The way we ask for someone's pain level?

[cmav8]

I've come across patients, usually post op, that needs to be routinely assessed on their pain levels.

Now I'm trying to look for a way to ask them on their pain level without planting into their minds the idea that they're actually feeling pain. Of course we can plan a response from their report, but we might be addressing pain that is actually not present in that moment.

Can we ask a general question of "how are you feeling right now?", instead of "are you feeling any pain right now?" Should we be direct or indirect in these kind of situations?

Is that possible? Thanks for your time! :)

[FMF Corpsman, MSN, RN]

WeepingAngel, I'm not quite sure about your response. My critique of VA nurses was not meant to be all-inclusive by any means. I have met some Silent Angels there as well. Those who go through their shift and commit to their task with barely a sound as some are surrounded by incompetence on nearly every level from administration to housekeeping to Safety and Security, and I know it makes it very difficult for one to continue to do their job, day in and day out when you are surrounded by mediocrity. I’ve worked on and seen, some “bad floors” myself in the past 30 years, I would have had to have had my head stuck up somewhere “anatomically uncomfortable,” if I hadn’t.

[Morainey, BSN, RN]

Just sounds awfully inflammatory. I know several former VA nurses who would disagree with your assessment. I would also disagree with your assertion that a disproportionate amount of decedents in the obituaries pass away as a direct result of being patients at the VA.

[LadyFree28, BSN, LPN, RN]

If you wanted to be in Law Enforcement you should have made that decision long ago, not when you are standing in front of a patient seeking treatment for an illness or acute pain.[/quote']

^This!!!

We, as nurses, are giving pt focused care...it's not about how "YOU" would be in pain.

Working in areas where pain management is paramount, I'm in who will medicate...I'm not for "chasing" pain...I'm about getting intervention, watching for breakthrough pain, and transitioning to other non-opioid meds, and utilizing non-pharmacological treatments.

As someone who had a consistent high pain threshold by having a history of migraines suddenly endure a major medical trauma, I remember needing break through pain medication, even though I was on Dilaudid PCA. I remember being in the PACU; the nurse was caring for me stated "you are on a PCA," and had the "I don't want her to become addicted" look. The anesthesiologist came over and I have them the riot act...told them "I'm a nurse, I have a migraine, I need medicine for it, I prefer toradol."

One well seasoned nurse was VERY happy in helping with breakthrough pain...and I was very thankful for that. Because of my Injuries, I developed Complex Regional Pain Syndrome (CRPS). I've had it five years post trauma, along with my migraines that hit, especially after the trauma, and I was a frequent flier at my local ED when an exacerbation occurs. I hate to go, but having episodes of palapations and vertigo, or vomiting profusely is not going to do any good.

I have always been treated efficiently and compassionately.

Sometimes we need to check ourselves at the door and assess accordingly...and I'm sure most of us do, and sometimes, we do get the patients that are outright needing a wean off, but are fighting against their dependency; and some have a pain management team, which can make it complicated as well, especially if they are hospitalized for something else...the focus is on the acute pain; however, providing a realistic focus of the acute pain, and getting that pain under control is still possible.

And you still have pts and families that can still have you scratching your head...I had a family member if a pt state that the pt was in pain, and the pt was very unhappy about their pain control. I stated, "how long the pt has been asleep? The pt had been sleeping for 45 mins.

Obviously, I didn't medicate the patient.

PS:Great to "see"you FMF!!!

Back to the thread...:)

[Ayvah, RN]

This reminds me about the question of if asking someone is suicidal plants the idea in their mind. If we can all agree that it doesn't, I think we can then agree that asking directly about pain doesn't plant the idea in a person's mind either.

[Caffeine_IV]

I'm not stingy with pain meds at all. I prefer direct questions. "Are you having pain?" What is your pain level? Would you like something for pain?

I have too much to do besides worry if someone is lying or exaggerating pain or if I made them think they had or should have pain because I asked.

[FMF Corpsman, MSN, RN]

Maybe it depends on where you look or live.

[FMF Corpsman, MSN, RN]

Just sounds awfully inflammatory. I know several former VA nurses who would disagree with your assessment. I would also disagree with your assertion that a disproportionate amount of decedents in the obituaries pass away as a direct result of being patients at the VA.

Weeping Angel and any other VA Nurse I may have unintentionally offended. I attempted to stress in my OP, that I certainly wasn't being all-inclusive. I've known some excellent Nurses who worked at VA Hospitals; unfortunately, I've also known many bad nurses who have worked there. I can only relay my experience and it has been my experience, that it takes and act of Congress to dislodge a Nurse from his or her position at a VAMC, while they apparently will hire anyone with a Nursing license who happens to wander in from the streets. My own administrative experience tells me to hire only the best nurses and I will have the best staff, with the least turnover, with fewer c/o, higher than average patient satisfaction surveys, and overall the least number of fires to put out. You don't build that kind of team when you hire slipshod, lazy nurses who are only there to collect a paycheck every two weeks, and try their very best to get by with the least amount of effort expended. We've all worked with nurses like that; some of you might even be nurses like that. I've been absent for a couple of months and certainly didn't mean to start a controversy with my first series of post on my return, but many of you know I don't shy away from issues and I don't sugar coat my replies.

[Morainey, BSN, RN]

I'm not a VA nurse. I just don't like sweeping generalizations that define nurses by where they work. There are good nurses and bad nurses everywhere.

[rngolfer53]

Why wouldn't you just ask them if they are in pain?

Why are you concerned about "planting in their minds the the idea that they're actually feeling pain?"

I agree with this. What is the downside of asking a post-op Pt if they're having pain?

If they say "yes" and there are orders for meds, then you give the meds. In some small number of people, I may end up feeding their addiction. (OK, so be it. That is their responsibility. I have no powers that allow me to unerringly determine who's lying.)

That's the better outcome than having a patient in pain that could and should be controlled. The number of people helped swamps the number of people harmed.

[rngolfer53]

I find that hospitalized people(patients) often respond better to the "pain" questions and the 1-10 scale than do patients in their homes, and the very elderly.

Too often elderly people don't count their aches as pain.

Our language can affect how people answer us, especially if there are cultural issues at play. An Athabaskan indian may answer about pain quite differently than say an Irishman.

In my view, as nurses, it is our obligation to have a GOOD appreciation for the comfort needs of the patients under our care. For some that can be determined easily and quickly, for others we must dig a bit.

I work inpatient hospice, and I get a good % of people who will respond with "uncomfortable" when I ask about pain, and I ask directly. Without getting into a lexicography debate, I try to dig to get at what they're communicating. I alway ask if I can bring these people something for pain. If I have a range of dosing, usual where I work, I'll tell them I'll give them the lowest dose if they are reluctant.

If they don't want any meds, I obviously don't give them, but I do provide education on not letting pain get out of control and I follow up with them often.

[rngolfer53]

In the hospital is the last place I would want someone to be unclear with me. If I want to know if my patient is having pain, then I ask them if they are having pain and then use the appropriate pain scale to determine what the appropriate nursing intervention is. It is not my place to try and deter a subjective measurement by attempting to skirt around the subject of pain, and I definitely do not want my patient to be undertreated for pain.

As a hospice nurse, I always think that un/undercontrolled pain is a cardinal sin.

[DLS_PMHNP, MSN, RN, NP]

As a hospice nurse, I always think that un/undercontrolled pain is a cardinal sin.

Yes!! It does indeed seem negligent