Evidence Based Practice for Pain Assessment

Evidence Based coiffe for Pain sagacityIntroductionPain is a sensation of dis protect that is inborn to severally individual, and it is characterized by an unpleasant feeling that can be either physiologic or psychological. Acute agony is a sudden feeling of hurting, occurring for a short duration lasting less than 3 months and disappearing at a beat the injury has healed. Nurses ar the intimately wellness apportion providers present on the unit with endurings therefore, they ar the main providers responsible to carry out hassle judging appropriately. Nurses be expected to intervene harmonisely to a individuals self-reported vexation, and work with the somebody to manage the torture appropriately. Hence, nurses are indispensable to possess the competencies to assess and manage fussful sensation, including experience and skills in interviewing techniques, and the ability to do physical discernment and manage hurt of individuals who dont suck up the ability t o self report (Herr, Coyne, McCaffery, Manworren, Merkel, 2011, as cited in RNAO, 2013). It is evident that unrelieved or poorly managed disoblige in the neck in the neck 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 diligents do not attain sufficient distressingness rilievo (Huang et al., 2001 Chung Lui, 2003, as cited in Bell Duffy, 2009) and whatever providers underestimate the gaudiness of the agony for 50% of the cases (Helfand Freeman, 2009). Therefore, this discover nursing practice gives rise to a PICO clinical question. In adult patients with slap-up sufferingful sensation, does utilizing a standard imposition legal opinion protocol, in comparison to the current practice, affect the distress relief process?Literature reviewEffective smart heed is a persons right. Hence, assessing irritation, implementing interventions to alleviate it, and prevent it are forw ardities magical spell care 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 pang opinion, which are the beliefs and attitudes of patients and nurses, and time care. Research done by Sloman et al. reinforced that pain sensation 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 carryd that not having enough of time, enough staff on the units and being overwhelmed with work were study features contributing to unproductive pain judgement (as cited in Bell Duffy, 2009). Regarding time steering, an observational study was performed for random nurses that showed that interruptions, such as answering the telephones, alive(p) in the multidisciplinary rounds, assisting other nurses and looking for things contributed in poor pain assessment practice. In addition, it was renowned that nurses priorities were to get all tasks and activities done sooner the wind up of their shift rather than al starting timeing 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 prize 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 any(prenominal) 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 as well famed th at instituting routine pain assessment along with an preparational component meliorate rates of assessment and treatment. The protocols in the institutions tend to guide the assessment and the management of pain thereof 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 a(prenominal) assessment tools are used to rate and assess pain, such as the optic Analogue shell, the Verbal mathematical evaluation Scale, Verbal rendering 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 optical Analogue Scale for pain assessment is used universally, however its efficacy and reliability is specify to question since it may bias the results. A randomized control trial was tested over forty healthy volunteers where they were induced by caloric laser stimulations. Pain was tested during different sessions development two different visual home plates the unmixed pain visual parallel of latitude scale (unbearable pain/ no pain), and the pleasantness visual analog scale ( very(prenominal) pleasant/ very unpleasant). And at same time, somatosensory elicited potentials were measured. Results showed that the thermal laser stimulations that were of low intensity were reported as painful on the visual analog scale of pain, whereas they were rated as pleasant on the visual analog scale of pleasantness. Meanwhile, following the low intensity thermal stimulation, the cerebral responses indicated the activation of that C-fibers which indicate the warm sensations that are not painful. Therefore the somatosensory evoked potential results matched with the pleasantness visual analog scal e and not with the classical pain visual analog scale. This signifies that when healthy individuals rate the no pain using the classical visual analog scale of pain, they are more likely to rate the intensity of the stimulation and not their pain apprehension (Kemp, Despres, Dufour, 2012)EBP ProcessObservationsIn infirmary X, Y, Z pain assessment was discover being performed by RNs. However, in hospital