Ask the pain expert ... about evaluating pain

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Sherrie Dornberger, RNC, CDONA, FACDONA, executive director, NADONA
Sherrie Dornberger, RNC, CDONA, FACDONA, executive director, NADONA

We use the numeric pain scale in our skilled care facility, but many of our residents can't communicate well. Is there another suggestion?

Patients/residents over 65 are the fastest growing age group and are also at an increased risk for adverse reactions according to Lippincott's Nursing Center.com.

The common numeric rating scale tells a resident to select a number between 0 and 10 that best reflects their feeling of pain at that time. Another scale, the Iowa thermometer pain scale, uses descriptions such as “slight” pain and “moderate” pain, giving 12 descriptive choices.  

If a resident has visual impairment and he or she is shown a thermometer with numbers, it might not be the best scale to use. The resident is reminded how a temperature rises and is asked to think about pain rising in the body. This scale is not good for cognitively impaired residents, either.

The PACSLAC is a commonly used assessment for impaired residents. This uses body movements, facial expressions, sleeping and eating changes, and social changes as a few areas to assess. 

Great nursing assessments need to come into focus here. Also, get the family involved so they can assist you as to whether a movement is new or if they have done that same thing for years (if a resident is new to you). 

Ask the family to get involved in a pain diary. The more eyes you have on a resident who cannot express his or her needs, the better the assessment will be. The family and the CNAs may need training on what to include and how to complete a pain diary. 

Once everyone knows how to complete it, the quality of life of a resident in pain will be improved greatly. Remember to individualize your pain assessments. A single type will not work for everyone.