Based on Tawil’s study in 1998 (1), pain was a huge reason for hospitalization and it’s still the same today. Pain is one of the most common reasons why patients see their doctors. And despite the advances in technology and methods to relieve it, a lot of patients still experience undertreatment. This makes it important for nurses to have the skills not just in assessing the pain but managing it as well.
And to help you out, here’s a guide to drafting the best nursing care plan for pain management.
What is Pain?
Pain is highly subjective (2). What your patient says about the pain he is experiencing is the best indicator of that pain. We can’t prove or disprove what the patient is feeling. We also can’t assume.
Pain can be classified into two types. You can distinguish one from the other according to the cause, onset, and duration.
Acute pain
Acute pain can have a sudden or slow onset with an intensity ranging from mild to severe. It can happen after a medical procedure, surgery, trauma or acute illness. It has a duration of less than 6 months.
Chronic pain
For pain to be classified as chronic, the patient needs to be experiencing it for more than 6 months. Its intensity can range from mild to extremely incapacitating. In some cases, chronic pain can restrict a patient’s ability to perform his Activities of Daily Living and this usually ends up with feelings of despair.
Chronic pain has two subcategories: malignant and non-malignant.
Malignant refers to pain associated with cancer (3) and other progressive diseases. Non-malignant chronic pain, on the other hand, refers to pain that persists beyond the expected time of healing.
The Nursing Care Plans
If you are caring for a patient who is in pain, it’s important that you know the skills to assess and manage his discomfort properly. As a guide, here are some nursing care plans for pain management you can use.
Acute Pain
May be related to
-Injuring agents (biological, chemical, physical, psychological)
Possibly evidenced by
-Patient’s report of pain
-Guarded and protective behavior
-Loss of appetite
-Inability to perform Activities of Daily Living
-Narrowed focus
-Autonomic responses
-Changes in muscle tone
-Expressive behavior (restlessness, crying, moaning)
-Facial mask of pain
-Sleep disturbance
Desired outcome
-Verbalizes pain relief methods
-Demonstrates the use of appropriate diversional activities and relaxation skills
-Reports pain management methods relieve pain to a satisfactory level
-Reports ability to get enough sleep and rest
-Displays improved vital signs and muscle tone
| Nursing Interventions | Rationale |
| Perform a comprehensive assessment. Assess location, characteristics, onset, duration, frequency, quality and severity of pain. | Assessment is the first step in managing pain. It helps ensure that the patient receives effective pain relief. |
| Observe for nonverbal indicators of pain: moaning, guarding, crying, facial grimace. | Some patients may deny the existence of pain. These behaviors can help with proper evaluation of pain. |
| Accept the patient’s description of pain. | Pain is highly subjective. |
| Obtain vital signs. | Vital signs are usually affected when pain is present (4). |
| Assess the client’s current use of medications. | Aids in planning and in obtaining medication history. |
| Anticipate the need for pain management. | Early and timely intervention is the key to effective pain management. It can even reduce the total amount of analgesia required. |
| Provide a quiet environment. | Additional stressors can intensify the patient’s perception and tolerance of pain. |
| Use nonpharmacological pain relief methods (relaxation exercises, breathing exercises, music therapy). | Works by increasing the release of endorphins, boosting the therapeutic effects of pain relief medications. |
| Provide optimal pain relief by administering prescribed pain relief medication. | Various types of pain require different analgesic approaches. Some respond well to non-opioid pain relievers while others demand a combination of non-opioid and low dose opioid. |
| Review patient’s medication records and flow sheet. | It helps determine the effectiveness of pain control measures. If the patient demands pain medications more frequently, a higher dose may be needed. |
| Document patient’s response to pain management. | It helps the entire healthcare team evaluate their pain management strategy. |
Chronic pain
May be related to
-Chronic physical and psychological disability
-Injuring agents (biological, chemical, physical, psychological)
Possibly evidenced by
-Patient’s report of pain
-Changes in sleep pattern
-Changes in appetite
-Irritability, restlessness, depression
-Weight changes
-Atrophy of involved muscles
-Less interaction with people
-Sympathetic mediated responses
-Facial mask
-Guarding behavior
Desired outcome
-Verbalizes or demonstrates relief or control of pain
-Demonstrates use of both nonpharmacological and pharmacological pain relief strategies
-Shows the ability to engage in activities
-Shows use of appropriate therapeutic interventions
| Nursing Interventions | Rationale |
| Perform a comprehensive assessment. Assess location, characteristics, onset, duration, frequency, quality and severity of pain. | Assessment is the first step in managing pain. It helps ensure that the patient receives effective pain relief. |
| Check current and past analgesic/narcotic drug use. | It helps obtain a medication history. |
| Review the patient’s expectation of pain relief. | It’s possible that pain may not be completely resolved but it can be lessened significantly. |
| Encourage patient to use breathing techniques and positive affirmations. | This helps the patient achieve generalized relaxation which aids in reduced perception of pain. |
| Explore the patient’s need for medications from the three classes of analgesics: NSAIDS, opioids, and nonopioids. | Combinations of analgesics may enhance pain relief. |
| As much as possible, use tranquilizers, narcotics, and analgesics sparingly. | These medications promote addiction and can cause sleep disturbance. |
| Encourage the use of nonpharmacological interventions (massage, guided imagery, breathing techniques). | They help reinforce pharmacological interventions. |
| Determine the patient’s appetite, bowel elimination, and the ability to rest and sleep. | Side effects should be monitored and managed accordingly. |
| Evaluate the effectiveness of pain medications and ask to decrease or increase dose and frequency as necessary. | Medications should be adjusted to achieve optimum pain relief without causing severe adverse effects. |
Nursing Interventions for Pain Management:
Assessment:
- Regularly assess and document the patient’s pain using a standardized pain scale, considering the location, intensity, quality, and duration of the pain.
