Nurses need to make habit of pain assessment
Nurses need to make habit of pain assessment
They may find problems that others have missed
(Editor's note: This is the conclusion to a two-part series on teaching staff about pain assessment and alternative forms of pain management.)
Home care nurses often find themselves on the front lines of determining whether a patient has pain and providing relief, but few home care agencies require nurses to ask patients about pain on every admission.
At least that's what Wisconsin researchers surmised after delving into the issue of pain management in the home care setting.
Researchers asked some Wisconsin home care agencies whether their documentation system was set up to have nurses ask every patient on admission whether they have pain. "The answer is usually `no,"' says Karen Stevenson, RN, MS, project director for a program called Institutionalizing Effective Pain Management Practices in Home Health in Madison, WI. It is funded by a grant from the Robert Wood Johnson Foundation of Princeton, NJ.
"Pain assessment may be a subset of a gastrointestinal or neurological diagnosis, but nurses are not focused on it as a specific symptom," Stevenson says. "Some of our early quality improvement data shows that about 80% of home health setting patients have pain, so pain of various types is a big issue - but they just don't ask about it."
Pain assessment: First step toward treatment
Assessing a patient's pain is an important first step toward treating it, says Pamela Bennett, RN, BSN, managing director of the St. Elizabeth Medical Center Pain Management Center in Boston. Bennett also is the president of the American Society of Pain Management Nurses in Pensacola, FL.
"The nurse is a huge factor in being able to identify and treat pain because people suffer in silence a lot of times, and by our prodding we can make sure people seek additional help," Bennett says. (See story on working with a hospice to improve palliative care, p. 61.)
Bennett previously had worked for a home care agency, and she has had first-hand experience in assessing homebound patients for pain.
One time she visited an elderly patient who had been bitten by a cat and had been treated in an emergency room.
Bennett asked the woman about her pain during a home visit assessment, and the woman replied that she felt pain on the right side of her chest, and she felt a burning pain in her armpit and down her right arm. So Bennett asked her if she could listen to her lungs, and she instructed the woman to take off her shirt.
"I noticed her breast looked like an orange, which is typical of significant advanced breast cancer," Bennett recalls.
It turned out that the woman had not visited a doctor in years, other than her emergency visit. Bennett directed the woman to see a physician the next day, and sure enough the woman had breast cancer that had metastasized to her bones. "But she was made comfortable with adequate medication."
Another time, Bennett saw a multiple sclerosis patient who had chronic pain. "My job was to go into the home and start her on an IV and then teach her how to care for the IV," she says.
Bennett asked the woman questions about her history, and the woman said she was having back pain. The woman described symptoms of a nerve compression, stating she was having pain shooting down her leg.
"She had been treating it with aspirin at home, and I told her she needed to talk with her doctor about it and that there were potential treatments that could be done with her," Bennett adds.
The woman visited her doctor, and he gave her an MRI that showed she had a herniated disk. "He took her off aspirin and put her on different medicines and started her on physical therapy."
Both of these examples show how a nurse, simply by inquiring about pain, might be able to help a patient discover problems that other medical professionals had missed.
"To me, the role of the nurse is first and foremost that of the patient advocate," Bennett says.
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