How to Conduct a Pain Assessment
Marijke Durning | NursingLink
Objectivity in Pain Assessment
Obviously, doing an effective pain assessment isn’t possible if we bring our own history into play, knowingly or unknowingly. So how do we find an objective way to identify pain in patients?
1- Pain Scales
Pain scales were adapted to help standardize an important part of pain assessment. By using a scale of one to 10 (sometimes one to five), patients are asked to rate their pain, with 10 being the most excruciating pain they have ever experienced, to zero being no pain.
Keeping in mind that everyone’s interpretation of pain is different, two people with similar injuries may have radically different pain scales. Take the bruised toe, for example. Patient “Sally” may say that her pain is at a 3/10 or so, while patient “Joe” may rate his pain at 7/10. However, they should both be offered pain relief if the situation allows for it, because a 3/10 is still above normal – which is zero.
A half hour later, when assessing both patients, ask each to rate their pain on the same scale. This is where the scales become quite helpful, because now you have a basis for comparing the new pain scale. In Joe’s case, his pain level has come down to 3 or 4/10, but Sally’s remains the same. This should trigger a thought that Sally – although not outwardly complaining of pain – is not getting relief from her ordered medications, while Joe did experience some relief.
Another advantage to the pain scales is they leave less room for interpretation. Whether you assess their pain at 10 a.m. and your colleague at 10:30 a.m., because you’re depending on the objective pain assessment rather than your own experiences, the patient receives better care.
2- Visual Pain Scales
Not all patients are able to articulate what their pain scale may be. In this case, use the Visual Analogue Pain scale, such as the one developed by Dr. Donna Wong and Connie Baker. The Wong-Baker VAS has a series of faces, with the expressions ranging from very sad (extreme pain) to very happy (no pain). Originally developed for children, this scale can be adapted for adults who are unable to speak either due to aphasia or other problems, such as dementia.
In some situations, pain scales are not appropriate or they aren’t as useful as they could be, which means nurses must rely on their subjective assessments of the patient. In these instances, it’s important to have more than one reference point when making the final assessment.