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Can you provide me with scripting techniques that will help my staff confidently discuss pain assessment with patients?

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Often, a patient’s worst fears, which can lead to great anxiety, is that he or she will be left to suffer in pain or become addicted to drugs. Communicating openly with patients about pain control and discussing acceptable levels of pain can help reduce that anxiety. Demonstrating the use of a pain scale will help patients establish their comfort level, as everyone tolerates pain differently. And providing information on the proper use of medications to patients will decrease their fears of becoming addicted. The following example illustrates how scripting can be used to assess pain and establish a comfort level for patients.

Mrs. Talbot was last medicated for pain at 6:30 a.m.; it is now 7:15 a.m. Upon entering her room, the nurse:

  1. Introduces herself. “Good morning, Mrs. Talbot. I’m Annabelle Case and I will be your nurse today.”
  2. Acknowledges that she was recently medicated and asks about any relief since the medication was administered. “Susan told me in report that she medicated you at 6:15 a.m., and it is now 7:15 a.m. Are you feeling any relief from your pain?”
  3. Considers using a pain scale to evaluate her current pain level. “Mrs. Talbot, on a scale of 0-10, what would you say your pain level is right now?”
  4. Establishes an acceptable pain level. “On a scale of 0-10, what do you consider a pain level that would be acceptable at this time?”
  5. Reassures the patient that she will work with her to keep her pain at an acceptable level. “Mrs. Talbot, your doctor has written pain medication orders for you every four to six hours. Please let me know if you are starting to feel uncomfortable, and I will get you your medication.”
  6. Comforts her before leaving the room. “Mrs. Talbot, are there any questions I can answer for you before I go? If not, I’ll be back to check on you at 8:30 a.m. and assist you with getting out of bed. If you need me before that, please press your call button.”

In this scenario, the nurse conveyed a great deal of information very quickly. The patient knew who was going to be taking care of her that day, that the nurse was concerned about her pain and how she was reacting to the medication, how often she could have her medication administered if needed, when the nurse would be back to check on her, and what was going to happen when the nurse returned. The nurse also reminded the patient to contact her with the call button if necessary. Providing patients with such information alleviates fears, addresses concerns, and conveys a message of caring.

—Jo-Ann C. Byrne, RN, BS, MHSA, director of education and organizational development, and Frances M. Moore, RNC, BSN, MSA, manager of the department of education and organizational development at St. Vincent's HealthCare in Jacksonville, FL

(August 2009)