Patient Satisfaction and Documentation of Pain Assessments and Management after Implementing the Adult Nonverbal Pain Scale
Patient Satisfaction and Documentation of Pain Assessments and Management after Implementing the Adult Nonverbal Pain Scale
Introduction
The topic explores the main aim of the research paper, which is the use of the Non-Verbal Pain Scale as a pain assessment tool for patients. The topic introduces the concepts of pain assessment and management techniques. These techniques are necessary for a nurse giving primary and secondary care to patients in the intensive care unit. The research identifies that pain assessment and management are essential nursing skills especially for patients in the ICU that cannot communicate their conditions. Effective assessment and management of such pain is vital to patient satisfaction, since patients in the ICU often are nonverbal or a cognitively impaired (Topolovec-Vranic et al., 2010). Carrying out a research on the ability of the Nonverbal Pain Scale to assess pain is a focus on this research. This is because the research identifies that there is no accepted pain assessment tool in the healthcare sector. The main objective of the research is to assess the impact of implementing the nonverbal pain scale tool as an assessment tool in the trauma intensive care unit (Topolovec-Vranic et al., 2010). This work analyses the approach, literature, and results of the paper and discusses the main ideologies in the research.
Main Research Concepts
The main concern for the researchers is the investigation of a nonverbal pain scale that will assist in the assessment of pain for intensive care patients. Pain assessment is a major area of concern for the paper as its reports indicate that pain assessment is inadequate among such patients. The pain and pain management are a major research concern for this paper as they are stressful and create discomfort for ICU patients. Moreover, healthcare providers often overlook or under appreciate it in cases of life-threatening illness. It is necessary to find tools for pain assessment for it faces different challenges among ICU patients. Pain assessment practices often face challenges from patients will low levels of cognition, consciousness due to head traumas, sedation, or alterations in their physiological state. In these situations, healthcare providers tend to interpret related physiological and behavioral indicators. The paper finds that effective pain assessment makes it possible for the healthcare provider to give the best care to the patient, making the patient’s stay and treatment satisfactory. Effective pain assessment is therefore the appraisal of the aspects that influence the experience and expression of a patient to pain. It is a comprehensive approach to describing pain and its impact on the function and satisfaction of patients. Lastly, it is the realization of the barriers that prevent nurses from making proper assessment and management of pain.
The other concern for the research is the effective management of pain. Pain management goes hand in hand with pain assessment. The research identifies that pain management entails proper understanding of the basic principles of pharma-codynamics and pharma-cokinetics of opiods often used in pain relief. The research indicates that pain management for ICU patients is challenging since, many healthcare providers do not understand pharma-codynamics and pharma-cokinetics of opiods. In addition, it is challenging given the conservative use of opiods by healthcare providers. This is because they believe that opiods can cause addiction, advance effects, and tolerance for lengthy hospital stay. It is also challenging in cases where healthcare providers make the wrong interpretation of agitation and anxiety as indicators of pain. Lastly, the challenge is the existence and use of validated pain assessment tools for nonverbal and sedated patients.
This creates a need for using the “Nonverbal Pain Scale” (NVPS) for the assessment of pain in patients that are sedated and nonverbal. The NVPS is a tool for the assessment of behavioral as well as physiological indicators in nonverbal patients in critical care units. The tool is an adaptation of the FLACC (Face, Legs, Activity, Cry, and Consolability) Scale used in the assessment of pain in children. The NVPS has five classes identified as facial expression, guarding, activity, physiologic I and II, each of which has a score of 0 to 2, for a total score of 0 for non-pain and 10 for greatest pain. The research’s interest in NVPS arises from the fact that there are various tools available for the assessment of pain, but most are applicable in patients with verbal skills and cognitive functioning (Topolovec-Vranic et al., 2010). Nonverbal patients cannot therefore make use of verbal assessment tools like the Visual Analogue Scale or the Wong-Baker FACES Rating Scale. This is because, these scales measure a patients self-report of pain by analyzing their behavioral in addition to physiological indicators. The research indicates that the NVPS was successful in this study as it led to an increase of the number of assessment of pain per patient per day (Topolovec-Vranic et al., 2010). Seventy eight percent of the staff found the tool easy to use and found pain assessment and administration easy with the tool.
An analysis of the literature indicates that these tools have limitations, as they are nonspecific and indirect on behavioral and physiological signs of pain. The behavioral and physiological indicators, nurses often look for are facial expressions like tense face, tears, grimacing; body movements like irritability, agitation, writhing; and reaction to physical examination like immobility and combativeness. Nonverbal patients often make it impossible for nurses to assess pain thereby drawing them to rely on behavioral and physiological changes. The nonverbal behavioral and physiological changes indicated provide nurses and healthcare providers an easy and quick way of assessing pain and the use of analgesics.
Summary and Discussion
The results of the study indicate that reliable pain assessment for patients in critical care is essential in the improvement of pain management. This is because pain assessment assists in the identification of the factors that are causing pain, and the administration of appropriate therapy. Proper administration of therapy increases the comfort, confidence, and assurance of the patience. This is essential in the improvement of the wellbeing and recovery of patients, especially for nonverbal patients that cannot make use of the self-report pain. Pain assessment for nonverbal patients is an area of concern since pain affects the emotional and physiological well being of patients. I believe that pain assessment is necessary even in the absence of physiological and behavioral indicators of pain, since their absence does not necessarily indicate a lack of pain. Pain assessment should be an essential area in the field of psychology since pain is a subjective experience that affects the mental, psychology, and physiology of a person.
