This document outlines a pain management course that teaches students to assess and manage pain in residents. The course objectives are to identify ways to assess pain in cognitively impaired and alert residents, evaluate pain using scales, assess and set pain goals upon admission, recognize pain signs and symptoms, implement pain interventions, and improve resident satisfaction through pain management. Students will learn to assess chronic and acute pain, use non-pharmacological and pharmacological pain interventions, document pain assessments and treatments, and evaluate pain management effectiveness. The course covers pain diagnosis, factors, scales, and managing pain through various treatments and ensuring resident comfort.
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Spear barbara activity 1
1. PAIN MANAGEMENT
Barbara Spear
Kaplan University
April 3, 2012
2. COURSE OBJECTIVES
The student will identify ways to assess and document
pain in the cognitively impaired resident.
The student will identify ways to assess and document in
the alert and oriented resident.
The student will evaluate effectiveness of pain
management by utilizing a pain scale.
3. LEARNING OBJECTIVES
By the end of the course the student will be able to:
Assess and obtain a pain goal upon admission.
Recognize signs and symptoms of pain.
Implement interventions to decrease pain levels.
Manage pain.
Improve resident satisfaction through pain management.
4. TECHNOLOGIES
Email power point presentation prior to webinar.
Webinar for conference with guest speaker.
On line research to support the data.
Lab simulation inserted into power point presentation
5. PAIN IS…
Chronic (obtain the history).
Acute (why admitted?).
Perception of the resident (varying ability to endure pain).
Disease related (Neuropathy, CVA, Osteoporosis…).
Physical and emotional stressor (newly admitted, chronic
depression…).
6. FACTORS
Culture and traditions (alternative medicines, non medical,
spiritual…)
History (chronic disease, trauma…).
Condition emotionally and physically (depression, stress,
anxiety…).
Age related (Osteoporosis, decreased mobility…)
Cognition related (dementia/behaviors, decreased activity…).
7. COGNITIVELY IMPAIRED
Unable to communicate needs (review records,
interventions identified…).
Unable to reposition frequently (schedule repositioning,
care plans…).
Poor nutrition (intake/output records, weights, medical
review…)
Depression (referrals).
8. DIAGNOSIS
X-ray (baseline)
Disease process (know the history!).
Positional (interventions, referrals, schedules…).
Further intervention versus comfort care (medical review,
family meetings).
Team approach (social worker, nurse, aid, educator…).
9. PAIN ASSESSMENT
Goal upon admission (varying pain tolerance).
Signs (facial grimace, body position, vocal, behaviors,
Symptoms (nausea, depression, descriptors).
History
Chronic versus acute
SCALES!! (questionnaires, audit, tools, interview…).
11. PAIN MANAGEMENT
Symptoms
Medication
Non-medication relief (rehab consults)
Control (interview and assessment)
Care plans with interventions
12. NON-PHARMACOLOGICAL
Reposition
Rehab consult for Physical or Occupational Therapy
Socialization
Hand to hand contact
Heat cold or alternative
Meditation
13. PAIN DOCUMENTATION
Flow sheets
Care plans
MAR and TAR’s
Progress notes with interventions
Review staff reports
Ongoing education for either discharge or maintenance for
LTC resident.
14. RESIDENT SATISFACTION
Did the intervention work?
What worked?
Medication review
PRN versus a standing order to be more effective?
15. OVERVIEW
Obtain a goal for pain upon admission!
Assess, intervene and document pain relief measures.
Is the pain intervention working?
Scales!
Is the resident comfortable, improved quality of life?
Any questions?
16. REFERENCES
Billings, D. M., & Halstead, J. A. (2009). Teaching in nursing: A guide for faculty. St. Louis, MO:
Saunders Elsevier.
Oermann, M. H., & Gaberson, K. B. (2009). Evaluation and testing in nursing education. New
York, NY: Springer.
Editor's Notes
There are multi ways to identify pain. The learner will be able to recognize signs and symptoms of pain in the cognitively impaired and cognitive resident. The student will continue to implement a care plan that monitors and assesses for pain. Assessment is a higher level in Blooms Taxonomy (Oermann & Gaberson, 2009).
The student will identify whether the interventions are working by understanding the process for pain management. Explore signs and symptoms from evidence based practice/research. Prepare various researches that can be included in the email to review as supporting data. Review those that are chosen.
Obtain a guest speaker that is a pain specialist.Review of the Id, password and importance of checking emails prior to the webinar via a schedule phone conference. Review of the directions for utilizing the webinar such as the phone and access code will be included in the email with the power point presentation. Review that the information obtained is from evidence based research that upholds peer review measured against criteria (Billings & Halstead, 2009).
Review chronic and acute signs and symptoms. Also explore the perception of the resident: Utilize all his or her senses. Understand that if can be related to the disease process. Explore the physical and emotional stressors related to pain.
Identify various cultures and traditions that would influence the management of pain. Explore the role age related dementia has with many residents behaviors that have traditionally been treated with chemical restraints.
Explore the effect pain has on the cognitively impaired individual. The increased assessments and delegation to other staff regarding repositioning. Also the ongoing assessment of an administered pain medication. Pain increases the chances of poor nutrition and cognitive changes. Individuals that have chronic pain also can have depression. Explore the role within a facility of the team such as the clinical psychiatrist as well as the social worker.
Rule out other causes of pain by obtaining baseline data such as an X-ray or labs. Review prepared data on various diseases that contribute to increased pain or immobility that can cause increased pain. This is an opportunity to review alternative medicines or treatments such as meditation or massage therapy.
Monitor facial expression and body language. Vocal complaints or frequent attempts to reposition self if in a wheelchair. Utilize pain scale. Obtain resident goal if able to express.
Have other pain scales available to insert into the presentation once the webinar has started. This can be done through the webinar by opening another window.
Assess upon admission. Continue to voice the need for a pain goal that should be obtained upon admission. Care plan updates with any changes so all staff are continuing with the same process for pain management. Obtain a consult from physical or occupational therapy if necessary. Also explore the use of rounds by a team that includes rehab social worker, a nurse, an aid and the nurse educator.
Scheduled pain medicines versus prn’s. Alternative activities for all residents to keep them active. Less activity increases the chances of chronic pain. Spend time with residents - offer information about other programs. Explore the use of meditation for pain control as well as benefits for other ailments.
Insert flow sheets, care plan, discharge transition plan and MAR/TAR’s examples into the webinar.
Review the MAR! Is it working??
Overview of the entire presentation quickly and answer any questions.
