Pain scale in corrections

tewdles, RN · Jan 15, 2010

Only if the patient can communicate with you and is able to understand the scale...otherwise use a different one.

Truegem · Jan 15, 2010

Well, I guess what I mean is...don't you get an awful lot of 10's? Wow, we do. I even try to educate them and they still say 10 as they are sitting there smiling and everything.

tewdles, RN · Jan 15, 2010

I don't work in corrections. I imagine there is a considerable burden of substance abuse and escapism in that environment. The failure then is not the scale you are using...the scale is fine, the patient report is the flawed element.

If you simply cannot believe the patient's report then you have nothing to fall back on except the clinical signs of pain/discomfort. Of course, any inmates with chronic pain issues will not have traditional signs of pain and may suffer.

Good luck.

Truegem · Jan 16, 2010

We are not allowed to fall back on the patient's clinical signs of pain and discomfort because the BRN says that the pain is what they say it is, period. I completely disagree with this, because a. some either do not understand the pain scale even after trying to educate them or b. some think they are going to get some good meds if they say 10. Sorry, but I don't care what number the patient says, a hangnail is not and never will be a 10. I feel that we should be able to assess based on their signs (behavior, grimace, posture, etc) but according to the BRN we are NOT allowed to do this. And if they can speak we are not allowed to use faces. If they say 10, then they must truly feel as if their testicles have just been ripped off, so we have to treat it. It's poor medicine in my opinion and I feel that our nursing assessment skills are being taken away from us.

I do understand that perhaps some nurses were thinking "BS" when people were complaining of pain, and these nurses were refusing to medicate them, but I think they could have come up with a more accurate way of assessing pain, than NOT assessing pain at all, which is what we they are telling us to do.

deyo321 · Jan 16, 2010

Do you have a lot of standing orders for PRN narcotics? I don't. If someone has chronic pain issues they see the doc and get rx orders. If someone asks for motrin I give it. I try very hard not to have the doc write PRN orders. If he doesI prefer he put a stop date.

I have a problem with the "PRN for anxiety" crowd. They rouse themselves from their bunk sleep walk to the door and want the anxiety medicine. Hello? My assessment skills tell me they are not anxious, but I don't give it? Then they sure will be. I tell the doc if they need it schedule it. If any emergency arises I'll call the doc for a PRN order. But to have that crap on the books for the inmates to take on demand? Chaps my butt. You know when someone is truly suffering from anxiety, or is escalating. My mental health will come to me and say Mr. soandso is having a rough time I'll call and get a one time order. Then they can reassess after crisis passes. Gotta run...

Truegem · Jan 17, 2010

The only meds we give for anxiety would probably be atarax. We use ativan for agitation only. But, yeah, it would probably have the same effect on me. The pain scale annoys me more because it's mandatory that no matter what the patient says, that's their pain. It's only going to take about 5 minutes before it catches on that all they have to do is say the magic number "10".

It would not surprise me if this rule soon applies to anxiety as well. Some peole are pushing for the 6th vital sign to be "emotional state".

tmed · Jan 18, 2010

:uhoh3:The Pain Scale is a ROYAL PAIN;