- Explore the patient’s perception of pain, including any cultural or personal factors that may influence their experience.
- Assess for any physiological or psychological factors that may contribute to the pain, such as anxiety, depression, or previous experiences with pain.
Medication Administration:
- Administer analgesic medications as prescribed by the healthcare provider, ensuring accurate dosing, timing, and route of administration.
- Monitor the patient’s response to medications, including pain relief, adverse effects, and changes in vital signs.
- Educate the patient about the prescribed medications, including potential side effects, proper administration techniques, and the importance of adhering to the prescribed regimen.
Non-Pharmacological Interventions:
Implement non-pharmacological pain management techniques based on the patient’s preferences and healthcare provider’s orders, such as:
Heat or cold therapy: Apply heat or cold packs to the affected area to reduce pain and inflammation.
Massage: Provide gentle massage to promote relaxation and relieve muscle tension.
Distraction techniques: Engage the patient in activities or conversations to divert their attention from the pain.
Relaxation techniques: Teach the patient relaxation exercises, such as deep breathing, progressive muscle relaxation, or guided imagery.
Acupuncture or acupressure: Collaborate with qualified practitioners to offer alternative therapies that may help alleviate pain.
Transcutaneous electrical nerve stimulation (TENS): Apply TENS units to provide electrical stimulation for pain relief.
Positioning and Mobility:
- Assist the patient in finding a comfortable position that minimizes pain and reduces pressure on affected areas.
- Encourage and assist with frequent position changes to prevent stiffness, muscle fatigue, and pressure ulcers.
- Provide supportive devices, such as pillows or cushions, to promote proper alignment and reduce pain during rest or activity.
Collaboration and Communication:
- Collaborate with the interdisciplinary healthcare team to identify and address the underlying cause of the pain.
- Communicate the patient’s pain assessment findings, responses to interventions, and any concerns to the healthcare provider.
- Involve the patient and their family in the pain management plan, ensuring their understanding and participation in decision-making.
Education and Support:
- Educate the patient and their family about pain management strategies, including medication use, potential side effects, and non-pharmacological techniques.
- Provide emotional support and reassurance, acknowledging the patient’s pain and validating their experience.
- Teach the patient about self-care techniques, such as pacing activities, using assistive devices, and maintaining a healthy lifestyle to manage pain effectively.
Evaluation and Documentation:
- Regularly evaluate the effectiveness of pain management interventions and document the patient’s pain level, response to treatments, and any modifications made to the plan.
- Review and update the care plan as needed, considering the patient’s changing needs and preferences.
References:
- Tawil, S., Iskandar, K., & Salameh, P. (2018). Pain management in hospitals: patients’ satisfaction and related barriers. Pharmacy Practice (Granada), 16(3).
- Coghill, R. C. (2010). Individual differences in the subjective experience of pain: new insights into mechanisms and models. Headache: The Journal of Head and Face Pain, 50(9), 1531-1535.
- Hamieh, N. M., Akel, R., Anouti, B., Traboulsi, C., Makki, I., Hamieh, L., & Tfayli, A. (2018). Cancer-related pain: prevalence, severity and management in a tertiary care center in the Middle East. Asian Pacific journal of cancer prevention: APJCP, 19(3), 769.
- Bendall, J. C., Simpson, P. M., & Middleton, P. M. (2011). Prehospital vital signs can predict pain severity: analysis using ordinal logistic regression. European Journal of Emergency Medicine, 18(6), 334-339.
Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2019). Nurse’s pocket guide: Diagnoses, prioritized interventions, and rationales. Philadelphia: F.A. Davis.
