Adequate Pain Assessment

Last week at my clinical placement, I was assigned two clients. One of the clients had a diagnosis of entero-cutaneous fistula and the second patient had developed pancreatitis about two months ago. I was able to build up a therapeutic relationship with one of my clients. However, it is worth mentioning that I had a hard time even talking to my second client and his wife. Every time, I went in to the patient’s room, I was unable to have a conversation with the client or his wife. Even, they tried to answer all of my open ended questions by nodding or just “yes or no”. This was too much frustrating for me, not to have answered for any of my questions that I asked either to the patient or his wife. There was a massive block to communication that I wanted to explore and overcome. Being loyal to my profession and keeping in mind the values of client centered care, I decided to provide continuous care to my patient, respecting him and his family wishes (RNAO, 2006).

It was afternoon, when I came back from my lunch break. I went to the patient’s room to administer a medication and perform a physical assessment of the patient; his wife asked me a question regarding his medication. I responded to her question with patience and knowledge. I was quite unsure what was going on in their minds that they would not communicate properly. However, I remember during initial shift assessment and the one that I performed in the afternoon, I asked the client if he had pain or tenderness anywhere in his body. I gave emphasis to the question to make sure my patient was free from pain. This was the end of that communication barrier after the patient and his wife realized my concern about their care. The patient and his wife would start sharing with me, their previous experiences with nurses at a different facility. The patient complained that his pain was underestimated by nursing staff at a different facility and would not get enough pain medication; even he had physician’s orders for pain medication.

Only wearer of the shoes knows where the shoe pinches, meaning pain is a subjective experience. Nurses cannot be judgmental and underestimate if their patients are in real pain and not providing them appropriate and proper dose of the medication to relieve pain (Joelsson, Olsson, & Jakobsson, 2010). The pain that my patient would have experienced at other facility made him and his family to develop an image that nurses did not care. Their previous experience with nurses at a different facility also shattered the image of caring nurses. 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 for a longer time in future the patient was unresponsive to nurses.

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, whenever he called them to have his pain medication. Researchers have found that unrelieved pain can lead to many complications, such as emotional and psychosocial disturbances, unnecessary suffering for the patient and it can also trigger some negative feelings (Tschoeke, Fisk, Pellino, & Gordon, 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 situation that I had with my patient, I can say that patients are suffering and there is need for nurses to understand their patients’ perceptions and also need for adequate pain assessment. It was the adequate pain assessment that helped me develop that therapeutic relationship. Care would make a difference only, if provided according to patients’ wishes. Also, there is need for holistic nursing care, meaning taking care of all the aspects of care for patients. I could see that it was not just the patient but the whole family was suffering. The patient’s wife was also suffering because she had to be there with him for over two months. I can picture her restless and tired face in my mind.  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). The situation has taught me a lesson that if I come across such situation in future, I would make sure that I have done an adequate pain assessment of my patients. I will also keep in mind that pain is a subjective experience, which means “pain is what the patient says it is”.

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 www.rnao.org

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=201090719

The article has been written by Nasir Ahmad, a student at York University Toronto. The author authorizes Peace In Home Health Care Services to use this article for their clients. Please contact the author if there is any question at 23.ahmad@gmail.com

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