[webbiedebbie]

My hospital uses a pain scale of 1-5 with faces. How effective is this, really? I had a patient tell me she was a 5 (worst pain) and yet she was on the phone laughing with a friend. Of course I documented that she said she was a 5 on the scale, but I also documented what she was doing at the time. And yes, I did make sure she knew that a 5 was the worst pain on the scale.

Why can't we go back to just documenting exactly what their pain level is by what they say, what they are doing, and our assessment? If my notes indicate a 5 (worst pain) and I don't document what is really going on with the patient, then I may be omitting information. Then again, a 5 is an oxymoron to how she is behaving with the laughing.

The 5 may be her worst pain, but the face on the scale says it is unbearable. How reliable are these scales?

[gwenith]

Webbiedebbie this is another thread I would like to start - how do nurses REALLY assess pain. Yeah we use the 1-10 pain scale with varing success and yes I get the cardiac patient sitting up in bed wolfin thier meal damanding to know what is on TV while telling you their pain is 10/10.

Jay Jay posted this on one of my humour threads and I loved ot so musch I thought I would copy it down here.

A young man in his 20's who had been in a motorcycle accident and collapsed a lung was whining about his chest tube, and how much it hurt. Eventually, the doctor came by to see him.

"What's the problem?" he asked.

"My chest hurts!" whined the young man.

"How much on a scale of 1 to 10?"

"10!" responded the patient, without hesitation.

"I don't think you understand the pain scale," replied the doctor. "If I took two bricks and smashed your balls between them, THAT pain would be a 10. Now, how much does it hurt?"

"Uhhhh.... about a 3, I guess!"

Says it all really.................

[sbic56]

OMG, I love that! Pain is subjective, but the joke gwenith posted shows exactly how misused/misunderstood pain scales can be. Patients don't seem to fond of them in my experience either, but I'm not sure what the alternative is.

[CraftyLPN]

The wong=baker scale is for used mostly for kids though, at least tht's what I thought...

[webbiedebbie]

Thanks gwenith...gives me some ideas on how to modify the scale with my patients!

[Nurse Ratched]

!

[memphispanda]

We use a 1-10 scale, and it seems to be very effective. We rarely have someone say "10" who isn't aacting like they are in pain. We also were taught in school that pain is what the patient says it is. I don't think we should judge someone who says they are in pain by their behavior. Some people (myself included) can be very good at hiding pain when we want to. A lot of it has to do with how often they have pain--you end up having to go on with life despite the pain. You can't whine about it all the time.

Personally it upsets me to see so many people who are nurses believe they can assess a person's pain better than that person themself can. No wonder it's hard to get meds in the hospital sometimes.

[rn500]

(b)"I don't think you understand the pain scale," replied the doctor. "If I took two bricks and smashed your balls between them, THAT pain would be a 10. Now, how much does it hurt?"

"Uhhhh.... about a 3, I guess!"

Says it all really.................(/b)


LMAO!!!

You know what I thought of when I read about that rock climber that cut his own arm off to save himself?

'Now THERE'S somebody who knows what a 10/10 is!'

[Shamrock]

Originally posted by memphispanda

Personally it upsets me to see so many people who are nurses believe they can assess a person's pain better than that person themself can. No wonder it's hard to get meds in the hospital sometimes. [/b]

I gotta agree with memphis here. Pain
is what the person says it is. Does not
matter what they are doing. May be that the patient of webby's was trying to make the person on the phone feel better about her, (the patients), situation. Maybe the person on the phone was the patients young child and mom was trying to make them feel better. Who knows?

[gwenith]

Memphispanda

I wish to explain further - Admittedly "teh book"states that we are to accept pain is what the patient says it is but the nurses posting here have developed thier practice far beyond "the book"

I HAVE to make value judgements about pain because I work in a Coronary Care unit and must assist my patients to distinguish between pain of cardiac origin and other chest pain. I truly wish this was as simple as telling the patient that it is a central crushing pain - it isn't. Some cardiac pain is very difficult to distinguish from say, back pain.

Anxiety also plays a big part - we have to help the patient not only to distinguish what is cardiac but how severe that pain is - else we will cause them to become cardiac cripples afraid to move out of a bed for the rest of thier lives so I HAVE to assess what they are saying the pain is against visible physiological responses.

Yes there are people who are very good at hiding pain and they usually UNDER report pain - guess what I don't believe them either and will titrate the meds until I am sure through all assessment data that they are indeed free from pain. Why would anyone under report pain? Try macho males who won't don't accept that they aer having a heart attack.

When in doubt I always err on the side of giving relief/medicating the patient BUT I will also repost incongruent behaviour because this provides invaluable data to be used to help a patient MANAGE thier own disease later on.

So please do not lecture me on what you learnt at school you will soon enough learn that there is a huge "Theory-Practice Gap" in nursing and this is one area where it is widest.