Whether nurses work in a hospital, outpatient clinic, skilled nursing facility or hospice they share one commonality working with a variety of patients suffering from acute and chronic pain. While pain management is an emerging specialty area for nurse practitioners, treating pain is a universal part of nursing care.
Nurse.com recently spoke with Patricia Bruckenthal, RN, PhD, APRN-BC, ANP, clinical associate professor and chair of the department of graduate nursing education at Stony Brook University School of Nursing in Stony Brook, N.Y., and current president of the American Society for Pain Management Nursing, about the nurses role in pain management and how nurses can improve their pain assessment skills and integrate psychosocial care with their patients physical care.
Q: What is the most important and the most difficult challenge pain management nurses face today?
A. The biggest challenge is often looking beyond analgesics and employing a multimodal approach to pain management that includes medication plus non-pharmaceutical options such as physical therapy, stress reduction, support groups and massage therapy. Patient compliance and reimbursement also add to the challenge. We know that opioids arent a permanent solution for patients who experience chronic pain many patients cant tolerate the side effects, and the medications also lose their effectiveness as patients build tolerance to them. Addiction also is a risk. Palliative care programs provide a good model for nurses since they use a multidisciplinary approach, in which physicians, nurses, social workers and other professionals work together to relieve a patients pain and suffering.
Q: How can nurses best advocate and care for patients who are experiencing pain?
A. The reality is that every nurse is a pain management nurse. Nurses are leaders in education and counseling and they can help not only in assessing pain in patients, but also in helping them access and connect with the best resources for managing their pain. In addition, nurses can help patients set small goals such as mastering meditation techniques or attending weekly behavioral therapy sessions that can help them to self-manage pain.
Q: How can nurses best work with nonverbal patients who are experiencing pain?
A. For patients who cant articulate their pain, nurses need to look for subtle, non-verbal indicators of pain. Older adults with advanced dementia, infants and preverbal toddlers, critically ill or unconscious patients, persons with intellectual disabilities and hospice patients may all fall into this category. Nurses can observe non-verbal patients for facial grimacing and other behavioral indicators of discomfort. Often a patients family will report that their loved one isnt eating or their behavior has changed, and this can be an indicator of pain. A thorough assessment can reveal conditions such as a hidden infection that may be causing pain. The Checklist of Nonverbal Pain Indicators and the Pain Assessment in Advanced Dementia Scale also can be useful tools.
Q: Over the past few years, what do you think has been the most important development or tool in pain management?
A. More hospitals are adopting an integrative approach to treating chronic pain in patients that promotes individualized, patient-centered care and includes mindfulness training, psychologists and healing touch therapists. Im currently working with a group at Stony Brook and Duke University that is training nurses to lead coping skills training, and showing patients techniques they can use to self-manage pain. Psychologists usually do this type of training, but our early results are showing effective outcomes for nurses, as well as better pain management and improved mood and quality of life for patients.
Read the story NIH-funded study: Brain is hard-wired for chronic pain to find out more about the mental connection to pain. Available at Nurse.com/Article/Brain-Pain
To see what else is trending in pain management, visit www.Nurse.com/Pain-Management.