Pain initiative changes staff and patient mindsets
December 1, 2001
Pain initiative changes staff and patient mindsets
Goal: Reducing pain scores to improve recovery
The initiative for pain management implemented a couple of years ago at Duke University Health Systems in Durham, NC, has made all providers at the institution aware of the impact pain has on patients. It also helped staff identify the number of ways there are to control pain and resources to help patients who are experiencing pain. As a result, they are able to get a better handle on pain control for their patients, says Linda E. Hood, RN, MSN, AOCN, an oncology clinical nurse specialist at the health care facility.
Hood has monitored the pain scores of cancer patients upon admission to the hospital to see how quickly the scores can be reduced to below a level of three or four on the pain scale and how many are discharged with levels of less than three or four. "To get people’s pain under control is really an important issue for our whole team," says Hood.
To lower pain scores, patients now learn why staff are asking them about pain and how they can best communicate the degree of pain they have. The institution uses the zero-to-10 pain scale to help adults evaluate their level of pain and the faces scale for children, which pictures faces with expressions ranging from crying to smiling. The education is verbal and is supported by written materials, such as the patient pain guides published by the Agency for Health Care Policy and Research in Silver Spring, MD.
All patients receive a bill of rights for pain, and cancer patients receive a special version adapted for cancer pain. In this document, patients are told:
- They can expect to have their pain addressed.
- Staff will assess their pain level and believe their reports of pain.
- It is the responsibility of staff to respond in a timely fashion.
- Staff will keep track of pain interventions and whether or not they were helpful.
Staff will also discuss whether or not patients are satisfied with their pain relief. The bill of rights for pain covers the agents used to relieve pain and explains that there are specialized techniques for people who have unrelieved pain, including nonpharmacological interventions. The education channel at the hospital broadcasts information on nonpharmacological pain relief methods such as progressive muscle relaxation and guided imagery, and patients often are given relaxation tapes to take home.
Need More Information?
- Louise Hoelker, RN, MHA, Director of Volunteers and Public Relations, Shriners Burns Hospital, 3229 Burnet, Cincinnati, OH 45229. Telephone: (513) 872-6059. E-mail: [email protected]. The cost of the program, which includes a teaching guide and video, is $35. To order, call or e-mail Hoelker, give your name and address, and ask her to send an order form for Kids Informed, Kids Aware Burn Prevention Education.
It’s important to teach patients that if pain can be kept under control, they tend not to have as many complications. Patients who don’t have their pain well-controlled following surgery or some other medical incident can develop long-term chronic pain problems, says Hood. One of the mottos selected when the pain initiative was launched is "healing doesn’t have to hurt." "Once you start talking about pain, you have a big impact on helping relieve patients’ pain and improving their quality of life by helping them understand that it isn’t something they have to accept," she says.
Some patients avoid pain medications
With chronic pain such as cancer pain, pain management often involves changing patients’ mindsets. Patients often put off taking their pain medications because they are afraid of becoming addicted, yet continual pain drains their energy and depresses their immune systems, says Hood.
When the pain initiative was launched, all staff had to watch a videotape on pain and complete a self-learning packet. In addition, champions from each area of the hospital were selected to receive extra education about pain and its control. These champions were then available to provide support to staff, monitor the outcomes of patients, conduct in-depth pain assessments when necessary, and make referrals as indicated.
Champions are now recruited and trained annually, attend educational update sessions twice a year, and participate in monthly grand rounds on pain and palliative care. The pain initiative has been a re-educating process for both staff and patients, changing their perception of pain, says Hood.
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