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There, I said it, now let the collective nursing/medical community rain fire upon me. I'm sorry, but I refuse to accept the idea that pain is a vital sign. I vital sign in a physiological response that is measurable, comparable and deviations represent a serious disruption of homeostasis. Pain is a subjective sensation felt in response to injury. The pain scale we use is useless for traditional "vital sign" purposes. I can't tell you how many times I've triaged a person with 10/10 belly pain while they sit there and eat McDonalds/doritos in front of me. I've never seen a person with a fever of 105, a HR of 180 or a RR of 40 sit there and eat McDonalds. The fact is that pain is far too subjective to be considered a "vital sign". VS are used to assess a patient's physiological condition, and are compared with normal ranges of known, universial numbers. That doesn't mean that pain is not important, because it is a useful tool. The pain scale can be used to asses the efficacy of treatment, but I don't think it's a good indication of homeostatis. For example, I once had a woman who was in a fairly minor car accident and had 4/10 side pain but she said she had a high tollerance for pain. Her spleen was ruptured. Yet our McDonalds friend is still in 10/10 pain. Without a frame of reference, the pain scale tells us little. There are a lot of other things that deserve to be a vital sign before pain does, such as pulseoximetry or blood glucose level. We care if our pt is in pain, but it should not be considered a VS... just my thoughts.
I agree, Jo - the poster said exactly what I was attempting to say but their phrasing was much more eloquent than mine would have been.I know that not every hospital in every state isn't going to look at it being the 5th vs and require it unless Joint Commission/State, or whoever says so, but I know at our facility in north Louisiana it is a requirement by hosp. administration. I am also a cardiac pt and had surgery in New Orleans at Oschners and they "treated it" as the 5th also. When I asked, the nurses said they were required also.
Anne, RNC
I have also talked to SNs around the area, and they said it has been incorporated into their classes also. Maybe it's just a regional thing??
Perhaps Anne, it might be. I just think it is a very, very important issue to me personally and I know when I care for patients, I struggle with many mindsets that don't want to address discomfort for fear of oversedating or truly not understanding, and the worst--prejudging. It's very unfair.
Our program hasn't incorporated it as a 5th vital sign. However, our faculty has mentioned that some hospitals do consider it to be, so we need to be aware of what their specific protocols are. I have been in clinicals where it was considered a 5th VS and been in others where it hasn't.I have also talked to SNs around the area, and they said it has been incorporated into their classes also. Maybe it's just a regional thing??
It just really depends.
Too many doctors and nurses put their subjective and very personal opinions and biases about pain right smack dab in the middle of people's healthcare. This means that the guy who says he has pain 8/10 but doesn't behave the way the nurse thinks he should be behaving will not likely be taken seriously. That translates into being dismissed and undertreated. Are there people who are drug seekers and who are out for a high? Certainly. I would suggest that there are more people who are denied adequate pain control because of the fears and biases of healthcare professionals than there are people who are actually abusing the medications. The truth is that the average PCP is not well versed in and not very comfortable with the management of on-going pain issues. It is no wonder then that there are scores of people who have undertreated pain. This pain affects EVERY ASPECT of their daily life. They learn to LIVE with it, but they would like to have it controlled. They are viewed as drug seekers and hypochondriacs by too many health professionals. How long has he had the pain? If his pain is chronic it is no surprise that he can eat while experiencing pain. Chronic pain is no less important than acute pain. Chronic pain often presents itself to the healthcare professional with fewer changes in the VS than does acute pain...these people are adapted. THAT DOES NOT MEAN THEY DO NOT HAVE REAL PAIN.Is it a vital sign? ...call it what you want...it is as important an assessment as breath sounds, heart tones, or bowel sounds. It can be quantified and qualified. It can be assessed in the nonverbal, demented, and pediatric client. The appropriate treatment of pain has a profound effect on the life of the patient and lack of treatment can have a tragic equally profounjd effect. Our model of traditional medicine has come a long way in understanding pain in the human patient but we have a long way to go. Do you remember the days when docs thought it was too dangerous to give pediatric patients opioids? Do you remember when they circumcized infants with no pain control? Do you recall when the common thought was that persons with fibromyalgia were just crazy? Or that phantom pain was "all in their heads"? We must be compassionate and thoughtful when considering a reported pain level. We do not want to be dupes but we also do not want to contribute to on-going medical neglect when it comes to chronic pain control. We must not allow ourselves to become so involved in finding and fixing the "problem" that we forget to take care of the symptom in the process. Pain is a symptom. Sometimes we cannot fix the problem that causes the symptom. Sometimes we are not even sure what the "problem" is but that does not mean that we should not treat the symptom.
Thank you for giving me the opportunity to regurgitate one of my passions as a nurse.
