One of the important responsibilities of registered nurses caring for hospitalized patients recovering from surgery is to assess and report pain levels.
With any surgery, there is an expectation that a patient will have some degree of pain. Thorough, accurate pain assessments that are properly documented establish a baseline that doctors and nurses can refer to when determining whether the patient is improving, getting worse, or staying the same. When there's a change in pain status, it can be a sign that's something wrong that needs fast medical attention.
What nurses are required to assess when it comes to pain
The standard of care requires nursing evaluations of pain to include, at a minimum, the following:
• Whether pain is present.
• The location(s) of the pain. Pain at the surgical incision or area of the surgery would be expected, but pain in another area of the body would be unusual.
• The quality of the pain (burning, throbbing, electrical, etc.). This description of the pain provides physicians with information that is useful to determining what the cause is.
• Interventions used to treat the pain. Most pain interventions require a doctor’s order. If the patient’s pain needs to be treated, then the nurse must report the findings to a physician and advocate for an appropriate order.
• The patient’s response to pain interventions. Texas Board of Nursing rules require nurses to understand the rationale and effects of all medications that they administer. This includes pain medications. After giving a patient pain medication, the nurse must follow up to re-assess the patient’s response and document findings. If there’s a problem, of course, the next step is to notify the physician.
The risk of standardized pain tools
Many hospitals use standardized scales to assist the communication between patients and nurses about pain. For adults, it’s common for nurses to ask the patient to rate pain on a scale of 1 to 10, with 10 being the most severe pain. Many hospitals encourage nurses to use a facial expression scale for children.
While these tools are beneficial, they aren’t comprehensive and don’t substitute for the thorough pain assessment that nurses are required to perform regularly during their shifts.
A real-world example of the serious problem this can cause comes to mind in a lawsuit that I handled for a family involving a major Houston hospital in the Texas Medical Center. The patient had lower back surgery. Over the next two days, the nurses made very spotty documentation of pain assessments, often only noting a number on the 1-10 pain scale.
It seemed like the registered nurses were on autopilot, thinking that any complaints of pain were related to the back surgery and that part of the body. They were wrong. In reality, the patient was experiencing severe head pain, but providers reviewing the nursing notes attributed it to a headache and didn’t think it was serious.
As the pain persisted, the patient began to have an altered mental status and hallucinations, followed by speech abnormalities. The spouse pressed the nursing staff hard to get another evaluation, and a radiology scan showed a brain bleed.
This unfortunate patient has permanent brain damage because the nurses weren’t giving careful attention to assessing, re-assessing, documenting, and communicating important information about pain.
What you can do
If you’re hospitalized and having problems with pain, be sure to give your doctors and nurses a thorough explanation of what’s going on, whether they ask about it or not. Talk about where the pain is located and precisely how it feels.
Avoid describing pain in common terms, like a headache. Be more descriptive. One client told me that his head pain was the worst that he had ever felt in his life. Another client told me that his head pain felt like glass shards were being rammed into his brain. These descriptions are more likely to get the attention that you need, rather than a common complaint of having a headache.
If you or someone you care for has been seriously injured because of poor hospital, nursing, or physician care, then contact a top-rated Houston, Texas medical malpractice lawyer for help in evaluating your potential case.