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.
The problem I have with "pain as a vital sign". Is that the "1-10" scale isn't measureable. Someone mentioned a patient with "10/10" pain, that later rated as "20/10".
Someones pulse can go up. Normal might be 60-120, but theirs can be 140, 160, 200.....it can keep changing OUTSIDE OF THE PATIENTS ABILITY TO CONTROL. The same with all the other "standard" VS. I know some people can control their pulse, breathing, etc. But having a way to OBJECTIVELY measure something is what I consider a VS.
I've said it a thousand times: The person who invents a "painometer" should be a rich dude.
Specializes in PICU, NICU, L&D, Public Health, Hospice.
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.
i think that a person experiencing intractable 10/10 pain will have a shortened life span. i think that a person experiencing intractable 10/10 pain will long for a shortened life span. in that sense, the physical pain is vital.
the important part really is that as nurses we need to be assessing pain in some fashion every time we encounter our patients. if there is any alteration of comfort, in any fashion, in the nursing assessment then we are bound to assess their comfort in an ongoing fashion. i know that pain assessments can be problematic in a number of settings. in my hospice capacity i visit patients in a broad spectrum of environments, from university hospitals to single wide trailers. there are some facilities who are very proactive about pain management in their residents. most, in my experience, struggle with anything outside of routine scheduled medications. those who struggle do so it seems either because of a "qualified staff" issue or inadequate education. let me say that it does not take a nurse to understand the basics of a pretty good pain assessment. i trust, implicitly, the pain assessments of the aides on my team. secondly, pain seminars are likely available to most skilled or assisted facilities from the local hospices who provide service for their residents. if it is really simply a lack of staff issue then shame on the facility. what surprises me sometimes is the discomfort with and exclusion of pain assessments in the acute hospital setting. i routinely encounter nurses who are unsure of their pain assessments, some who clearly are simply not well informed. so...back the the important part...documentation of nursing assessments of pain is very much less than stellar. from acute care hospital to skilled nursing facility. even on patients who have known alterations in comfort. that fact is why they want it considered as a vital sign. because it is very important, and because it is sorely neglected.
Specializes in Emergency Dept. Trauma. Pediatrics.
So did anyone know that student nurses came up with the whole Pain is the 5th Vital sign thing?? They got together to have it implemented or amended or whatever it's called. We just learned about it at our NSNA meeting. Based on some of these posts I am not sure I should be even stating this since it appears to be a bad thing and I am a student nurse
Naw, few understand the difference between objective and subjective. Pain is not a sign, duh. Let's argue apples and oranges. I say apples are a fruit and beneficial. O.k. oranges are a fruit, but you can get vitamin C from other sources and well the acidity of oranges makes them difficult for some people.
All here agree that as a symptom, pain is very important, but it is not a sign.
Specializes in Emergency Dept. Trauma. Pediatrics.
Naw, few understand the difference between objective and subjective. Pain is not a sign, duh. Let's argue apples and oranges. I say apples are a fruit and beneficial. O.k. oranges are a fruit, but you can get vitamin C from other sources and well the acidity of oranges makes them difficult for some people.
All here agree that as a symptom, pain is very important, but it is not a sign.
Specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU.
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.
s lio they assigned it as the 5th vital sign,kely 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
EXACTLY why it is to be considered "a vital sign"--there are too many prejudgments (see original OP that has evidence of this) and therefore many people remain in unnecessary pain.
I agree with you--it is a matter of semantics. But notice without it, many people tend to disregard a patient's subjective data based on their personal beliefs.
So did anyone know that student nurses came up with the whole Pain is the 5th Vital sign thing?? They got together to have it implemented or amended or whatever it's called. We just learned about it at our NSNA meeting. Based on some of these posts I am not sure I should be even stating this since it appears to be a bad thing and I am a student nurse
I did not know that, but thank you - I am probably in the minority, but I agree with you, and our hospital also follows that train of thought about it being the 5th vs.
Specializes in Emergency Dept. Trauma. Pediatrics.
I did not know that, but thank you - I am probably in the minority, but I agree with you, and our hospital also follows that train of thought about it being the 5th vs.
Anne, RNC :yeah:
Yeah it was a neat story, I was at my first NSNA meeting at our school and the State Chapter came in to talk to us and they were talking about the importance of student nurses and went into the story about the whole Vital Sign thing. How Students started wondering why it just wasn't incorporated with VS's since it was such an important part of care, then the whole process that took place thereafter to start having it brought in across the country.
Being that I have only had 1 day of clinical experience as of yet, and no other hospital experience other then being a patient many times I have no idea if this was good or bad or if it's a big deal to have it called a VS or not. I do think pain is important. Anyway, I just found this topic interesting since it is something fresh in my mind from school and saw a comment in this thread about how some bored nursing scholars probably though it up and since I just heard the story I thought I would share
That is really neat, and I bet you will be one heck of a nurse when you are finished. Thanks again, from an OLD nurse - I've had to quit working as an ER nurse after 19 years with cardiac disease and surgery.
Hmmm...I understand what you are trying to say, however, I am not sure how you justify that pain doesn't effect homeostasis. Pain certainly has physiological effects and causes stress to the body. Pain is also measured via non-verbal communication for the patient who cannot understand the pain scale and/or assessment tool the nurse is using. Pain can delay healing and/or prevent wellness. Like other vital signs, pain can be an indicator of health or illness.
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.
It just really depends.
I am in a 2 year program in Mn that is holistically based, and from the get go we have been taught that pain is the 5th VS, and is pounded in our heads to assess this regularly when we are in clinicals.
I have also been taught that people have varying levels of tolerance to pain; for example some one may say that they are experiencing a 4/10 pain level, and the next person may say the same type of pain is a 10/10. My personal experience is r/t my 8 year old autistic son who had a double ear infection last spring and didn't say anything until he woke up one morning crying, and covering his ears (and a very low grade temp). Brought him right to Children's and the Doc took one look into his ears and saw redness and pus. I wonder how long my little guy was suffering in pain, but didn't/couldn't express this to me.
.thumb.jpg.5aa4d55557c0228e31b94de19666bbbb.jpg){kind=small}
:yeah:
Pat_Pat RN
472 Posts
The problem I have with "pain as a vital sign". Is that the "1-10" scale isn't measureable. Someone mentioned a patient with "10/10" pain, that later rated as "20/10".
Someones pulse can go up. Normal might be 60-120, but theirs can be 140, 160, 200.....it can keep changing OUTSIDE OF THE PATIENTS ABILITY TO CONTROL. The same with all the other "standard" VS. I know some people can control their pulse, breathing, etc. But having a way to OBJECTIVELY measure something is what I consider a VS.
I've said it a thousand times: The person who invents a "painometer" should be a rich dude.
Pat