X, RNs were not using a pain assessment tool to assess the pain, some were just inquire if the patient was in pain or not, even though the Visual Analogue Scale was available on the knock down, others for sedated patients, were squeezing the patients skin to check response to pain, in addition to assessment of nervus facialis expressions and vital signs (heart rate), meanwhile in hospitals Y and Z, RNs were mostly using the Numeric Rating Scale to assess for pain by asking the patient to rate the pain between 0-10, where 0 was explained to be the absence of pain and 10 to be the worst pain. In hospital X, some RNs were discovered documenting the pain assessment by filling a pain persist sheet, while others were only seen to document pain assessment on the pain give sheet if the patient was on Patient-Controlled Analgesia, meanwhile in hospital Y, RNs were observed to document pain assessment per shift basis, whereas in hospital Z, RNs documented pain assessment only after a pharmacologic intervention. In hospitals X and Y, RNs were not reassessing pain after pharmacological interventions, while in hospital Z, RNs were observed to do so. In the tierce hospitals, RNs were observed to inform the physician if the patient was assessed to have pain.infirmary ProtocolsPain assessment protocols were taken from 3 hospitals X, Y Z. It is important to note that the 3 hospitals were correspondent in the method/system that they adopted The American system. That is, one of the references from which the pain assessment protocol of hospital X was taken, w as JCR, J.Caho, control stick Commission Resources (USA), 2003. The protocol was issued on 15/01/2011 and updated on 15/01/2013. On the other hand, hospital Y has the followings as main references Joint Commission International standards, Hospital standards, 4th edition, January 2011, Care of patient, and 2006 Lippincott Williams Wilkins, Inc., Volume 1 (4), August 2006, p. 20-28. The pain assessment protocol is issued on January 2011 and revised on March 2012. While the pain assessment protocol of hospital Z is based on the Joint Commission International Accreditation Standards for Hospitals-5th edition, JCAHO Pain Management Standards (CAMH 2002) and The Ministry of Public Health (MOH), (2003). The protocol was issued on December 2006 and revised on June 2014. We can note that some references are outdated thus the protocols should be often revised to admit them equivalent with the latest evidence based practice.3 of the pain assessment protocols stress on that pain assessment s hould be individualized according to the patients age and beliefs, values and cultural considerations. Hospital Z adds that pain assessment should be part of patient handover report. Three of the protocols state that assessment of pain should be done Post-procedure (or within 1 minute of arc of admission), post pharmacological and non-pharmacological interventions, with routine vital signs assessment, at time of discharge, before any planned activities (physiotherapy, stress test, post-operative ambulation). Apart from the assessment of pain, reassessment is considered as a crucial aspect, to monitor the pain level, in the 3 hospital protocols. Hospital Y mentions that prior to reassessment nurses should always refer to the literature of the analgesic agent for its peak action period. In hospital Z when pain is identified (score 2 and above), DMS-MRM-Nursing Sheets-Scale is activated while in hospital Y when pain is identified (score three and above), pain assessment and intervent ions flow sheet is activated.The scales used to assess the pain of adult patients with acute pain green in 3 hospitals is the numeric scale, where the patient is instructed to choose a number from 1 to 10 that best describes his current pain, where 0 refers to no pain while 10 refers to the worst possible pain. Another common pain assessment scale among the three hospitals is the Visual Analogue Scale, where the patient points out his/her pain level across a continuum with the extremities of no pain and worst pain. The FLACC (Face, Legs, Activity, Cry, Consolability) scale is used for critically ill, sedated and paralyzed, intubated and ventilated patients in intensive care unit in hospital Y while it is used for children up to 3 years old in hospitals X and Z. In addition, Adult sign(a) Scale is used for patients unable to report pain in hospital Z. Similar to the FLACC and Adult Nonverbal scales used in the 2 hospitals, hospital X uses the Behavioral rating scale (components Fac e, Restlessness, Muscle tone, Vocalization, Consolability) for patients unable to self-report pain. Wong baker Facial Grimace is a common scale in the 3 hospitals for patients who cannot communicate their pain, recommended for patients of 3 years of age and older in hospital X, while up to 7 years of age in hospital Y.GuidelinesAccording to the guidelines mentioned in Assessment and Management of Pain Clinical Practice Guidelines (Registered Nurses Association of