Self Directed Learning Package - University of Queensland

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84 • The Palliative Approach ToolkitPain assessmentUsing an evidence-based assessment tool establishes a sharedview of the resident’s pain experience and therapy goals. It canalso enhance your ability to tailor individualised interventions tothe pain situation.A pain assessment tool gives you a baseline from which toevaluate treatment interventions. It also gives the resident amore active role in dealing with their pain. Residents feel theirpain is being taken seriously which in itself can be beneficial.For residents who can communicate• The most accurate and reliable evidence of pain in residentswho can communicate (even with mild to moderate dementia)is self-reporting.• Assessment is often more accurate and useful whenundertaken during movement or transfer of the resident(rather than at rest).• Allow enough time for the assessment and for the resident toformulate a response to the questions.The following story illustrates the importance of listening to theindividual about their pain experience.Case Study: AlfredAlfred is 82, with a history of osteoporosis, arthritis and afractured hip, and has been living in your facility for almosttwo years.Some of the nurses describe him as a “complainer” and statethat he always “goes on” about his pain. These same nursesfeel that because he never “looks” like he has pain then hemust just want their attention so they avoid him.It is not until a new nurse starts at the facility and performsa comprehensive pain assessment that the GP prescribesappropriate analgesia. Alfred’s pain reduces from severe tomild and he becomes more interactive with other residents.Key PointIt is important to never make your own judgmentsabout the pain the resident is experiencing.Listen to what the resident describes andincorporate the use of a validated pain assessmenttool.Never presume to know what the resident isexperiencing; even two people with exactly thesame diagnosis will experience pain differently.
85 • Self Directed Learning Package - Advanced Registered & Enrolled NurseInitial assessmentModified Resident’s Verbal Brief Pain Inventory (M-RVBPI)A copy of this tool can be found in Module 3.• Although this tool is primarily utilised with competentresidents, it is also reliable and valid for residents who havemild dementia. You can enlist a careworker or relative to jointlyreport when there is moderate to severe dementia.• The M-RVBPI assesses physical and psychosocial factorsrelevant to pain in appropriate detail. Pain intensity and theeffectiveness of current treatments is also evaluated.• On average, it takes about seven minutes to administer.• The first question determines the need for further assessment.If the answer to the first question is ‘no’, no further questionsare indicated.• A body map records and defines the site of pain.This is helpful in evaluating the cause of pain.• The size of the area in which pain is felt, the shape(distribution) and travel path (radiation) also suggest theunderlying cause (for example, sciatica).• Identifying the location of the pain also guides the effectiveapplication of local treatments.• The remainder of the M-RVBPI looks at the impact of pain onactivity, mood, mobility, socialisation and sleep. 2Case Study: JudyJudy, who we met earlier, has advanced bowel cancer witha fungating rectal mass as well as metastasis in her liver andbones (right hip and ribs).You sit with her just after she’s been assisted with hershower. She looks like she wants to cry when you ask her ifshe has any pain.She describes:1. Severe pain in her ‘bottom’ when she is sitting on a chair.This stops her from going to the activities room to playbridge with her friends.2. Moderate hip pain when she walks or moves in bed (dropsto mild when lying still but never goes away completely).3. Mild discomfort in the right upper quadrant of herabdomen radiating to her right shoulder.Judy tells you that she always has some level of pain,especially in her hip.Thinking PointRefer back to the assessment you made of Judy’spain. How would you classify each pain she describes?Key PointCompleting an assessment is important BUT equallyimportant is doing something with the informationthat is obtained. Be sure to follow the action guideat the bottom of the M-RVBPI form.ActivityRead through the M-RVBPI and scoring instructions.Then complete the tool using the informationprovided about Judy.Ongoing assessmentPain rating scales are the best tools for ongoing pain assessmentand intervention evaluations.
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Self Directed Learning Package - University of Queensland

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