Letter to Students

   



       You have chosen a wonderful and rewarding career path in nursing. The world of nursing is a very dynamic profession where learning never ends. I myself have been a nurse for twenty-one years and I'm still  amazed at the abundant information that is out there. Today's nursing students are lucky to have the world of technology at their finger tips. Most students today have a PDA, and a Laptop to use on a daily bases to complete assignments or seek out additional information. Nursing in the 21st century poses many challenges but also many opportunities. I recently have learned many new ways to use technology to enhance student learning. Technology and health care are the future of safe, competent and quality care for our patients. Currently in nursing programs all over the world nursing simulation is teaching students a variety of experiences by bringing clinical situations to life in a safe conducive learning environment which helps students apply theory to real scenarios.

There is no telling where the future of technology will take us in the nursing realm, but I believe it will be exciting and rich with new experiences. 

Pain Assessment Tools

Objective pain assessment is essential to appropriate management of pain. For some patients, only physiologic and physical exam assessments are possible (pre-verbal, neurologically or developmentally compromised). However, for patients who are able to understand and communicate abut their pain even in basic ways, a pain assessment tool should be selected that is appropriate to the patients age and cognitive ability. Most frequently used pain assessment tools are shown below.

Numeric Scale for Pain Intensity (0-10)

For adults who are cognitively and developmentally appropriate. The care provider is to explain to the patient that the "0" represents "NO PAIN" and "10" represents the "WORST" pain.

Wong-Baker Faces Scale (0-10)

For children over the age of three, for adults who are cognitively or developmentally delayed, and for the use with geriatric patients who are unable to use the numeric scale. The care provider is to explain to the patient that the "0" represents "NO PAIN" and "10" represents the "WORST" pain.

FLACC scale (0-10)

For children less than three years, except for infants in the NICU or newborn nursery.

Neonatal Infant Pain Scale (NIPS)

Scale (0-7) for premature infants and neonates



Pain Assessment

Pain assessment is a subjective piece of data that health care professionals collect during a patient assessment. Pain assessments are as important as taking a patient’s blood pressure, pulse and temperature; that is why pain has been coined the fifth vital sign within health care. Pain assessments should be made-

• On initial contact with the patient
• Whenever other vital signs are taken
• With any change in medical condition
• After providing treatment for pain
• With any complaints of unrelieved pain

When making an initial pain assessment it is important to assess for the following components-

Ten Components	Questions to Ask
History of onset	How or when did your pain begin? When was the last time you were pain free?
Location	Where exactly is you pain?
Quality	What does it feel like? (sharp, dull, burning)
Intensity	How would you rate your pain? (See tools)
Temporary Pattern	Is your pain constant or intermittent?
Aggravating Factors	What factors make your pain worse?
Alleviating Factors	What factors decrease your pain?
Associated Symptoms	What other sensations are associated with your pain? (nausea, vomiting, dizziness, weakness)
Previous Methods of Treatment	What treatments have you tried for you pain? (medications, acupuncture, massage, herbal therapies) How effective have they been?
Impact of Pain on Quality of Life	What effect has your pain had on your quality of life? (mood, sleep, appetite, activities of daily living)

Acute vs. Chronic Pain

Pain can be defined further according to its duration, location and etiology:

Acute Pain: Usually the result of acute trauma, illness or surgery, that resolves once the underlying condition has been treated or improves; lasts less than three months but can occasionally persist up to six months depending upon the type of injury.

Chronic Pain: Persists beyond the expected recovery time, generally longer than three to six months; usually not associated with the autonomic nervous system response seen in acute pain, but instead associated with sleep difficulties, loss of appetite, increased irritability, depression, decreased motor and or sexual function.

Introduction

This blog site has been created for nursing students who want to increase their knowledge of pain management and how to effectively care for patients in pain. This blog is to be used as a resource to assist students in assessing, treating, and educating patients in pain in the clinical setting.

Joint Commission on Accreditation of Healthcare Organization

 (JCAHO) Standards

Definition of Pain

"Pain is whatever the experiencing person says it is, existing whenever the experiencing person says it does"  (McCaffery, 1968).

"Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage or both"  (International Association for the Study of Pain, 1994).