This is the process of identifying and managing acute non-traumatic/medical pain by the nurse using oral medications and non-pharmacological measures to relieve pain.
Aims
· Assess level of pain in patient
· Relieve the patient of pain, discomfort and suffering
· Promote the dignity of the patient
· Promote early ambulation and discharge of patient
· Prevent complications
Principles of Pain Management
1. Pain assessment is part of vital signs
2. Provide patient and family with adequate information and education on pain management
3. Assess the pain using objective scales such as 0-10 Numeric Pain Rating Scale, Wong-Baker Faces Pain Scale, Colour-Circle Pain Scale etc. and document
4. Treat each patient as an individual and involve the patient and family in the pain management
5. Employ evidence-based contemporary recommendations for pain management such as:
· Pre-emptive analgesia (analgesic given before a painful stimulus)
· Multi-modal analgesia (using two or more forms of analgesic concurrently)
· Time-scheduled analgesic administration (giving the analgesics according to the time prescribed regularly)
· Non-pharmacological methods of relieving pain such as early mobilization, passive mobilization, positioning, and other appropriate measures should be used as adjuncts to analgesic administration for pain management
6. Evaluate the pain management and review decisions per assessment findings
7. Investigate allergies to pain medications and other co-morbidities
8. Employ effective teamwork with doctors and other health team members when managing pain
9. There should be hospital protocol for pain management
10. There should be input and monitoring from hospital management and departmental leadership to achieve effective pain management
11. Guard against dependence or addiction
Requirements
a. Patient’s folder (electronic or manual)
b. Pain assessment tools: numerical scale or facial scale
c. Vital signs tray
d. Medication tray
e. A tray containing the following
· Patient treatment chart (Electronic or Manual)
· Spoon
· A cup
· A saucer
· A jug/bottle/sachet of water
· A pair of scissors
· Tissue paper/napkin
· Prescribed pain medication and other adjuvant medications
Steps
1. Establish rapport and explain pain management strategies to the patient
2. Perform the five moments of hand hygiene
3. Assess the level of pain using appropriate pain assessment tool based on the level of literacy of the patient
4. Reassure patient of proper pain management
5. Show empathy to the patient
6. Provide diversionary/distraction therapy by allowing the patient to listen to music or watch television or engage in a healthy conversation with the patient
7. Position patient appropriately ensuring the use of bed accessories and less discomfort
8. Ensure patient is not wearing tight or excess clothing
9. Assist patient with activities of daily living
10. Assess baseline vital signs: Temperature, Pulse, Respiration, Blood pressure and Oxygen saturation
11. Observe the rights of medication administration
12. Prepare tray and send to the patient bedside
13. Serve medications to the patient and provide him/her with sufficient water
14. Dispose off, decontaminate and clean used items
15. Sign the treatment chart (Electronic or Manual)
16. Observe patient for therapeutic and adverse effects of prescribed pain medication within the next hour
17. Continue to assess patient’s pain level and report to ward in-charge if pain persists for use of alternative analgesics
18. Document and report in the nurses’ notes (Electronic or Manual)
Management of Patients with Sickle-Cell Disease with Non-Trauma/Medical Pain:
· Put patient in a comfortable position supporting limbs with pillows
· Ensure adequate intravenous fluid therapy
· Monitor fluid intake and output
· Assist patient with activities of daily living
· Administer oxygen if necessary
Management of Patients with Cardiac Disease with Non-Trauma/Medical Pain:
· Position patient in a high Fowlers position in a cardiac bed ensuring the use of bed accessories
· Ensure patient is not wearing tight or excess clothing
· Assist patient with activities of daily living
· Administer prescribed adjuvants targeting the cardiovascular system
· Administer oxygen if necessary
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