Nursing process for pain: an initial assessment and classification of pain

The profession of a nurse has a number of features. But first of all, it represents a certain process of interaction with doctors and patients. What is the subject of labor for this category of nursing staff? All the activities of a nurse are aimed directly at the patient. In this case, the ultimate goal of all activities is the recovered patient.

The nursing process for diseases combines diagnostic and treatment methods and personal relationships. That is why the moral and psychological aspects of this category of workers are highlighted. Nurses should be able to feel and understand what depresses and disturbs a person, implementing an integrated approach to the patient. This requires representatives of this profession to have knowledge not only in the biomedical, but also in the psychological field.

The concept of nursing

Today in medicine there is a special science that involves the implementation of actions aimed at using the environment surrounding the patient for his recovery. This is the sister process. It is based on knowledge of the natural sciences and humanities, such as medicine and biology, sociology and psychology.

A nurse, in the performance of her professional duties, must assume responsibility and act within her authority. At the same time, she has a need for planning and assistance. The nursing process in the rehabilitation of the patient after a disease is also important.

All actions of paramedical personnel should be carried out in accordance with the requirements of the State educational standard. What is the concept of nursing according to this document? The state educational standard states that this is a certain method of implementing and organizing nursing care for the sick, the purpose of which is to satisfy the psychological, social and physical needs of society, family, and people.

The patient’s body is restored and maintained largely thanks to the nursing process. And this requires not only excellent technical training from nursing staff. A huge role in this matter is played by the ability of the nurse to work with the patient’s personality, as well as the creative attitude towards the performance of her duties.

Main stages

The methodology of the nursing process includes the implementation of certain actions. These are five stages that paramedical personnel must go through sequentially:

1. First of all, it is important to conduct a nursing examination. It is a collection of information indicating the patient’s health status. This is the first stage of the nursing process. These data can be either subjective or objective. In the first case, such information includes psychological and physiological, as well as social factors relating to the patient and his environment. It is provided by the patient himself, as well as his relatives during the survey. Thanks to the objective method, it is possible to assess various parameters of a person related to his appearance, state of consciousness, etc. These data are obtained during a physical examination of the patient. The final outcome of the first phase of the nursing process is the documentation of the available information. This creates a nursing medical history, which is a legal protocol.
2. At the second stage of the work of paramedical personnel, the problems of patients are established. This makes it possible to formulate a nursing diagnosis. All problems of the patient are divided into two categories. These are existing and potential. The first of them include those that cause discomfort to a person at the present time. Potential ones do not exist yet, but their probability of occurrence is extremely high. In addition to identifying these two types of problems, the nurse must be able to identify factors that contribute to their development. In this case, the strengths of the patient are revealed. They are used to counter disease. However, the patient often has several problems at once. The task of a nurse is to determine a system of priorities that are classified into primary and secondary. The first ones relate to those problems that have a particular detrimental effect on the patient. At the end of the second stage of the nursing process, a nursing diagnosis should also be established, which, unlike a doctor, does not consider the pathological conditions of a person. It describes the patient’s reactions to problem states of the body (limited self-care, communicative and psychological disorders, changes in life cycles, etc.).
3. At the third stage of work with the patient, the nurse determines her future goals and plans professional activities. At the same time, operational and practical tasks are considered, the implementation of which will allow achieving short-term and long-term results. When forming a goal, it is important for the nurse to take into account the action or performance, as well as the criterion (time, date, distance and expected result) and conditions (whether someone or something is involved for help). For example, the goal of the nursing process: the patient should be able to get out of bed by July 5, using the help of a nurse. After identifying the main tasks, a written guide is drawn up, listing all the actions necessary to achieve the goals.
   
4. After passing the first three stages of work, the implementation phase begins. It provides for the implementation of measures aimed at the prevention of the disease, treatment, examination and rehabilitation of the patient. Medical practice nursing intervention is divided into three categories. The first of them is dependent. This category includes all actions of paramedical personnel carried out as prescribed and under the supervision of a physician. There is also independent intervention. It includes the actions of a nurse, which she performs on her own initiative. This may be teaching the patient hygienic skills, organizing his leisure time, etc. There is also a sisterly intervention of an interdependent nature. It provides for the implementation of the activities of nurses in conjunction with doctors and other specialists. The choice of a particular category of nursing process is determined based on the needs of the patient.
5. At the last stage of work with patients, an assessment is made of the effectiveness of the work of nurses. It is based on studies of the patient's dynamic responses to nurse intervention.

Benefits

The nursing process is very important in medical practice. Its significance is due to:

• universality of the method;
• providing an individual and systematic approach to the healing process of the patient;
• widespread use of professional standards;
• providing high-quality medical care, reliability and safety of medical services;
• involving the patient and his family members in the healing process.

Pain

What is the main reason people go to medical facilities? This is undoubtedly a pain. However, this feeling is subjective, and all patients have different emotional colors. Pain sensations cannot be registered in any way. Moreover, their nature, assessment and intensity directly depend on the subjective perception of the person. Sometimes, for one reason or another, he hides pain from the doctor, and sometimes it greatly exaggerates. In both cases, this threatens to distort the prescribed course of treatment.