What an awesome post. :loveya::yeah:
:yeah:
:yeah:
The OP was dismissive of the patient and judgmental. Which leads me to believe that in that logic, he will continue to make prejudgments on patients. I see many nurses do that. Blow people off and then realize later on when someone has seen the patient (much of it cultural) that there really is an issue that needs addressing.It is a common thing.
You're being quite presumptive here. I'm sticking to the point: pain isn't a vital sign.
It's an important thing to assess for, but so is anxiety and nausea. You don't hear anybody calling those vital signs.
It's an important thing to assess for, but so is anxiety and nausea. You don't hear anybody calling those vital signs.
the above statement, makes a very valid point...
for me, especially anxiety or any other type of mental/emotional pain.
my experience is ltd to inpatient hospice.
very, very sick folks.
and too many are not afforded the luxury of time, to await the effects of antidepressants.
i continually assess for any type of pain.
if a little extra dilaudid helps ease their mental pain, i'm all for it.
i have seen narcotics ease the mental anguish.
and so, i sympathize w/addicts who look for that extra 'perk', because you know addicts do not become addicts because they are happy people.
they use to escape their pain.
if there is an order, i will give it w/o judgment.
i truly do not believe pain is a vital sign.
and if it is, it is high time we consider nausea, constipation, depression and any other symptom that impedes healing, as a type of 'pain'.
otherwise, it should always and continually be frequently assessed.
'pain' is just as vital as any other distressing symptom...
but it is NOT calculable like vs, which would reflect the science of nursing.
assessing pain in a neonate, or a stoic elderly pt, reflects the art of nursing.
it is the ability to integrate the art and science of nursing, that makes the "good nurse".
leslie
The reason it isn't a vital sign isn't because it is subjective- it is because it isn't a ... Wait for it... Vital sign.
Think about it: blood pressures, heart rates, O2 saturations, and temperatures quickly become incompatible with living as they further deviate from the mean. You're not too concerned with possible 10 out of 10 pain when your patient is dead. Pain sucks. Its often a huge warning flag. But it isn't in and of itself incompatible with living.
The reason it isn't a vital sign isn't because it is subjective- it is because it isn't a ... Wait for it... Vital sign.Think about it: blood pressures, heart rates, O2 saturations, and temperatures quickly become incompatible with living as they further deviate from the mean. You're not too concerned with possible 10 out of 10 pain when your patient is dead. Pain sucks. Its often a huge warning flag. But it isn't in and of itself incompatible with living.
while i agree w/what you're saying, subjectivity is still reason enough for it not to be "vital"...however one interprets that.
but more absolute, vs reflect the priorities of maintaining life...nsg's abc's.
for me, that is double reason why pain shouldn't be a part of vs, but SHOULD still be a part of every thorough assessment.
at this point, we're talking semantics.
leslie
Perhaps Anne, it might be. I just think it is a very, very important issue to me personally and I know when I care for patients, I struggle with many mindsets that don't want to address discomfort for fear of oversedating or truly not understanding, and the worst--prejudging. It's very unfair.
It is to me, too, because I have seen pain levels get ignored, whether it was on purpose or not, and I just really hate to see that happen. I know not long after I finished nursing school, I undermedicated a patient because I didn't understand the combination of the pt's pre existing conditions and also the acute illness that brought him to the hospital. My preceptor was able to explain it to me, and I was so appreciative to be able to understand this pt's situation. Kind of a long story, but it was just so sad and the patient was in a lot of pain from the acute illness combined with the previous.
Thanks! Anne, RNC
while i agree w/what you're saying, subjectivity is still reason enough for it not to be "vital"...however one interprets that.leslie
i would like to expound on the above, a bit more.
any critical, life-sustaining data, should always be objective.
that still does NOT mean that assessing pain, is not important.
it just literally, should not be called a vital sign.
the day that subjective data is accepted "vital", all sorts of potentially devastating decisions can result.
objective data...measurable, calculable data, is imperative in order to make appropriate dxs and txs.
science wouldn't have it any other way.
jcaho decided that allowing pts to writhe in pain, is admittedly inhumane.
so they assigned it as the 5th vital sign, likely r/t it being an important reminder.
as i stated already, it really is semantics.
good nurses will know to assess for pain, with or w/o these requirements.
leslie
sissiesmama, ASN, RN
1,899 Posts
I agree, Jo - the poster said exactly what I was attempting to say but their phrasing was much more eloquent than mine would have been.
I know that not every hospital in every state isn't going to look at it being the 5th vs and require it unless Joint Commission/State, or whoever says so, but I know at our facility in north Louisiana it is a requirement by hosp. administration. I am also a cardiac pt and had surgery in New Orleans at Oschners and they "treated it" as the 5th also. When I asked, the nurses said they were required also.
Anne, RNC
I have also talked to SNs around the area, and they said it has been incorporated into their classes also. Maybe it's just a regional thing??