The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [335]
In adults with no or mild cognitive impairment, both numerical rating scales (0–10) and verbal descriptor rating scales (no pain, mild, moderate or severe pain) are both reliable and valid for patients’ self-report of pain intensity. Older or vulnerable adults with moderate to severe cognitive/communication impairment may be able to use pictorial rating scales such as the Pain Thermometer or the Faces Pain Scale (Royal College of Physicians, British Geriatric Society and British Pain Society 2007). For patients with dementia or who may be unable to vocalize, an observational tool that assesses pain behaviours may need to be considered, such as the Abbey Scale (Royal College of Physicians, British Geriatric Society and British Pain Society 2007).
Fixed times for reviewing the pain have been omitted intentionally to allow for flexibility. It is suggested that, initially, the patient’s pain is reviewed by the patient and nurse every 4 hours. When a patient’s level of pain has stabilized, recordings may be made less frequently, for example 12-hourly or daily. The chart should be discontinued if a patient’s pain becomes totally controlled.
Procedure guideline 9.7 Assessment and education of patients prior to surgery
1 If patient has had previous surgery, ask for details of:
(a) Previous and current pain control methods (pharmacological and non-pharmacological)
(b) Effectiveness of these methods
(c) Experience of side-effects, such as nausea and vomiting.
2 Assess patient for pre-existing long-term pain problems. Obtain information on:
(a) Pain type, location and intensity
(b) Use of analgesics.
3 Check patient suitability for various pain control methods, for example renal function, clotting abnormalities, dexterity, visual impairment.
4 Liaise with multidisciplinary team and patient to select most appropriate pain control method(s).
5 Explain and discuss with patient:
(a) How pain will be assessed and the use of a pain scale
(b) How pain will be controlled
(c) Goals for pain control at rest and on movement.
6 Provide patient with written information about pain control.
7 Where appropriate, demonstrate the use of pain control methods before surgery.
8 Document information in nursing and care plan.
Procedure guideline 9.8 Pain assessment chart: chronic pain recording
Essential equipment
Copy of a pain assessment chart (Figure 9.11)
Preprocedure
Action Rationale
1 Explain the purpose of using the chart to the patient. To ensure that the patient understands the procedure and gives their valid consent and co-operation (NMC 2008a, C; Witt-Sherman et al. 2004, R4).
Procedure
2 Encourage the patient, where appropriate, to identify pain themselves. The body outline (see Figure 9.11) is a vehicle for the patient to describe their own pain experience (Witt-Sherman et al. 2004, R4).
3 When it is necessary for the nurse to complete the chart, ensure that the patient’s own description of their pain is recorded. To reduce the risk of misinterpretation. E
4 (a) Record any factors that influence the intensity of the pain, for example activities or interventions that reduce or increase the pain such as distractions or a heat pad.
(b) Record whether or not the patient is pain free at night, at rest or on movement.
(c) Record frequency of pain, what helps to relieve the pain, what makes the pain worse and how the patient feels when they are in pain.
Ascertaining how and when the patient experiences pain enables the nurse to plan realistic goals. For example, relieving the patient’s pain during the night and while they are at rest is usually easier to achieve than relief from pain on movement (Davis and McVicker 2000, E).
To ascertain an understanding of the experience of pain for the patient (Twycross and Wilcock 2001, R5).
5 Index each site (A–D; see Figure 9.11) in whatever way seems most appropriate, for example shading or colouring of areas or arrows to indicate shooting pains. This enables individual pain sites to be located (Witt-Sherman et al. 2004,