Indicators indicating what kind of pain the patient is concerned have not yet been created. However, instruments have been developed to evaluate the strength and nature of discomfort. About what pain in intensity bothers the patient, you can find out by observing various indirect phenomena, such as:

• increase in blood pressure;
• dilated pupils;
• rapid breathing;
• redness or blanching of the face;
• muscle twitching;
• biting the lips.

All this relates to subjective assessments that determine pain (types of pain). The nursing process in pain aims at eliminating the causes of its appearance, as well as alleviating human suffering.

Many understand that it is impossible to completely eliminate discomfort. An example of this is chronic ailments. In such cases, the nursing process for pain will be directed not only to the conduct of drug therapy as prescribed by the doctor, but also to help the patient overcome this condition. In this case, it is possible to use heat or cold, rubbing or stroking the pathological area, etc.

Pain assessment

What are the methods that the nursing process involves in the first stage? With pain, the subjective sensations of the patient are taken as the starting point. Next, there is a reaction to it. Often, the patient points to a sufficiently large area, claiming that it is here that he feels discomfort. Based on this story, the initial assessment of pain may become incorrect. To determine its localization, a more detailed questioning is necessary. At the same time, a possible cause of unpleasant sensations, the time of their appearance, disappearance, duration, as well as enhancing and weakening factors are found out.

The nurse's task also includes determining the main aspects that affect the sensation of pain, which can be:

1. Physical , that is, be a symptom of a disease, a complication of the existing pathology, and also be a side effect of the treatment. In such cases, uncomfortable sensations can lead to the development of chronic fatigue and insomnia.
2. Psychological . Sometimes pain occurs due to the patient’s anger or disappointment in the results of treatment. In such situations, a person can be driven to despair. He has a feeling of helplessness and a desire to isolate himself from the outside world. In this case, there may also be a constant fear of pain, which causes a feeling of anxiety. And if friends are less likely to visit such a person so as not to disturb him, then he feels himself useless and abandoned.
3. Social . A person, realizing that this or that part of the body is constantly hurting, realizes that he will not be able to perform the work that is familiar to him. At the same time, a sense of self worthlessness appears with a simultaneous loss of self-confidence. All this reduces the quality of life and self-esteem of the patient.
4. Spiritual . Constant and frequent pain causes fear of death. This is especially present in cancer patients. There is a fear of the very process of passing away from life. A person has a feeling of guilt before others for the fact that he causes them unrest. In this case, the patient loses all hope for the future.

Pain intensity

What else is the first step in the nursing process? For pain, it is important to know its intensity. This indicator is determined based on the feelings of the patient. It is recommended to use a scale for assessing pain in points. The rating of discomfort is defined as follows:

• absence of pain during movement and at rest - 0 points;
• slight discomfort during movement, leaving at rest - 1 point;
• moderate pain during movement and slight discomfort at rest - 2 points;
• severe discomfort during movement, moderate at rest - 3 points;
• severe pain in any condition - 4 points.

Information about the patient’s condition is also collected during observations of him. This method often uses the nursing process for pain when it is not possible to carry out verbal communication with a person. This can be, for example, with blurred consciousness, etc.

An example of a nursing process in such cases is the establishment of severe pain due to pallor of the skin, rapid breathing, increased sweating, biting of the lower lip and grinding of teeth. Sometimes a reaction to this condition is a moan.

Nature of pain

What else should the nurse determine when evaluating the patient’s discomfort? At this stage of the work, it is important to clarify the types of pain that indicate its nature. For example, blunt or sharp, constricting or burning, stitching, etc. At the same time, it is necessary to find out from the patient how he suffered a similar pain before.

Based on the initial assessment, the nurse must draw certain conclusions. It is necessary that they are based not only on the results of the examination of a person and his behavior. It is important to determine the nature and types of pain that torment the patient, relying on his words and feelings. All this becomes especially useful in those cases when the person himself takes an active part in monitoring his condition. In this case, the first stage of the nursing process provides all the prerequisites for carrying out effective measures that contribute to the alleviation of pain.

Goal Definition

How does the nursing process proceed when it is established what hurts and with what intensity? The main goal of patient care in this case is to eliminate the causes of an uncomfortable state. This will alleviate the suffering of man.

Nurse intervention

In order to achieve their goals and evaluate the effectiveness of painkillers, representatives of the nursing staff should clearly know the whole complex of phenomena associated with uncomfortable sensations. Nursing responsibilities include monitoring the correct use of drugs prescribed by the doctor (under the tongue or by mouth), as well as the administration of drugs (intravenously, intramuscularly or subcutaneously). And here it is important to know how the painkiller used works. Only in this case, the nurse, together with the patient, is able to indicate the adequacy of the drug.

Evaluation of the results

How successful was the implementation of the nursing process in pain? It is important to apply objective criteria to evaluate the performance of nursing staff. One of them is the intensity of pain at the beginning and at the end of the therapeutic course. A special scale has been developed for this, indicating the characteristics of the weakening of discomfort.

It takes into account how the pain has changed:

• disappeared completely;
• partially gone;
• decreased significantly;
• no noticeable changes.