Pain management: Educate to alleviate Teaching techniques to help your nurses manage patients’ pain Nurses want to provide patients with safe, comfortable care so that they don’t have to bear unnecessary pain. However, “nursing research is rich with examples of patients receiving substandard pain management and sparse individualized education,” according to an article in MEDSURG Nursing. Train your nurses on pain management and give them the tools and motivation they need to manage discomfort because the absence of pain management education can be far-reaching. “Pain is the one thing with patients or residents that if you don’t control it, it’s going to affect everything else,” says Anne Marie Kelly, BSN, RN-BC, CHPN, a pain management educator and consultant at Catholic Memorial Home, a 300-bed long-term care facility in Fall River, MA. “If they have pain, they won’t want to socialize and they won’t sleep well or eat well. It’s going to impact their whole well-being and their ability to get well.” Research supports the theory that pain management helps not only your patients, but your hospital’s budget as well. A recent article in Nursing noted that: “One incentive for improving the standard of care for patients with pain is the recognition that unrelieved pain is both harmful to the patient and expensive. Besides being better for the patient, good pain control is better for the hospital’s bottom line.” Margaret Shaw, RN, PNP, a nurse practitioner at Children’s Healthcare of Atlanta at Egleston, says the importance of pain management education should not be underestimated. “You must keep it front and center,” says Shaw, who has been in nursing for 31 years. “The hardest thing is helping them translate the clinical knowledge into practice.” Plan your pain management lesson The following strategies will help you educate students about pain management and keep this critical topic a priority: ➤ Use case studies. “Give them a case and discuss the symptoms the patient has. Ask the nurse, ‘What would you do? How would you assess this person?’ Have them tell you what they would report to a physician, what diagnostic tests they might suggest, and so on,” says Kelly. A case study helps nurses learn how to assess a patient’s pain, identify symptoms, recommend the appropriate medications and understand their potential side effects, she says. “If you present them with a case, they remember talking about a real-life scenario. It goes beyond textbook stuff.” ➤ Role-play. “Have a nurse play a patient and a nurse play a nurse,” says Kelly. “Have the patient say how he or she is feeling and teach the nurse how to respond.” ➤ Use imagery. Shaw has child patients use guided imagery and visualization to help them define and communicate the pain they experience. “If a child has a painful procedure, next time they come in, they’re going to remember it,” says Shaw. “They don’t forget. So if you get this across to nurses, they will work to make it as painless as possible.” ➤ Apply tactile communication. Tactile strategies are often extremely effective, says Kelly. “I ask my students to put a clothes pin on the inner part of their arm,” Kelly says. “I tell them to leave it on there until I tell them to take it off. Some nurses will have it on and it won’t bother them; others, you see them grimace from the pinching. At the end, I ask them to tell me what the pain rating is from one to 10. The ratings will go from one all the way to 10. It teaches them that the same clothes pin placed on the exact same place will elicit different amounts of pain.” Dulling painful misconceptions Perhaps the biggest challenge you may face when educating your nurses on pain management is eradicating misconceptions. “Some people, for instance, believe that good patients don’t complain or that pain is inevitable,” according to the Nursing article. For example, some nurses may have misunderstandings concerning older patients. “There are misconceptions with the elderly that ‘They’re old, so they’re supposed to have pain,’ ” says Kelly. Others may believe that pain is visual. “They might believe that if someone’s in pain then they’re supposed to look like they’re in pain,” says Kelly. These fallacies are rooted in a lack of education and demonstrate the strong need for thorough pain management education. “When you hear about someone with a misconception, educate them,” Shaw says. “We are continually trying to get the point across of what pain management is and the importance of it.” References Behrens, E. (1996). “An ethical approach to pain management,” MEDSURG Nursing 5 (6): 457–458. McCaffery, M. (2001). “Overcoming barriers to pain management,” Nursing 31 (4): 18. Source: The Staff Educator, May 2008, HCPro, Inc.