Original articlePain Assessment in the Nonverbal Patient: Position Statement with Clinical Practice Recommendations
Section snippets
Ethical tenets
The ethical principles of beneficence (the duty to benefit another) and nonmaleficence (the duty to do no harm) oblige health care professionals to provide pain management and comfort to all patients, including those challenging individuals who are vulnerable and unable to speak for themselves. Providing quality and comparable care to individuals who cannot report their pain is directed by the principle of justice (the equal or comparative treatment of individuals). Respect for human dignity,
General recommendations
All persons with pain deserve prompt recognition and treatment. Pain should be routinely monitored, assessed, reassessed, and documented clearly to facilitate treatment and communication among health care clinicians (Gordon et al 2005, Gordon et al 2005). In patients who are unable to self-report pain, other measures must be used to detect pain and evaluate interventions. No single objective assessment strategy, such as interpretation of behaviors, pathology, or estimates of pain by others, is
Persons with advanced dementia: Guiding principles for the assessment of pain
Recommendations for pain assessment in nonverbal older adults with dementia unable to self-report that are unique from the general recommendations include the following:
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Self-report. The ravages of dementia seriously impact the ability of those with advanced stages of disease to communicate pain. Damage to the central nervous system affects memory, language, and higher order cognitive processing necessary to communicate the experience. Yet, despite changes in central nervous system functioning,
Infants and preverbal toddlers: Guiding principles for the assessment of pain
Recommendations for pain assessment in infants/nonverbal children unable to self-report that are unique from the general recommendations include the following:
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Self-report: Infants, toddlers, and developmentally preverbal children lack the cognitive skills necessary to report and describe pain. As children develop verbal and cognitive skills they are able to report the experience and intensity of pain. The ability to indicate the presence of pain emerges at approximately 2 years of age.
Intubated and/or unconscious persons: Guiding principles for the assessment of pain
Recommendations for pain assessment in intubated and/or unconscious persons unable to self-report that are unique from the general recommendations include the following:
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Self-report. Self-report of pain should be attempted; however, obtaining a report of pain from a critically ill patient may be hampered by delirium, cognitive and communication limitations, level of consciousness, presence of an endotracheal tube, sedatives, and neuromuscular blocking agents. Because of delirium that can wax
Summary
Individuals who are unable to communicate their discomfort are at greater risk for inadequate analgesia. This position paper describes the severity of this issue, defines populations at risk, and offers strategies, tools, and resources for appropriate pain assessment. Nurses have a moral, ethical, and professional obligation to advocate for all individuals in their care. Just like all other patients, these special populations require consistent, ongoing assessment, appropriate treatment, and
Acknowledgments
The authors sincerely thank the following expert reviewers: Margaret L. Campbell, RN, PhD(c), FAAN, Constance Dahlin, APRN, BC, PCM, Joann Eland, PhD, RN, FNAP, FAAN, Jill Loeb, BSN, MSN, RN, Chris Pasero, RN, C, MS, FAAN, Kathleen Puntillo, RN, DNSc, FAAN, and Roxie L. Foster, PhD, RN, FAAN.
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