Pain. Nobody likes it, but in the hospital, someone’s going to have it. So, what is the nurses role in addressing pain and how should you go about it? Let’s jump in.
Address the Cause
What is causing your patients’ discomfort? By addressing this question, you already have an advantage. Is it poor positioning for a weaker patient? Maybe it’s chronic pain? Or is it acute pain?
By asking these questions, you now know if the pain can be addressed right away with a non-pharmaceutical remedy. Something like positioning or a heat or ice pack for example.
If it is chronic pain you’re dealing with, then the patient is likely always in some sort of discomfort. So be sure to address what their baseline is on a scale of 1 to 10 and be sure to ask them what their acceptable level of pain is. This way you know when some sort of pain management is needed.
For example, if the patient has rheumatoid arthritis, then their baseline pain level may be a 6 and their acceptable level of pain is a 7. Meaning anything over a 7 causes them enough discomfort that it needs to be addressed with medication and/or a non-pharmaceutical remedy.
For more information, visit Patient Education: How to Effectively Manage Acute and Chronic Pain.
If its acute pain what was the cause? Was it a sports injury? Or a burn? Depending on the cause, the types of pain may be treated in different ways with different priorities.
History
Find out if the patient has ever experienced pain like this before. If the answer is no, then see what you can do immediately to help. If there is a non-pharmaceutical remedy you think may help, then try it while you wait to get orders for a pharmaceutical one too.
Ask the patient about the onset (when did it start, did something trigger it?) and duration (how long has it been going on for) of their pain. What makes it worse and what makes it better? And be sure to have them rate their pain on a scale of 1 to 10.
Self-Treatment
If the patient answers yes, that they have experienced pain like this before, then see if they know a way that makes it better. If it’s chronic, then chances are they are going to have both a non-pharmaceutical remedy along with a pharmaceutical one they use at home. In cases like this, listen to what your patient is saying and do your best to treat it like the patient normally would at home.
PRN Pain Medication
Does the patient already have a PRN (as needed) medication for pain ordered? Great! Then administer it when available.
Is the PRN not cutting it? Are they still complaining of extreme discomfort even after you’ve given them medication? Then you’re going to need to call the doctor.
Does the patient not have any PRN medications ordered for pain? Then you’re definitely going to need to update the doctor on the situation and request some sort of medication appropriate to the situation.
Be sure to read up on Tips for New Nurses on Calling the Doctor, Nursing Fundamentals: An Intro to Pharmacology and A Guide to the 10 Rights of Medication Administration for more information.
New Pain Medication Orders
If you do find yourself needing to call the doctor, make certain you have double checked that there aren’t any PRN pain medications previously ordered. And be sure to have all your information together on the patient.
When calling, remember to have the patients chart open to answer any questions the doctor may have and have a pen and paper handy to write down any new orders. Don’t forget to always repeat any new orders back before hanging up with the doctor!
If your patient knows that a specific type of pain medication has not worked for them in the past, then mention this to the doctor. Likewise, if the patient knows what medication will ease this specific pain they’re experiencing, then recommend it to the doctor. If the patient has any medication allergies, make sure the doctor is aware of this as well.
Implement
Once you get that new order from the doctor and input it into the computer system, then pharmacy is going to have to approve it. After it’s approved you can go ahead and administer it to the patient.
Check Back In
Make sure to always check back in with your patient to make sure the medication is taking effect. Continue to ask them if there are any non-pharmaceutical things you can do for them, like getting them another pillow for comfort. Make sure the patient reevaluates their pain on a scale of 1 to 10 to make sure it is in fact improving. And be sure to chart their progression and ease of discomfort.
Create a Plan
Once you have that PRN pain medication and given the first dose, you can now come up with a plan for your patient. Make sure your patient contributes to the plan and agrees to it. This will make the rest of your shift a lot easier with the both of you on the same page.
After discussing the plan with the patient, write their pain medication plan/schedule on their whiteboard so they know exactly when they can call for their next PRN if needed. Also be sure to write this schedule down on your brain so when they call you can quickly reference your brain instead of having to log back into the computer.
Also visit Charting Tips for New Nurses for more tips.
Report
Now that you have a successful pain plan, share it! When it’s time to give report to the next nurse, go over the patients’ pain onset, if it’s acute or chronic, and what seems to make it better and worse. Let them know what the patients’ acceptable level of pain is and what plan the two of you have come up with to help with their discomfort.
Be sure to include any non-pharmaceutical remedies that have seemed to help as well. Give the oncoming nurse this information in front of the patient so that the patients 1) feels included in the plan, 2) can add anything you might have forgotten, and 3) knows that they are going to get the best care possible from the new nurse.
And that’s it! Open communication and anticipating patient needs is the key when addressing pain.
Be sure to check out Essentials of a Good Bedside Handoff Report and incorporate your pain plan into it!
And visit the rest of the Nursing Fundamentals series below!