment directs the healthcare providers on the need to examine certain parts of the victims’ bodies with greater scrutiny. Untreated pain could be a symptom of an underlying health factor, which if untreated, can result in greater individual harm. Pain assessment is always to be conducted at the start of the patient’s treatment process as it helps in knowing the patient’s comfort level and diagnosing the need for administering pain controlling treatment. More comprehensive assessments could, however, be conducted when pain reports change significantly from records. This could be an indication of deeper pathological processes, and therefore, the healthcare provider has to determine the actual cause of those changes. Any processes in pain management also depend on the nature of the pain itself.

The pain assessment process within the healthcare setting depends on a general tool founded on the acronym LOTTAARP which abbreviates location, onset, timing, and type of pain. The last four letters represent associated symptoms, alleviation, radiation, and the precipitating events. From this description, it can be observed that the strategy focuses on the aspects previously discussed through the pain theories in that features such as location, onset, and radiation point to a pattern, while the others point to the intensity of pain (Doyle & McCutcheon, n.d). Through such tools, healthcare practitioners seeking to manage pain in patients can effectively obtain as much information as they need from them. This subsequently helps in the planning and implementation of pain management processes.

Strengths and Limitations of Pain Assessment Tools

Application of LOTTAARP as a pain assessment tool goes hand in hand with pain rating meters. According to Haefeli and Elfering (2006), pain can be rated on a numerical scale with zero indicating no pain at all and ten indicating unbearable pain. While this can be an effective way to obtain optimum communication from the patient, it is also possible that the same rating could present wrong ratings. Haefeli and Elfering (2006) suggest that pain perception can be influenced by several factors including the psychological and psychosocial health of the patient. This implies that such tools could be used negatively where the patients’ perceptions are extreme or exaggerated. Considering how LOTTAARP is used as a pain assessment tool, it is synonymous with the verbal rating scale described by Haefeli and Elfering (2006) and has various advantages, as well as disadvantages.

One of the major advantages of the tool is that it is as subjective as pain itself. Pain assessment efficiency lies in the capacity to obtain information about the pain from the patient. Pain is highly specific and subjective and so is its assessment and evaluation. Getting the report from the affected individual, therefore, means that high accuracy levels could be maintained even with little time. Moreover, the use of such verbal rating scale like tools for pain assessment eliminates the medical jargon that could confuse patients and thus affect their capability to give accurate information. Where the patients need to make further clarifications, the nurses or other healthcare providers should be capable of interacting with them more in order to understand where there is a need for greater care. Risk identification and quantification also become more efficient with greater objectivity in data collection, relative to depending on other sources of information on a patient’s pain.

Despite the efficiency of pain assessment tools in realizing their objectives, various limitations arise when using tools such as LOTTAARP. One of the main limitations is that it is time-consuming. Where the questions asked are closed-ended, patients may have limited opportunities to express how they feel. Where there are many patients, or there is need to examine differences in pain intensity between two conditions, it can be complicated due to the qualitative nature of the data collected. The magnitude of change in pain intensity is also difficult to measure where the verbal rating scales are used for pain assessments. Changes across temporal zones could also impact the quality of information obtained and reported through verbal pain rating scales. As such, LOTTAARP and any other verbally-oriented pain rating scales should mostly be used where there is a need for instantaneous pain management. This would include areas such as the casualty healthcare department, labor rooms, and any other cases that require pain assessment as a vital sign consideration.

Service User Involvement

The patient is the service user when it comes to pain assessment and management. As the only reliable source of information on his/ her pain, the patient has to participate actively in their treatment process from diagnosis through to healing. The service provider, on the other hand, has to put in place measures to ensure that the user’s needs for dignity, care, privacy, sensitivity, and compassion are met. In each of these instances, specific activities would also take into consideration the social needs of the service users. For the patients, maintaining dignity could be the most important indicator of user involvement. As much as the healthcare provider requires a lot of information from the patient, the patient’s dignity must be maintained at all times. The patient must be treated with decorum and without any discrimination. The service provider ought to empathize with the patient as much as pain is individualized. The information used for treating the patient or at least managing the pain should be entirely based on what one reports concerning the pain.

