17. Theoretical framework for the recognition and assessment of pain (432)

Julie Gregory, Clinical Nurse Specialist, Pain Management, Royal Bolton Hospital, Bolton, United Kingdom
Julie.Gregory@rbh.nhs.uk

Abstract:

Assessment of pain is an important aspect of pain management (Price and Check 2000), the foundation upon which pain related interventions should be based (de Rond et al 1999). In practice pain is not always recognised and or is inadequately assessed leading to inappropriate pain management (Schofield and Dunham 2003). Good pain relief is a fundamental aspect of patient care (Bucknall, et al 2003). Effective pain relief reduces complications and therefore reduces the length and cost of the hospital stay.A theoretical framework is proposed which has identified seven elements that are required to ensure health care professionals recognize and assess pain appropriately. The elements are: Education; health care professionals require the knowledge skills and attitudes to assess individuals’ pain. Organizational factors; including staffing levels, workload, priorities in care provision, work place culture and interruptions affect whether knowledge is used in practice. Nurses’ influence; they interprete patients pain make judgments and have been found to underestimate pain. Patients may be reluctant to express pain, have low expectations, fear injections, addiction and side effects from pain medication. The scale used to assess pain needs to be used consistently, understood by the health care professionals and by patients to avoid misunderstandings. Observation charts are recommended to document the pain score with other vital signs. Guidelines are produced based on scientific evidence and state the score used, frequency of assessment, but do they actually influence clinical practice. This paper will examine these factors that have been identified and compared to the data obtained to examine how pain is managed on an acute medical unit in a hospital in the North West of England. For example observation of nursing staff identified a lack of consistent pain assessment, poor documentation of pain scores and numerous interruptions.

Biography:

Julie is a nurse specialist at a Royal Bolton Hospital. She is currently studying for her PhD at the University of Salford. The study is an action research project that has examined how pain is managed on an acute medical unit and is currently introducing changes in practice with a view to developing the health care professionals pain management skills and at the same time improving the quality of pain management patients experience on the unit.