Nursing Assessment Of The New Chronic Pain Patient Sr Christine Wakefield

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Lecture given to the North British Pain Association on 16th May 2008 by Sr Christine Wakefield. In this talk, Sr Wakefield discusses the role of the nurse specialist in the assessment of the newly-referred patient with chronic pain. www.nbpa.org.uk

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Nursing Assessment Of The New Chronic Pain Patient Sr Christine Wakefield

  1. 1. Nursing Assessment of the New Chronic Pain Patient Sr. C Wakefield Clinical Nurse specialist In Chronic Pain management
  2. 2. Baguley Pain Unit- Wythenshawe Hospital University Hospitals of South Manchester NHS Foundation Trust
  3. 3. Background <ul><li>Sister on NSU Hope Hospital for 12 years </li></ul><ul><li>Trained as Associate Pain Nurse Specialist for Neurosurgery </li></ul><ul><li>Acute Pain Sister at Warrington Gen 3years </li></ul><ul><li>CNS Chronic Pain at NMGH for 3years </li></ul><ul><li>CNS Chronic Pain present post for 4 years </li></ul>
  4. 4. My Role - Manager <ul><li>Coordinator of MDT </li></ul><ul><li>Manage day to day running of unit </li></ul><ul><li>Nurse Manager – team 6 nurses </li></ul><ul><li>Manage administrative team </li></ul><ul><li>Assist with budget/target/waiting list management </li></ul>
  5. 5. My Role - Clinical <ul><li>Run 2 nurse led drug/procedure review clinics </li></ul><ul><li>Run opiate review clinic </li></ul><ul><li>Run primary care based chronic pain service – Tier 2 </li></ul><ul><li>First contact for patients and hospital staff </li></ul><ul><li>Audit research and education </li></ul>
  6. 6. New Patient Triage – Tier 2 <ul><li>All primary care referrals </li></ul><ul><li>Directory Services </li></ul><ul><li>Triage new patients </li></ul><ul><li>Direct referrals from other Tier 2 services </li></ul><ul><li>Links with GP’s </li></ul>
  7. 7. Tier 2 - Limitations <ul><li>Limited treatments </li></ul><ul><li>Lone practitioner </li></ul><ul><li>No Psychologist </li></ul><ul><li>Limited review appointments </li></ul><ul><li>Tier 2 philosophy treat and discharge </li></ul>
  8. 8. Nurse Assessment of New Patients <ul><li>Controversial </li></ul><ul><li>Based Good Triage </li></ul><ul><li>Not dissimilar to consultant assessment </li></ul><ul><li>Good explanation </li></ul><ul><li>Treatment goals </li></ul><ul><li>Honest </li></ul><ul><li>Accept own limitations </li></ul>
  9. 9. Assessment <ul><li>Structured Assessment </li></ul><ul><li>Back to front </li></ul><ul><li>Patient understands reasons for ? </li></ul><ul><li>More open </li></ul><ul><li>Personally - get more out of patients </li></ul><ul><li>Continuity of care </li></ul>
  10. 10. Social History <ul><li>Relationship status </li></ul><ul><li>Family status </li></ul><ul><li>Hobbies & interests </li></ul><ul><li>Work </li></ul><ul><li>Social life </li></ul><ul><li>Alcohol & Smoking </li></ul><ul><li>Recreational Drugs </li></ul>
  11. 11. 24hr Day <ul><li>Time awake </li></ul><ul><li>Time up </li></ul><ul><li>Activities of daily living </li></ul><ul><li>Spend day Doing? </li></ul><ul><li>Housework Cooking </li></ul><ul><li>Retire to bed </li></ul><ul><li>Sleep pattern </li></ul>
  12. 12. Previous Medical History <ul><li>Illness’s </li></ul><ul><li>Operations </li></ul><ul><li>Long term conditions </li></ul><ul><li>Family history </li></ul><ul><li>Current medications </li></ul>
  13. 13. Psychological History <ul><li>History of depression </li></ul><ul><li>Family history of depression </li></ul><ul><li>History of anxiety disorders </li></ul><ul><li>Significant events </li></ul><ul><li>Personality disorders </li></ul><ul><li>Previous medication </li></ul><ul><li>Psychological scores </li></ul>
  14. 14. Pain History <ul><li>How long </li></ul><ul><li>Onset of Pain/ Cause </li></ul><ul><li>Description </li></ul><ul><li>VAS score – best & worse </li></ul><ul><li>Better with </li></ul><ul><li>Worse with </li></ul><ul><li>Past treatments </li></ul>
  15. 15. RED Flags! <ul><li>Previous history ca </li></ul><ul><li>Night sweats </li></ul><ul><li>Age <20 & > 55 </li></ul><ul><li>Bladder & Bowel </li></ul><ul><li>Thoracic pain </li></ul><ul><li>Onset </li></ul><ul><li>Weight loss </li></ul><ul><li>Co-morbidity </li></ul><ul><li>Recent infection </li></ul><ul><li>Progressive neurological deficit </li></ul><ul><li>Trauma </li></ul>
  16. 16. Examination <ul><li>Posture </li></ul><ul><li>Range of movement </li></ul><ul><li>Power </li></ul><ul><li>Reflexes </li></ul><ul><li>Sensory changes </li></ul><ul><li>Obvious abnormalities </li></ul>
  17. 17. Discussion <ul><li>Patients model for their pain </li></ul><ul><li>Clinicians model </li></ul><ul><li>Explanation nature chronic pain </li></ul><ul><li>Pacing goal setting and exercising </li></ul><ul><li>Treatment options </li></ul>
  18. 18. Tier 2 - Treatments <ul><li>Education and Counselling </li></ul><ul><li>Physiotherapy – acupuncture, hydro </li></ul><ul><li>TENS </li></ul><ul><li>Pharmacological tx </li></ul><ul><li>Direct list to secondary care for injections/MDT/PMP </li></ul>
  19. 19. Tier 2 Treatments <ul><li>Referral Psychology </li></ul><ul><li>Referral to other tier 2 services </li></ul><ul><li>Referral to other specialities </li></ul><ul><li>Follow up and support </li></ul><ul><li>Refer on to secondary care </li></ul>
  20. 20. CNS Competencies <ul><li>No Clear Guidance </li></ul><ul><li>BPS guidelines 2002 - withdrawn </li></ul><ul><li>Job description/title </li></ul><ul><li>Key Skills framework </li></ul><ul><li>New Guidelines 2008 BPS RCN </li></ul>
  21. 21. CNS Competencies <ul><li>RGN </li></ul><ul><li>Post reg courses relevant to subject </li></ul><ul><li>3 yrs experience senior level </li></ul><ul><li>Masters level degree ? Pain </li></ul><ul><li>?Nurse prescribing </li></ul><ul><li>Management experience </li></ul><ul><li>Confident </li></ul>

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