Getting patients to tell you how much they hurt
Getting patients to tell you how much they hurt
Earleene Betterton, RN, patient care coordinator at House Call Hospice in Cookeville, TN, admits it can be difficult to get patients to tell you when they are in pain, and even if they admit it. She says getting them to describe their pain can be difficult. But her experience in hospice has taught her some tricks that home care agencies might find helpful as they prepare their policies and procedures to meet the new Joint Commission requirements on palliative care. (See related story, p. 123.)
House Call Hospice uses a 10-point scale with patients, with zero being no pain, and 10 being unmanageable, "like they are going to die from it," Betterton explains. Patients are asked to use the numbers to rate their pain at six different times:
• How it is now?
• How it is an hour after taking their medication?
• How it is three hours after they take their medication?
• How bad it is when it is at its worst?
• How bad it is when it is at its best?
• How it is most of the time?
Sometimes, patients find it difficult to use numbers to rate their pain. This can be particularly true, says Betterton, with elderly patients who may have problems making decisions or fear giving what they think may be the wrong answer. For them, she suggests trying descriptive words to rate the pain: "Ask them if the pain is intense or severe. Ask them if it takes their breath away."
Another tool that can be used with those who do not respond to the numeric scale is the smiley-face scale. This widely used tool has a series of faces, ranging from a happy face to one that is very unhappy. Betterton says this is also useful with children.
You should also be sure to ask patients what, if anything, makes the pain worse. If they are having pain that is 10, you want to know what they are doing when that happens."
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