Barriers To Pain Assessment

Nurses still have difficulty accepting the patient's report of pain as valid and credible (Berry et al., 2006; D'Arcy, 2008, 2009). There are some barriers that make accurate pain assessment difficult for nurses.

■ Cultural influences

■ Family values

■ Belief systems

In order to minimize the effects of these factors on pain assessment, it is important for the nurse to recognize these influences and consciously work to derive as accurate pain assessment as possible.

Today's nurses are being held accountable for the quality of their pain management, including assessment. It is incumbent on each nurse who performs a pain assessment to attempt to get as accurate a pain assessment as possible. When pain assessment is poorly done, it can affect the patient's plan of care and adversely affect outcomes.

Focusing on pain reliefas the primary end to the assessment process and treatment selection will help control fears and bias that can negatively affect patient care. Accepting and believing the patient's report of pain is essential to performing a good pain assessment. Using a recognized, reliable, and valid pain assessment tool; believing the patient; and accepting the patient's report of pain in a nonjudgmental fashion will provide the patient with the best chance for adequate pain relief.

Case Study

Mrs. Livingston, age 32, is your next door neighbor. She is a single mother with two small children to support. She works a regular job at a fast food restaurant and then cleans offices at night as a second job. She does not have much time to be with her children, and she seems terribly tired all the time. She seems to be depressed about her life, and to add to her problems, she hurt her back and has been off work for 12 weeks. Her insurance is covering her medical bills, but Mrs. Livingston needs to return to work to support her family. She has difficulty in her rehabilitation related to the high level of pain she is experiencing, and she cannot always participate in her therapy as needed. The health care provider has been prescribing short-acting opioid medication to control the pain, along with a muscle relaxant. Mrs. Livingston has been advised to see a neurosurgeon to explore the opportunity for back surgery to repair the damage she did to her back. She has been told she is not a surgical candidate. At her last visit, her primary health care provider said she was becoming addicted to her pain medications and she needed to stop taking them, so he was going to taper her off the current medication.

When you speak to Mrs. Livingston about her pain, she tells you, "I know I look bad, but you have no idea of how bad I feel. I am so worried about going back to work. I need to work, but the back pain I have is so severe. At times I know I would never be able to lift the crates and stand on my feet for 8 hours a day at the restaurant, let alone clean offices. I am so depressed about all of this, and then my physician told me he would stop prescribing pain medications for me. I know they aren't all that good for you, but I really need to get back to work. I can't sleep and feel like I'm a worthless mother. I'm really caught in a bad place here. I need to work, but the pain is severe at times. Who would hire me anyway, looking and feeling the way I do. I can't sleep at night because I'm worried about my finances. What am I going to do about the pain?"

Questions to Consider

1. What is the best tool to use to assess the pain Mrs. Livingston is having?

2. Does Mrs. Livingston seem to be evidencing any addictive or aberrant behaviors that you should worry about? Is she drug seeking or really relief seeking?

3. What are the biggest elements in the assessment process for Mrs. Livingston?

4. What could be some of the outcomes of the poorly relieved pain that Mrs. Livingston is experiencing?

5. Use the BPIQ to assess the pain Mrs. Livingston is having and determine what the major effect of the pain is on her life.

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