There is a close correlation between pain and psyche since patients feel and experience it even in its subjective form. Pain in its prejudiced form makes use of the patient’s self-report of pain. However, as discussed in the research, the nature of the pain involvement in a nonverbal patient is difficult to measure. I find that this presents a serious challenge to healthcare providers as the relief of pain can only occur if measurement of pain takes place to identify its causes and location. This is because in nonverbal patients, pain is in its objective form. The implication is that behavioral and physiological objective indicators are not detailed indicators of pain in such patients. These indicators cannot replace the self-report of pain for patients with poor cognitive functioning, under sedation, or unconscious.
I believe that pain assessment must prelude pain management. This is because measurement of pain especially in the use of analgesics will assist in an accurate diagnosis and comprehension of the meaning of pain for a patient. Pain assessment on this objective identifies observable and meaningful human behavior to pain and injury. Observations made through the NVPS are vital as it assists in identifying the behavior of a nonverbal patient towards injury and pain. This is because human behavior is often under the influence of associated social contexts. I believe it is necessary to understand pain assessment for clinicians to grasp the role psychological factors play in the presentation of pain.
An understanding of the factors influencing pain is necessary since pain does interrupt activities and changes the behavior of a person. These psychological factors include mood, anxiety disorders, and somatization. I find the study applicable since it will assist in the identification of such factors in nonverbal and critically ill patients. This is because there is evidence that mood disarrays are a common occurrence among critically ailing patients. This is because pain easily causes their depressive state. Moreover, patients in critical care are prone to anxiety caused by their experiences with suffering, treatment, and pain. Critically ill patients also suffer from stress due to the pressure of the changes to their bodily functions and sensations. Often, for the critically ill physical distress can be a manifest of emotional distress. For patients who have had a prolonged stay at the ICU due to a chronic illness, these psychological factors are highly predominant and cause excessive somatic communication and attention in the form of somatization. Often pain for a nonverbal patient is difficult to indentify, quantify, analyze or explain since there no identifiable physical or psychological causes. I find that not all pain is physical, as psychological factors cause pain. Therefore, for nonverbal patients it is difficult to assess pain due to their inability to express emotional or psychological aspects. For this reason, pain assessment of nonverbal patients is essential in management in order to prevent pain from interrupting a patient’s recovery process.
The research findings indicate that there are few and valid tools for assessing throbbing in nonverbal and critical ill patients. Pain assessment for such patients is necessary given that pain is often an indication of damage and a reference to the spatial location of damage. Therefore, pain assessment of nonverbal patients in critical care or for patients without cognitive functioning is difficult. I believe the identification of a valid pain assessment tool for nonverbal patients is necessary in understanding the behavior associated with pain. Pain assessment of such patients will assist in improved identification, diagnosis of human behavior to pain. Pain assessment therefore using the NVPS tool will assist in the assessment and management of unrelieved pain in chronically ill patients and those with poor cognitive functioning. Unrelieved ache among such patients is of interest it has unfavorable psychological and physical effects on the patient. This is because nonverbal patients will often identify pain with an unpleasant emotional and physical experience. It is for this reason pain assessment should adopt psychological and physical aspects of pain. This is necessary since pain management will require the successful understanding of the different ways patients respond to pain-induced stimuli. This is because for both verbal and nonverbal patients, they indicate different tolerance levels for pain. In theory, pain tolerance in people is different depending on background factors like energy levels, heredity, prior experience, and coping skills with pain. It is difficult to identify the background of patients with little or no cognition and those with head trauma or those under sedation.
The research indicates that the administration of the NVPS on trauma and neurosurgical patients decreases a patient’s retrospective rating of pain and their recollection of the pain level. The assessment tool has proven to assist healthcare providers assessment pain among nonverbal patients. This implies that the tool is applicable to the assessment of psychological factors that influence pain in nonverbal patients. This tool is useful, as it will assist clinicians in determining factors that prevent nonverbal patients from adapting to their disabilities and illnesses due to pain. Moreover, the results indicate that patients in the study found that the administration of the tool reduced the time needed in receiving pain medication. The tool also makes it possible for easy assessment and management of pain as clinicians can correctly identify the factors causing pain. This increases the satisfaction of the patients as regular assessment, documentation of pain led to high quality pain management. This is necessary since clinicians using the tool will effectively treat patients with chronic pain since they can evaluate and manage the psychological factors identified.
The NVPS tool is applicable in pain assessment and management for the chronically ill, cognitively and psychologically impaired patients that cannot self-report. This is more so for cognitively and psychologically impaired patients who cannot elicit information about their pain. The tool can assist healthcare providers caring for such patients since it identifies the characteristics of the pain. It can assist in the identification of the location of pain, either as localized pain that involves cutaneous, visceral, tendonitis and arthritis, or ad referred pain like angina and appendicitis.
Conclusion
The study looks at use of the Non-Verbal Pain Scale as a pain assessment tool for patients, and the assessment and management of pain. Pain assessment and management is necessary for a nurse giving primary and secondary care to patients in the intensive care unit. The research identifies that pain assessment and management are vital nursing skills especially for patients in the ICU that cannot communicate their conditions. This is vital to patient satisfaction, since patients in the ICU often are nonverbal or a cognitively impaired. The results indicate that the ability of the Nonverbal Pain Scale to assess pain, identify psychological factors affecting pain, and ease of pain management is essential. This is because the research identifies visual and sensory assessment tools used by visually able patients are not applicable to the nonverbal patient. The main objective of the research is to assess the impact of implementing the nonverbal pain scale tool as an assessment tool in the trauma intensive care unit.
Reference
Topolovec-Vranic, J., Canzian, S., Innis, J., Pollmann-Mudryj, M., McFarlan, A., & Baker, A. J. (2010). Patient satisfaction and documentation of pain assessments and management after implementing the Adult Nonverbal Pain Scale. American Journal Of Critical Care, 19(4), 345-355. doi:10.4037/ajcc2010247.