Ontario, 2013), nurses should screen for the presence, or risk of, any type of pain upon admission, after a change in medical status and prior to, during and after a procedure. Nurses should also perform a comprehensive pain assessment using a domineering approach and appropriate, clear tools and using appropriate tools for persons unable to self-report. The nurses should take into consideration the persons beliefs, knowledge and level of understanding about pain and pain management. Then, document the persons pain chara cteristics. After implementing pain relieving measures, the guidelines state that re-evaluation is important and should be done by reassessment of the pain characteristics, and accordingly documenting the outcomes. There are some validated assessment tools, recommended to be used by the guidelines, and are the following Faces Pain Scale Revised, Numeric Rating Score, Verbal Rating Score, Brief Inventory Short Form, and Behavioral Pain Scale (See Appendices).Proposed transpose/RecommendationsMost of the nurses in the three hospitals were observed to be unfamiliar with the pain assessment protocol. Hence, it is recommended to implement frequent sessions for all nurses to inform them about the criteria of the protocol, describe any gaps, and train them accordingly. Additionally, supervision is essential on each floor to evaluate the effectiveness of these sessions. It is recommended by the guidelines that health-care professionals should participate in ongoing education opportunities to improve their knowledge and skills to be able to knowledgeably assess and manage pain (RNAO, 2013). Apart from hospital setting, the guidelines recommend that educational institutions include guidelines, assessment and management of pain into their curricula for registered nurses, and all health care providers programs to indorse evidence-based practice (RNAO, 2013).It was noted that some of the hospitals pain assessment policies were established on outdated references. It is hence recommended that hospitals always update their policies and base them on up-to-date EBP guidelines. In addition, it is also recommended for hospitals to establish a model of care to support inter-professional collaboration for the participating assessment of pain and declare pain assessment as a strategic clinical priority (RNAO, 2013). Another common observation was that the three hospitals still used the Visual Analogue Scale, which is not among the list of recommended validated pain assessment too ls mentioned in the guidelines (RNAO, 2013) and research found it to be unreliable, since patients are more likely to rate the intensity of the stimulation and not their pain perception (Kemp, Despres, Dufour, 2012).The University of Zurich and ETH Zurich in Switzerland, invented a new method for accurate pain assessment The Pain Mouse. It is an electronic pain assessment tool that offers credible evaluation, lessening missing data and unclear markings concerning pain. The device captures the clenching reaction to pain through a pressure sensor that is connected to a man-portable computer (Schaffner et al., 2012). PM is recommended to be used in the near futurity considering that it distinguishes different levels of pain, is less time consuming, more accurate and can be used for patients with limited physical activity and vision impairment compared to the Visual Analogue Scale (VAS) (Schaffner et al., 2012).ReferencesBell, L., Duffy, A. (2009). Pain assessment and management in functional nursing a literature review. British Journal of Nursing, 18(3), 153-156. Retrieved April 4, 2015, from http//web.a.ebscohost.com.ezproxy.lau.edu.lb2048/ehost/pdfviewer/pdfviewer?vid=6sid=ff36c8fd-ed44-444c-8182-9487d39e913b%40sessionmgr4005hid=4104Helfand, M., Freeman, M. (2009). Assessment and management of acute pain in adult medical inpatients a systematic review. Pain Medicine, 10(7), 1183-1199. Retrieved April 10, 2015, http//web.ebscohost.com/ehost/detail/detail?vid=3sid=7b1adb63-ced7-4486-94ef-4ecc54ddc64b%40sessionmgr111hid=123bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3ddb=rzhAN=2010437732Kemp, J., Despres, O., Dufour, A. (2012). undependableness of the Visual Analog Scale in experimental pain assessment a sensitivity and evoked potentials study. Pain Physician, 15(5), 693-699. Retrieved on April 10, 2015 from http//www.painphysicianjournal.com/2012/september/201215E693-E699.pdfRegistered Nurses Association of Ontario (RNAO). (2013). Assessment and management of pain (3rd Edition). Toronto, ON Registered Nurses Association of Ontario (RNAO). Retrieved April 4, 2015, from http//rnao.ca/sites/rnao-ca/files/AssessAndManagementOfPain_15_WEB-_FINAL_DEC_2.pdfSchaffner, N., Folkers, G., Kappeli, S., Musholt, M., Hofbauer, G.F.L., Candia, V. (2012). A new tool for real-time pain assessment in experimental and clinical environments. PLoS ONE, 7(11), art. no. e51014. Retrieved on April 10, 2015 from http//journals.plos.org/plosone/article?id=10.1371/journal.pone.0051014