While determining the patient needs, the service provider has to base their reports on the Self-care deficits theory, which states that patient care can be made more holistic by comparing different aspects of health with the patient condition. The self-care deficits are outlined based on patient reports are as pain reports. This thus means that the patient must be involved both at the preliminary stage of pain characterization and in latter treatment stages involving the administration of pain medication and control. In all these, the privacy and respect of patient are paramount. Revealing private patient information without the consent of the patient can be a contributing factor to privacy violations and has to be managed effectively with or without the patient’s knowledge.

The Role of Communication Skills

When dealing with patient cases, communication skills are important from all parties involved. The care provider must give information to the patients periodically and must also obtain information from the patient throughout the treatment period. Communication skills are mandatory in pain assessment as they help in understanding the patient needs, as well as managing anxiety while dealing with the patient issues. According to Ali (2017), poor communication can result in grievous harm to patients due to misunderstandings. When nursing personnel and other healthcare providers pass wrong information to their colleagues during shift hand-over, there is an increased probability of medication errors. Moreover, when there is poor communication, there can easily be a misinterpretation of the message given by the patients. Understanding patient needs and the situation at hand also enhances the care providers’ capacity to manage anxiety and stress during pain assessment.

While engaging in communication with the patients during pain assessment, the nurses have to take into consideration the patient needs, what they need to communicate to the patients, the objectives of the conversation, and the language of communication prior to putting in place the required practices. Best practices for effective communication during pain assessment include the use of appropriate language for the patient, active listening, and focusing more on open-ended questions than on the closed-ended ones. Open-ended questions are more suitable for understanding pain scenarios and go well with seeking clarification where needed. Other practices include effective use of body language, reflecting on past performance, and confirming comprehension. When these practices are put in place, effective communication and understanding are achieved between the patient and the healthcare service provider, which foster holistic healing.

The Role of Observation Skills

Besides the verbal communication that is expected between the patient and the service provider, there are various other indicators of pain in a patient. Haefeli and Elfering (2006) describe various elements of pain, most of which can be indicated through physical features. Ali (2017) also adds that while communicating with the patient, it is important for the care giver to observe the non-verbal communication practices such as body language of the patient. Pain assessment in most cases may involve touch. While this is going on, the individual conducting pain assessment has to monitor the patient responses to touch, in order to determine the pain patterns or intensities before effective pain management. While responding to pain reports, the service provider has to ensure that the responses take into consideration the reactions of the patients at different times. For comparative purposes, observation can also help to categorize pains temporarily.

The Role of Recording Skills

Any health care services provided to a patient have to be recorded. This can be for future reference, as well as for sharing by different healthcare practitioners. Where there are shift changes, patients are attended to by different personnel, and each has to continue the treatment process from where the other left. Reports from one shift then have to be used in the next shift as the baseline. Patients may also need to be reviewed by other medical practitioners in entirely different medical facilities. In such cases, they have to be sent with their medical reports for reference purposes. Appropriate data recording also makes it possible to monitor pain over a given period. In this way, changes in the pain intensity and patterns can be noted and used to determine where there are underlying pathological issues. An effective recording is thus an inevitable practice in healthcare regardless of the nature of pain felt. Both healthcare providers and the patients have to be responsible for ensuring that accurate records are kept since inaccuracies can result in medication and other health-related errors which could cause harm to patients.

 

References

Ali, M. (2017). Communication skills 1: Benefits of effective communication for patients. Nursing Times [online]; 113(12), 18-19.

Doyle, G.R.,& McCutcheon, J.A. (n.d). Pain assessment. In Clinical procedures for safer patient care. BC Open Textbooks.

Haefeli, M., & Elfering, A. (2006). Pain assessment. European Spine Journal, 15(1), S17 – S24.

Moayedi, M., & Davis, K.D. (2013). Theories of pain: from specificity to gate control. Journal of Neurophysiology, 109, 5- 12.