Pain scale

  1. 0 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?
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  3. Visit  webbiedebbie profile page

    About webbiedebbie

    webbiedebbie has '22' year(s) of experience and specializes in 'OB, Telephone Triage, Chart Review/Code'. From 'Back home in NC and don't miss the SNOW!'; 57 Years Old; Joined Jan '03; Posts: 770; Likes: 74.

    40 Comments so far...

  4. Visit  gwenith profile page
    0
    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.................
    Last edit by gwenith on May 13, '03
  5. Visit  sbic56 profile page
    0
    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.
  6. Visit  CraftyLPN profile page
    0
    The wong=baker scale is for used mostly for kids though, at least tht's what I thought...
  7. Visit  webbiedebbie profile page
    0
    Thanks gwenith...gives me some ideas on how to modify the scale with my patients!
  8. Visit  Nurse Ratched profile page
    0
    :roll !
  9. Visit  memphispanda profile page
    1
    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.
    Nurse Maru likes this.
  10. Visit  rn500 profile page
    0
    (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!'
  11. Visit  Shamrock profile page
    1
    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?
    Nurse Maru likes this.
  12. Visit  gwenith profile page
    0
    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.
  13. Visit  KaroSnowQueen profile page
    0
    I do think the faces thing has a place in pain assessment. My son in law was in the hospital a few weeks ago with r/o SARS - he didn't have it, thank God. My husband and I went to visit, and the pain scale was posted on the wall at the foot of the bed. Hubby had been having complaining of back pain but said he didn't need to go to the dr, it wasn't that bad. After leaving SIL's room, he said to me, "You know, going by that thing on the wall, my pain is an 8 1/2. Maybe I should go to the dr."
    We left there and went to our hospital ER (it was the weekend, no doc open), and he rec'd pain shots, pills, and ended up taking over three weeks to get the pain under control.
    BUT if he hadn't seen that, he would have just stayed home and suffered. He doesn't show pain much other than by being quiet and he will NOT take OTC pain meds , so he would have just stayed home and been miserable.
    Just the other side of the story, I guess.
  14. Visit  ScarlettRN profile page
    0
    Memphispanda, I remember the pain rule from school well. That being said, once I got into the real world practicing in the ER with the drug seekers, I realized a few things about the pain scale. First of all, some patients think that if they report their pain as being anything less than a 10/10, they won't get anything to treat the pain. Second, and this has already been covered above, some people (mostly men and older people) will not declare their pain to be much over a 5 unless it is truly excruciating.
    There IS an assessment alternative in some facilities that makes room for the nursing judgement, and when we aren't running 6 ways from sunday, we are able to put the pain scale in perspective for some patients. I find that the FACES scale is better for the elderly because, most of them are going to report that "it hurts mighty bad" and do not understand the 1-10 question.
    Since pain has only been the "5th vital sign" for a couple of years, I am willing to bet that it will be modified to fit reality a few times in the future.
  15. Visit  Shamrock profile page
    0
    Originally posted by ScarlettRN
    Since pain has only been the "5th vital sign" for a couple of years, I am willing to bet that it will be modified to fit reality a few times in the future. [/B]
    Exactly!! I don't think memphis was
    trying to insult anyone, just stating her
    thoughts/feelings. Pain, as several
    have stated, is quite subjective. You
    definitly learn frequent flying drug seekers methods for obtaining "pain" relief and objective judgement by the nurse, also has it's place in assessing the situation. Maybe the joke Gwenith posted has the right idea, brick therapy!
    As always in nursing, there is often no
    black/white areas, just grey.


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