Pain Assessment Using The Eight Steps Of Pain Assessment

The Role of Nurses in Pain Management

Discuss about the Using The Eight Steps Of Pain Assessment.

This paper will focus on pain assessment using the eight steps of pain assessment. The eight steps include; acknowledging the pain experience that the patient has. Two, establishing a therapeutic interaction with the patient. Three, using the clinical reasoning to come up with the assessment plan and the treatment option to be used on the patient. Four, obtaining the appropriate equipment so as to assess patients pain. Five, Assessing the patient’s pain using the OLD CART method that is the onset, location, duration, characteristics, aggravating factors, relieving factors and the treatment options. Six, cleaning, replacing and disposing of the used equipment. Seven, documenting the pain experienced by the patient, the assessment is done, the interpretation and the intervention plan. Eight, reflecting on the approach used in intervening pain. For each step, a rational on why and how the above steps help in providing a good approach when assessing pain will be given. Two, the role of the registered nurse on each step and how each step displays professionalism will be explained. Three, there will be a description of why/how each of the steps above demonstrates critical thinking and clinical reasoning. Four, there will be an explanation of how the eight steps demonstrate coordinated care. Five, there will be an explanation of how these steps show collaborative and therapeutic practice. Lastly, there will be a conclusion to summarize all the above.

Pain affects more than 77 million people in the United States. It is the major reason for hospital visitation (Lessenot et al., 2013; Lewthwaite, et al. (2011). Pain is the top priority in patient care (McLean et al., 2014). The burden of pain management relies heavily on nurses. The responsibility of the patient comfort largely lies on the nurses (Cohen, 1980). The nurses are the cornerstone of pain management as they spend more time with the patients (Duke, Haas, Yarbrough and Northam, 2013). The effectiveness of pain management depends on the knowledge, attitude, and practices of nurses on pain assessment and management. Pain assessment is evaluating the reported pain, the factors that exacerbate or alleviate pain and its response to treatment

Pain is a subjective and multidimensional phenomenon; therefore, the self-report is the most valid way in which pain can be assessed (Cancer Care Ontario, 2008; OCC, 2010; British Geriatrics Society & British Pain Society, 2009). To have a thorough and individualized pain assessment on a patient the nurse has to acknowledge that the patient is in pain. The nurse assessing pain has to use the following principle, “pain is what the patient says”.

Factors Affecting Pain Assessment and Management

A good pain assessment is determined by the nurse’s perception and attitudes towards the patient. Most patients are left in pain because the nurses/care providers have doubts about the severity and the intensity of pain that the patients communicate. They also expect the patients to tolerate some degree of pain. This poor attitude in the care providers is a barrier to performing a good pain assessment which is a barrier to pain management (Kasabeh, McCabe, and Payne, 2016; Hearn, 2013; Hawksley, 2009).

It is clear that effective pain management is as a result of accurate pain assessment. Pain assessment is determined by the way the nurse/care provider perceives the patients and the attitude he or she has. For a nurse to assess the patient correctly, he/she should acknowledge the patient’s pain experience. This is in terms of severity and intensity. When a nurse does this, one, his/her professionalism will be depicted when assessing pain. Two, acknowledging patients pain experience means that one will be able to perform pain assessment more accurately, this shows critical thinking. Lastly, starting with this step shows there is a systematic order to be followed.

As mentioned above nurses spend the most time with patients. This time is used in coordinating, explaining and delivering care to the patients using therapeutic communication/interaction. Therapeutic interaction/communication is healing/curative nurse-patient interaction. It entails sharing feelings and information between nurses and the patients (Timmins and McCabe 2015). In pain assessment, establishing a therapeutic interaction between the nurse and the client is important as it increases the accuracy of the assessment.

A therapeutic interaction allows the patient to express feelings, their uncertainties, and communicate their thoughts knowing that is not being judged, rather, they are safe and supported (Timmins and McCabe 2015; Burnard, 2014; Bensing, 2011). Establishing a therapeutic interaction requires mutual respect between the nurse and the client. It requires the establishment of trust and warmth between them and lastly the nurse needs to be empathetic to the patient’s experience.  

The nurse/healthcare provider will be able to create a therapeutic relationship with the client by being an active listener, asking a question to get clarifications, using humor, using reflection, being assertiveness, negotiating and using conflict resolution (Goble 2012). Therefore, it is clear that it is important to establish a therapeutic relationship between the client and the nurse when assessing pain so as to get accurate results so as to manage pain effectively. When a nurse establishes a therapeutic relationship with the client, it clearly depicts his/her clinical reasoning and professionalism.

Tools and Equipment Needed for Pain Assessment

According to Levett-Jones et al., (2010) clinical reasoning is whereby the nurses collect the cues, processes the information, gets an understanding of the patient’s condition/situation, comes up with a plan of care, implements the plan, evaluates the outcomes and lastly reflects on the whole process. For it to be effective it depends on the nurse’s ability to be able to collect the right cues, come up with the right action plan for the right patient at the right time and for the right reasons. As mentioned earlier the major reason for hospital visitation is a pain. Pain is a sign of an underlying condition. In the acute care areas, patients are characterized by health problems that are often complex. These problems in most cases are likely to become more serious during their stay in hospital despite many warnings that precede these adverse events. It has been found out that the patients at risk are not identified and managed timely and appropriately (Levett-Jone et al., 2010). This failure in detecting patients whose conditions are deteriorating and intervening appropriately is as a result of poor clinical reasoning.

