Inadequate Pain Assessment: Barrier to Communication

Clients’ Teaching-Learning in Nursing Profession
January 6, 2017
Health and Healing: Community as Partner
January 6, 2017

Inadequate Pain Assessment: Barrier to Communication

Nursing assessment is an integral part of nursing process, which leads to accurate diagnosis and appropriate nursing interventions for the clients. On the other hand, inadequate pain assessment, which is completely a subjective experience, may lead to negative consequences for the patient as well as for the healthcare team (Tschoeke, Fisk, Pellino, & Gordon, 2010). This paper incorporates a case scenario, brief introduction of the disease “Pancreatitis”, patient’s perceptions of nurses, and what nurses can do to relieve their patients’ pain and facilitate communication.

Last week at my clinical placement, I was assigned two clients. One of the clients was diagnosed with entero-cutaneous fistula and the second patient had developed acute pancreatitis about two months ago. I was able to build up a good therapeutic relationship with one of my clients. My relationship with my other client (diagnosed with acute pancreatitis) however, was not as open. I was unable to hold an in-depth conversation with my second client or his wife. They responded to my open ended questions through simply stating ‘yes’ or ‘no’ or by nodding their heads. There was a massive communication block that I desperately tried to overcome while respecting my client’s privacy (RNAO, 2006). I maintained professionalism and kept in mind the values of client centered care, while providing my clients with the much needed care they expected. Although, I had many unanswered questions, I did not allow my curiosity to get in the way of my patient’s well being. It was mid-afternoon, when I arrived back from my lunch break. I went to my second patient’s room to administer a medication and perform a physical assessment of the patient’s health. At that time, his wife asked me a question regarding his medication. I responded to her question patiently with my acquired knowledge. However, their silence in response to my reply led me to confusion regarding their understanding and perspective of their current medical situation. During my initial shift assessment and the one that I performed in the afternoon, I had asked the client if he had any pain or tenderness anywhere in his body. I added emphasis to my question to ensure my patient’s understanding of the importance of answering honestly. Following this question, the communication barrier between my patient and I had broken. They had come to realize my genuine care for their well-being. The patient and his wife began sharing their feelings and concerns regarding the illness and medication. He had also explained that his previous experience with nursing staff had led him to react the way he did to my initial questions. The patient complained that his pain was underestimated by nursing staff at a different facility and would not get enough pain medication, although he had a physician’s order for pain medication.

Acute pancreatitis is a potentially fatal and quickly developing condition, which involves acute inflammation of the pancreas. It has been found that person suffering from the disease experiences acute abdominal pain, nausea, vomiting, fever, weakness, hypotension, and shock. Some risk factors include obesity, development of gallstones, alcohol abuse, abdominal trauma, hyperglycemia, and viral infections (Strayer, 2010). Considering the patient’s history, he was obese, diabetic, and developed gallstones, which ultimately obstructed the flow of pancreatic enzymes to the digestive system. During the acute episode of pancreatitis, he experienced acute pain in his abdomen which is proven by studies. In a conversation with the client regarding his pain, he said that he was a strong man and never paid attention to minor levels of pain; however, pain related to his illness was unbearable, and pain medication was an essential.

My patient’s experience has led me to the conclusion that one’s pain and suffering cannot be underestimated. It takes one to experience an incident to be able to understand or even comment on it. Nurses cannot be judgmental by underestimating their patient’s pain. Deciding on whether or not one should be provided with appropriate and sufficient doses of the medication to relieve pain; should be up to the patient on some degree (Joelsson, Olsson, & Jakobsson, 2010). The incidents experienced by my patient at other facilities caused him and his family to develop a specific image of nurses and labeled them as careless. The previous nurses’ inability to provide adequate assessment of the severity of his pain ultimately provided a block to communication, not only at the previous facility, where my patient was treated for the first time, but also at his current healthcare facility causing him to be unresponsive to my initial questions.

Chinn and Kramer (2008) describe ways of knowing, such as ethical knowing, aesthetical, empirical, emancipatory, and personal knowing. These ways of knowing help nurses understand their duties to patients. It also helps them focus on patients’ rights and provide equity in nursing care. Nurses who have knowledge of “ways of knowing” use several approaches to relieve their patients from suffering. In a discussion with my patient, he mentioned that at the previous healthcare facility nurses would not even respond to his call for help in time as needed. Researchers have found that unrelieved pain can lead to many complications, such as emotional and psychosocial disturbances. Unnecessary suffering for the patient can also trigger some negative feelings (Tschoeke et al., 2010).

The central focus of all nursing interventions is to plan for patients’ well-being and more-being, to improve their quality of life. However, these nursing interventions can be even more useful if reflected upon after implementation. Looking back at the incident with my patient, I believe that in the nursing profession, there is a high demand for educated and caring nurses. It was the adequate pain assessment that helped me develop that therapeutic relationship. Also, there is need for holistic nursing care, meaning taking care of all the aspects of the patients needs. Through my immediate field experience, I came to realize that inadequate patient support and attention leads to not only patient’s suffering, but the whole family as well.  Nursing is a sacred and self regulated profession; we are obligated to follow patients’ wishes with respect, dignity and in a timely fashion (RNAO, 2006). Through this experience, I will continue to consider the fact that pain is a subjective experience, which means “pain is what the patient says it is” and will provide adequate pain assessment and interventions.

References

Chinn, P., & Kramer, M. (2008). Nursing fundamental patterns of knowing. In Integrated theory and knowledge development in nursing (pp. 1-24). St. Louis, Missouri: Elsevier

Joelsson, M., Olsson, L., & Jakobsson, E. (2010). Patients’ experience of pain and pain relief following hip replacement surgery. Journal of Clinical Nursing, 19, 2832–2838. doi: 10.1111/j.1365-2702.2010.03215.x

Registered Nurses Association of Ontario. (2006). Client centered care. Retrieved from http://www.rnao.org/Storage/15/932_BPG_CCCare_ Rev06.pdf

Strayer, D. (2010). Acute pancreatitis. Cinahl Information System. Retrieved from http://web. ebscohost.com.rap.ocls.ca/ehost/detail?vid=20&hid=127&sid=1c6f2dc0-32fe-4df4-8794-2fb941ea9a11%40sessionmgr111&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=rzh&AN=5000000256

Tschoeke, N., Fisk, S., Pellino, T., & Gordon, D. (2010). Patients’ pain experience during and following the mohs’ procedure. Dertmotology Nurse, 22(6), 11-17. Retrieved from http//:.cinahl.com/cgi-bin/refsvc?jid=528&accno=2010907198

 

These articles have been written by Nasir Ahmad BSc. (HONS) Nursing, a graduate from York University Toronto, Ontario, Canada. The writer of these articles authorize Peace In-Home Health Care Services Inc to use these articles on their website as an additional resource for their clients. However, any unauthorized copying or distribution of these articles will be dealt strictly by the laws of the state. Please contact author for any queries at 416-648-2717 or email: 23.ahmad@gmail.com