EBP Article
Assessing Pain in the Critically Ill Adult
Assessing pain is a task the nurse must undertake for countless circumstances, whether it is for a reassessment of pain after a prn narcotic or the evaluation of a new patient admitted with severe epigastric pain. In order to effectively quantify or measure the pain, the nurse must utilize many separate methodologies. Although these approaches may differ from one another, their distinctions are necessitated by the broad array of patient affliction possibilities. For the nurse tasked with evaluating the critically ill adult a firm understanding of these processes is imperative.
According to the AACN Practice Alert the foremost method for interpreting pain in the critically ill adult is via the patient’s self report. Receiving first hand information about the symptoms detailing the pain is advantageous when selecting pain control methods. However, in many cases a patient’s ability to communicate can be altered. In these instances, “patients prefer the 0-10 Numeric Rating Scale in vertical and enlarged format (NRS-V); it is usually the best discriminative tool for use in the adult ICU.” (14) Patient’s may find it simpler to point to the numeric describing their pain intensity. To begin using these alternate means it is crucial the patient be instructed on how best utilize each scale. If a patient lacks the knowledge to successfully employ the pain scale then the findings will be skewed. Similarly some patient may have the physical capacity to reach out and point to number on a pain scale. Here head nodding, gestures, or even other non-verbal signals can be used. Often it may not be a physical limitation preventing a patient’s pain form being expressed; concentration can greatly affect how a patient reports pain. If a patient has difficulty articulating responses then simple yes/no questions should be asked. These protocols have level B support meaning the studies wee well designed, controlled, and supported a specific
Assessing pain is a task the nurse must undertake for countless circumstances, whether it is for a reassessment of pain after a prn narcotic or the evaluation of a new patient admitted with severe epigastric pain. In order to effectively quantify or measure the pain, the nurse must utilize many separate methodologies. Although these approaches may differ from one another, their distinctions are necessitated by the broad array of patient affliction possibilities. For the nurse tasked with evaluating the critically ill adult a firm understanding of these processes is imperative.
According to the AACN Practice Alert the foremost method for interpreting pain in the critically ill adult is via the patient’s self report. Receiving first hand information about the symptoms detailing the pain is advantageous when selecting pain control methods. However, in many cases a patient’s ability to communicate can be altered. In these instances, “patients prefer the 0-10 Numeric Rating Scale in vertical and enlarged format (NRS-V); it is usually the best discriminative tool for use in the adult ICU.” (14) Patient’s may find it simpler to point to the numeric describing their pain intensity. To begin using these alternate means it is crucial the patient be instructed on how best utilize each scale. If a patient lacks the knowledge to successfully employ the pain scale then the findings will be skewed. Similarly some patient may have the physical capacity to reach out and point to number on a pain scale. Here head nodding, gestures, or even other non-verbal signals can be used. Often it may not be a physical limitation preventing a patient’s pain form being expressed; concentration can greatly affect how a patient reports pain. If a patient has difficulty articulating responses then simple yes/no questions should be asked. These protocols have level B support meaning the studies wee well designed, controlled, and supported a specific
References: Assessing Pain in the Critically Ill Adult. (2013). AACN Bold Voices, 5(10), 10-13.