conducting a pain assessment - Royal Commission

Po1n Ad1·oca,} Nurse in Aged Ca,e for EducatH>'l & Assessment

Starting the Conversation

Objectives

What are the five vital signs?

-Temperature Pulse Blood pressure Respiration rate

\ ~ '

Pain the fifth vital sign 1 t~ RlNl.CEA

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Identifying and assessing pain • Pain needs to be assessed regularly1

- On admission - Significant changes in the resident's condition/

behaviour At least every 3 months Any time pain is suspected

• The best indicator of pain is the resident's own report1•3

• Residents able to repo1i pain (including those with mild to moderate dementia) need to be regularly asked about pain1

·3

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Does it hurt anywhere? Do you have any aching or soreness?

Right at this moment, do you have any ache, pain or discomfort? Is your pain a big problem, a medium-sized problem or a small problem?

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Biopsychosocial approach1

What is happening to the body?

What is happening in the person's world?

What is happening to the person?

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Assessing pain 1

Taking a pain history1

~ ..

rrgage supron staff assistance1

Registered nurses are primarily responsible for pain assessment, but support staff can help by:

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cnndrt1cting a pain assessment

The 1mporta ce of fa1 artne s

Family members can play a key role in the resident's care

Holding family care meetings (starting from admission) can help decrease the resident's and family's concerns regarding illness and treatments

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conducUng a pain assessment

Pain Advocacy Nurse in Aged Care for Education & Assessment

P in As es ment Tools

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Ctrrnducting a paln assessment

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The Modified Resident's Verbal Brief Pain Inventory

(MRVBPI)

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conducting a pa~r1 assessment

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• Adapted from the BPI • Uses categorical scales - mild, moderate, severe • Assesses:

• Plus alternative descriptors, ache, feeling tender, hurting, feeling stiff and sore, headache

I I

• Walking (if applicable) • General activity • Interactions with 0U1er people

Modified Residents Verbal Brief Pain Inventory (MRVBPI)

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Complet ng a MRVBPI

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Completing a MRVBPI {co t d

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Activity: Using the MRVBPI

In pairs, assess each other using the MRVBPI

Complete the scoring • Pain Intensity Summary

• Pain Interference Summa1y

How would you respond to your findings?

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The Abbey Pain Scale

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cund~cUng a patn assessme[1t

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I ser at anal

• Assesses key behaviours~

• Performed multiple times over a 24-hour period2

• Cannot distinguish between pain and other fom1s of distress<'

• If treatments are initiated, ongoing assessment using this scale is essentia!3

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Activity: Abbey Pain Scale

In your group, discuss the meaning of

for your allocated categories

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Cfilnducting a paf r1 assessment


The Pain Assessment In Advanced Dementia (PAINAD)

Scale

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Observational tools to assess pain -,

Assesses 5 indicators: breathing, vocalisation, facial expression, bodylanguage, and consolability"•" Easy lo use - involves less than 5 minutes of observation12

Pain should be assessed regularly - every four lo six hours~ I! is impossible to c!etem1i11e whether a person is in pain through behaviour· alone2

Use PAINAD lo evaluate pain before and after treatment2

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Completing the PAINAD1

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Activity· PAI NAO categories l✓;atch th,; observed behaviour 10 the PAINAD cat.;gory

ur • Striking out

• Distracted or reassured by voice or touch

• Cheyne-Stokes respiration

• C1ying

• Smiling

• Breathing

• Negative vocalisation

• Facial expression

• Body language

• Consolability

Using the PAI NAO Resident A

Score the resident's pain on the PAINAD tool using the information given below. • Facial grimacing • Fists clenched • Noisy laboured breathing • Low level speech with negative or

disapproving quality • Unable to be consoled, distracted or

reassured

Using the PAINAD - Resident B

Score the resident's pain on the PAINAD tool using the information given below. • Moaning when being moved • Hitting and grabbing staff • Settles when head stroked • Short periods of rapid breathing • Tears in the eyes

I ore

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NOPPAIN Pain Assessment Instrument

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18

Observational tool"' ~r ~~

• Observation of pain behaviours while doing common care tasks

• Observe and complete immediately fol lowing care activity

• Requires little time -complete following 5 minutes of activity Developed for use by care staff for assessing pain in residents with dementia Pain is assessed at rest and with movement

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Answer r if you did any of the activities listed, and • i if you obse!Ved pain when you did.

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Answer - r c to any of the 6 categories if pain behaviours were observed

Rate intensity of pain response on

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1½, the Norn/\ '~ 1 Tl""' Loc.ate ProblemJlr•H

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~ rtivity: NOP PAIN categories Ma1c,l1 the- obsc,rved re!.JX,n&e: lo th<- IK•PPl-.11~ (Jllr.g•Jry

O sr P f OPPAll\i

• Moans

• 'Ouch!'

• Grimaces

• Guarding

• Rocking

• Massaging affected area

• Pain Words

• Bracing

• Restlessness

• Pain Faces

• Rubbing

• Pain Noises

Activity: Pain response/ responsibility1

NPCEA

Pan Noises?

Pain Faces? Rubbing?

Rest ess ess?

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Ms Smith

Mrs Smith has a history of dementia and osteoarthritis. Sl1e is usually very active, walking up and down the corridor and into the garden. Staff report she is now quite happy to quietly sit down in her room.

Does she have pain? How would you assess her pain?

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Unidimensional pain scales

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conducUng a pain assessment

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Uniaimensional pain scales

Numeric Rating Scale O:nl)p.ll11

0 J None

2 3 j f __ s_; 7 •

10 - \'IO?o1 pa'in

8 9 10 • Can ba used for ongoing evaluation of pain intensity and to moni(or the response to treatment May nee<! lo trial several toals lo flnd the one that wort,s best with each resident1

Verbal categorical scales (e.g .. None, Mild, Moderate and Severe) are often preferred by older people and have the greatest reliability'

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Take hon1e messages ::"J

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NN:Jt~lnialmM I )

-· -··- - . -- . -- - ,..,

So start the conversation today!

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Notes

2'{• -- ---

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conducting a pain assessment - Royal Commission