Pain Assessment Tools in Pacu

I am going to compare and contrast 3 pain assessment tools, which would be appropriate for use in our clinical area, using current literature, benchmarks and practice guidelines. If pain is what the person tell he is (McCaffery M, Pasero, 1999) therefore pain assessment tools should be based on the patient’s own perception of their pain and its severity. But sometimes it’s difficult to express the pain that we feel into words.

Pain assessment tools have two main categories: multi-dimensional and uni-dimensional. I am going to only discuss on unidimentional because multi-dimensional tool is complex and time consuming you rarely find them to be use in assessing post-operative pain, for example, the McGill Pain Questionnaire (Coll et al 2004, Mackintosh 2005). The most commonly pain assessment tools in my workplace (Perioperative) are visual analogue (VAS), verbal pain scale (VPS) and Wong baker’s face pain rating scale.

They are uni-dimensional, focusing specifically on one or two aspects of pain, most frequently the intensity of pain and occasionally the location of pain through the use of a body diagram, which enables the patient to mark where the pain is on an outline body diagram. (Coll et al, 2004). Visual Analogue Scale With this pain assessment you would ask the patient to describe their pain using a verbal or written list of descriptors on a scale from ‘no pain’ to ‘the worst possible (or imaginable) pain’. This could also be done by simply be asking the patient to rate their pain from mild, moderate to severe.

The patient rates the severity of their pain on a scale of 0 to 10, based on the corresponding numerical equivalent of pain. This simple pain measurement tool is particularly useful for monitoring patient postoperatively because you are able to reassess pain that is expected to diminish over a period of time. A Verbal Pain Scale With a verbal scale, you can ask your patient to describe the degree of their discomfort by choosing one of the vertical lines that most corresponds to the intensity of pain that they are feeling.

This is a good way to explain early postoperative pain; the assessor can use this scale to determine if the treatment management in PACU is progressing in a positive direction. A Numerical Pain Scale A numerical pain scale allows your patient to describe the intensity of discomfort in numbers ranging from 0 to 10 (or greater, depending on the scale). Numerical pain scales may include words or descriptions to better label the symptoms, from feeling no pain to experiencing excruciating pain. Some researchers believe that this type of combination scale may be most sensitive to gender and ethnic differences in describing pain. Wong baker’s faces pain-rating scale.

To use this scale, the patient should be able that show how a person in pain is feeling by pointing at the picture of a face. Therefore, a person feel happy because he or she has no pain or a person may feel sad because he or she has some or a lot of pain. This is best explained by (Face 0) being happy because he or she doesn’t hurt at all and it will increment up to (Face 5) meaning it hurts to the maximum imaginable pain, although patient need not to be crying to feel this bad. * The use of happy an unhappy faces as pain scaling for 3 years old and above is well validated to children (Hicks al. 2001: 173). *

* Although Wong baker’s faces pain is designed for children, it also offers visual description for those who don’t have verbal skills to express how their pain or symptoms might feel, example are people with cognitive impairment and dysphasic (Makintosh, 2007). * * Comparison The well-known visual analogue scale (VAS) and numeric rating scale (NRS) for assessment of pain intensity agree well and are equally sensitive in assessing acute pain after surgery, they have the same concept, they have horizontal line with numbers from 0-10 on both ends and they are both superior to a four-point verbal categorical rating scale (VRS).

They function best for the patient’s subjective feeling of the intensity of pain right now—present pain intensity. * Advantages are simple and quick to use, no special training required, quick and easy to learn and use, the outcome is measurable and can be compare to other patients. * However, uni-dimensional pain assessment tools should be used with caution as they only focus on one or two aspects of the total pain experience. Uni-dimensional pain assessment tools may also be subject to misinterpretation.

Some patients have difficulty conceptualising their pain as a point on a line, or equating a numerical value to pain intensity. (Heikkinen et al 2005, Mackintosh 2005). Conclusion * Effective communication is fundamental in the accurate assessment of pain. Healthcare professionals should take time to speak and listen to patients, to respond to them as individuals and to make due consideration for any limitations in communication, which individuals may have, for example, deafness or other language barriers (Gray 2005, Mackintosh). * References: Campbell, W. I.

2003 Practical methods for pain intensity measurements. In Breivik, H. , Campbell, W. and Eccleston, C. (eds) Clinical pain management: Practical applications and procedures. Edward Arnold, London. Hicks CL et al, 2001 The faces pain scale-revised: toward a common metric in pediatric pain measurement. 93:173-83. McCaffery M, Pasero C, 1999: Pain: Clinical manual, pp. 68-73,Mosby, Inc. Mackintosh C, 2007 Assessment and management of patients with post-operative pain. Nursing * Manis E et al. , 2002 Observation of pain assessment and management: the complexities of clinical practice.

Journal of Clinical Nursing. 11, 6, 724-733. Noble B, et al. , 2005 The measurement of pain: Journal of Pain Symptom Management. (1): 14-21 * Wong D. L. , Hockenberry-Eaton M. , Wilson D. , Winkelstein M. L. , Schwartz P, 2001 Wong’s Essentials of Pediatric Nursing, ed. 6, St. Louis, Mosby. p 1301. McCaffery, RN, MS, FAAN and Chris Pasero, RN MSNc, 1999 Pain Clinical Manual, 2nd Edition, Mosby, Inc. H. Breivik, P. C. et al, 2008 Assessment of pain, British Journal of Anaesthesia. (101(1): 17-24. Sloman R. et al, 2005 Nurses’ assessment of pain in surgical patients. Journal of Advanced Nursing. 52, 2, 125-132.

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