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Evidence Based Practice for Pain Assessment Se R October 4, 2018 | No Comments Yolla Abi Khattar Melissa Makhoul Tsoler Pashayan Vera Tavoukjian Wael Riman Introduction: Pain is a sensation of discomfort that is subjective to each individual, and it is characterized by an unpleasant feeling that can be either physiological or psychological Acute pain is a sudden feeling of pain, occurring for a short duration lasting less than 3 months and disappearing once the injury has healed Nurses are the most health care providers present on the unit with patients, therefore, they are the main providers responsible to carry out pain assessment appropriately. Nurses are expected to intervene accordingly to a person’s self-reported pain and work with the person to manage the pain appropriately Hence, nurses are required to possess the competencies to assess and manage pain, including knowledge and skills in interviewing techniques, and the ability to do physical assessment and manage pain of individuals who don’t have the ability to self-report (Herr Coyne, McCaffery, Manwarren, & Merkel, 2011, as cited in RNAO, 2013). It is evident that unrelieved or poorly managed pain is a burden on the person, the health care system and society (Lynch, 2011, as cited in RNAO, 2013). In fact, 50 to 75 % of postoperative patients do not attain sufficient pain relief (Huang et al., 2001; Chung & Lui, 2003, as cited in Bell & Duffy 2009) and some providers underestimate the intensity of the pain for 50% of the cases (Helfand & Freeman, 2009). Therefore, this observed nursing practice gives rise to a PICO clinical question. In adult patients with acute pain, does utilizing a standard pain assessment protocol, in comparison to the current practice, affect the pain relief process? Literature review: Effective pain management is a person’s right. Hence, assessing pain, implementing interventions to alleviate it and prevent it are priorities while caring for a person (Jarzyna et al., 2011, as cited in RNAO, 2013). The article written by Bell and Duffy (2009) inspects two important barriers that serve as obstacles for appropriate pain assessment, which are the beliefs and attitudes of patients and nurses, and time management Research done by Sloman et al. reinforced that pain can be perceived differently in various cultures (as cited in Bell & Duffy, 2009). Regarding the nurses’ attitudes, a triangulated study performed by Schafheutle et al. found that 39.3 % of respondents stated that not having enough of time, enough staff on the units and being overwhelmed with work were major features contributing to unproductive pain assessment (as cited in Bell & Duffy, 2009). Regarding time management, an observational study was performed for random nurses that showed that interruptions, such as answering the telephones, participating in the multidisciplinary rounds, assisting other nurses and looking for things contributed in poor pain assessment practice. In addition, it was noted that nurses’ priorities were to get all tasks and activities done before the end of their shift rather than allowing time to interact directly with patients to assess their comfort and pain level (Manias et al., 2002, 2005, as cited in Bell & Duffy, 2009). While assessing acute pain in adults patients, nurses have to be aware of the routine pain assessment, the choice of measure and the protocols. According to Helfand and Freeman (2009) study, there has been an agreement among most of the institutions that routine assessment of self-reported pain is the best measurement for pain assessment, since some providers underestimate the intensity of the pain for 50% of the cases. According to Helfand and Freeman (2009) study, no evidence was found that directly linked the timing, frequency, or method of pain assessment with outcomes or safety in medical inpatients. It was also noted that instituting routine pain assessment along with an educational component improved rates of assessment and treatment. The protocols in the institutions tend to guide the assessment and the management of pain; hence the assessment should be unified and accurate in order to intervene accordingly. Pain is universal but it is a subjective experience. Hence, it is challenging to obtain adequate objective information about it Many assessment tools are used to rate and assess pain, such as the Visual Analogue Scale, the Verbal Numeric Rating Scale, Verbal Description Scales, Facial Pain Scales, Brief Pain Inventory and McGill Pain Questionnaire (Helfand & Freeman, 2009). For the choice of measure, it must be simple to use by the health care providers, and easy for the patients to understand and able to respond to it (Helfand & Freeman, 2009). The Visual Analogue Scale for pain assessment is used universally, however its efficacy and reliability is put to question since it may bias the results. A randomized control trial was tested over forty healthy volunteers where they were induced by thermal laser stimulations. Pain was tested during different sessions using two different visual scales; the classical pain visual analog scale (unbearable pain/ no pain), and the pleasantness visual analog scale (very pleasant/ very unpleasant). And at same time, somatosensory evoked potentials were measured. Results showed
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