It is important for the nurse/healthcare provider doing the pain assessment to have a good clinical reasoning. It will enable the nurse to perform a good pain assessment which will be used in the formulation of the pain management. It is clear that for accurate pain management, there should be accurate pain assessment and accurate pain assessment will be possible if the nurse assessing has a good clinical reasoning. It is therefore important to use clinical reasoning when assessing pain.

When assessing pain, it is important to use those tools that can be easily interpreted and understood by the client, family and the other healthcare providers (McAuliffe et al., 2009; Royal College of Nursing [RCN], 2009). The tool to be used by the nurse depends on the patient’s; age, clinical condition, ability to verbalize, literacy, culture, ethnicity, ability to communicate, developmental or cognitive level (Brown et al., 2015; Curry, 2010; Horgan, 2008; Dewar, 2010). The chosen tool should be practical, responsive, feasible to use, valid and reliable.

When appropriate equipment is used in pain assessment the health care provider is assured of; one, getting trustworthy and consistent results regardless the setting or the time it is being measured. Two, they are assured of detecting any type of pain. Three, they are able to assess the pain at ease and lastly they are able to detect changes in pain.

The Importance of Clinical Reasoning

It is therefore important to use the appropriate equipment when assessing pain so as to get the accurate measure. With the accurate measures, the pain management will be effective. This will reflect the nurse’s competence and use of clinical reasoning when assessing the pain. Following this systematic format shows that pain management is a coordinated procedure.

According to Hinkle and Cheever (2013), pain assessment is a systematically coordinated procedure that entails the following assessments. One, when assessing pain, the history of its onset is very important so as to determine if it is acute or chronic. Two, the location of the pain is important as some pain locations raises alarms. For example, chest pain and the abdominal pain. Three, duration of the pain is important as it helps in understanding the severity and intensity of pain. Four, characteristic of pain is also captured when assessing pain. It helps in classifying the pain and in diagnosis. For example, a stabbing pain in the chest is an indication of pneumonia. Five, the aggravating and relieving factors are important in formulating the pain management plan. The care plan focusses more on the relieving factors. Lastly, the treatment options available/suitable for the patient. At this point, the nurse is able to come up with the best treatment plan based on the type of pain the patient is experiencing.

When a nurse assesses pain following this format, it is clear that it will be accurate. The pain management plan used will also be effective as it is based on all the characteristics of the pain. When this is followed it shows that the nurse is competent as he/she depicts professionalism. It also shows that he/she has a good clinical reasoning. Lastly, it clearly shows that pain assessment is a coordinated procedure.

The proper and correct clinical waste management is vital in the clinical organization as it prevents the harm being caused to the environment, the healthcare professionals and the population at large. It is important as it helps in infection control. The hospital policies on waste disposal should be followed after assessing patient’s pain. The Australian and New Zealand standards, (2013) stipulates that the equipment that was used should be cleaned following the cleaning protocols stipulated by the hospital. This is in terms of the methods to be used, the frequency to be used when cleaning and the cleaning disinfectant products to be used. The standard precautions that are the protective gears should be used so as to protect oneself. The healthcare provider should ensure that the detergents used is fresh and lastly, the cleaning items should be changed after use and left to dry before being used again.

The Importance of Critical Thinking

When the nurse assessing patients pain cleans, replaces and disposes of the used equipment correctly, it helps in infection control. This prevents spread to others, the environment and to themselves. When this is done it clearly shows the professionalism in the nurse in terms of being competent, responsible and accountable. It also shows that the nurse has a good clinical reasoning. lastly, it clearly shows that there is coordination between different disciplines when assessing pain

The results to pain assessment should be communicated and documented to every individual that was involved in the healthcare of the patient so as to get optimal pain prevention and maximum pain management (Crowe et al., 2008). When assessing pain there are two types of results obtained; the subjective and the objective data. These are usually from the self-report from the client and the results of the assessment done. The results usually describe the characteristics of pain experienced by the patient. When they are documented they help the health team working on the patient to make the most effective clinical judgment on the patient’s pain status and in formulating an individualized care plan so as to prevent or decrease pain (Curry 2010; RNAO, 2009). Documentation also helps in following up the case. It provides baseline information that can be used when comparing the result of the assessments done in future.

It is therefore important to document pain assessment so as to have an effective pain management. In the nursing professional lack of documentation means that something was not done (Hinkle and Cheever 2013. When a nurse documents after assessing pain it shows his/her professionalism. It also shows her competence. Lastly, documentation shows that pain assessment is a collaborative procedure. It involves different disciplines.

Self-assessment and reflection aim at evaluating one’s strengths and limitations in performing a procedure. Gibbs cycle of reflection is one of the best tools to use in self-evaluation (1998). It has six phases (Dye, 2011). The first steps aim at describing the whole incidence. The second one is a description of ones feeling/reaction to the procedure they performed. The third step identifies the good and the bad experiences during the procedure. The fourth step, it involves an analysis of the bad and the good situations trying to come up with senses out of them. the fifth step tries to evaluate things that one could have done to make the experience better. lastly, it involves coming up with an action plan so as to improve on oneself for future.

The Importance of Collaboration and Coordinated Care

When a nurse evaluates him/herself after assessing pain, they are able to learn their strengths and limitations. With this, they are to improve their competence. This means in future they will assess patients in a better way hence improve pain management. Reflecting also shows the nurses professionalism.

Conclusion

Pain assessment is a multidisciplinary procedure. For it to be done effectively the health care providers has to work as a team. The eight steps of pain assessment are important and should be followed systematically so as to have accurate measures. It is clear that for effective pain management the pain assessment should be done accurately and promptly. Lastly, pain assessment assesses the health care provider’s professionalism, competence, responsibility, and ability to work as a team.

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