Nursing process with pain: primary assessment and classification of pain

The profession of the nurse has a number of features. But first of all it represents a certain process of interaction with doctors and patients. What is the subject of labor for this category of nursing staff? All activities of the nurse are directed directly at the patient. At the same time, the ultimate goal of all activities is the recovered patient.

The nursing process in diseases combines therapeutic and diagnostic methods and personal relationships. That is why the moral and psychological aspects of this category of workers are put on the forefront. Nurses should be able to feel and understand what oppresses and disturbs a person, realizing an integrated approach to the patient. This requires knowledge of the profession not only in the medical-biological, but also in the psychological field.

The concept of nursing process

To date, there is a special science in medicine that presupposes the implementation of actions aimed at using the environment surrounding the patient for his recovery. This is the sister process. It is based on knowledge of the natural and human sciences, such as medicine and biology, sociology and psychology.

A nurse, performing the professional duties assigned to her, must assume responsibility and act within the limits of her powers. At the same time, she has a need for planning and assistance. Important is the nursing process in the rehabilitation of the patient after the illness.

All actions of nursing staff should be carried out in accordance with the requirements of the State Educational Standard. What is the concept of the nursing process according to this document? The state educational standard specifies that this is a specific method of execution and organization of nursing care for a patient whose purpose is to meet the psychological, social and physical needs of society, family, and man.

The patient's body is restored and maintained in large part thanks to the sister process. And this requires from the average medical personnel not only excellent technical training. A tremendous role in this issue is played by the nurse's ability to work with the patient's personality, as well as the creative attitude towards fulfilling one's duties.

Main stages

The methodology of the nursing process includes the implementation of certain actions. These are five stages, which the average medical personnel must be passed consistently:

  1. First of all, it is important to conduct a nursing survey. It is the collection of information indicating the state of health of the patient. This is the first stage of the nursing process. These data can be both subjective and objective. In the first case, such information includes psychological and physiological, as well as social factors relating to the patient and his environment. It is provided by the patient himself, as well as by his relatives during the survey. Thanks to the objective method, it is possible to evaluate various parameters of a person related to his appearance, state of consciousness, etc. These data are obtained by physical examination of the patient. The final result of the first stage of the nursing process is the documentation of the available information. This creates a nursing history of the disease, which is a legal protocol.
  2. The second stage of the work of paramedical personnel establishes the problems of patients. This makes it possible to formulate a sister diagnosis. All patient problems are divided into two categories. These are existing and potential. The first of them include those that bring discomfort to a person at the present time. Potential as yet does not exist, but their probability of occurrence is extremely high. In addition to identifying these two types of problems, a nurse must be able to identify factors that contribute to their development. In this case, the strengths of the patient are identified. They are used to resist disease. However, the patient often has several problems at once. The task of the nurse is to define a system of priorities that are classified into primary and secondary. The first of these relate to those problems that have a particularly detrimental effect on the patient. At the end of the second stage of the nursing process, a sister diagnosis should also be established, which, unlike the medical one, does not consider the pathological conditions of a person. He describes the patient's reactions to problem states of the body (limited self-service, communicative and psychological disorders, changes in life cycles, etc.).
  3. At the third stage of work with the patient, the nurse determines his future goals and plans professional activities. At the same time, operational and practical tasks are considered, the implementation of which will allow to achieve short-term and long-term results. When forming a goal for a nurse, it is important to take into account the action or performance, as well as the criterion (time, date, distance and expected result) and conditions (whether someone or something is being used to help). For example, the goal of the nursing process: the patient should be able to get out of bed by July 5, using the help of a nurse. After defining the main tasks, a written manual is compiled, listing all the actions necessary to achieve the goals.
  4. After the first three stages of work, the implementation phase begins. It provides for the implementation of measures aimed at the prevention of disease, treatment, examination and rehabilitation of the patient. Medical practice nursing intervention divides into three categories. The first of them is dependent. This category includes all the activities of paramedical personnel, carried out under the instructions and under the supervision of a doctor. There is also an independent intervention. To it carry actions of the nurse which she carries out under own initiative. It can be teaching the patient hygienic skills, organizing his leisure time, etc. There is also a nursing intervention of an interdependent character. It provides for the activities of paramedical personnel in conjunction with doctors and other specialists. The choice of a category of nursing process is determined based on the needs of the patient.
  5. At the last stage of work with patients, the evaluation of the efficiency of the work of nurses is given. It is based on studies of the patient's dynamic reactions to the intervention of a nurse.


The nursing process is very important in medical practice. Its significance is determined by:

  • Universality of the method;
  • Providing an individual and systematic approach to the process of recovery of the patient;
  • Wide application of professional standards;
  • Providing high-quality medical care, reliability and safety of medical care;
  • Involving the patient and his family members in the process of recovery.

Painful sensations

What is the main reason for people to go to medical institutions? This is undoubtedly a pain. However, this feeling is subjective, and in all patients has a different emotional color. Painful sensations can not be registered in any way. At the same time, their character, evaluation and intensity directly depend on the subjective perception of a person. Sometimes for some reason he hides the pain from the doctor, and sometimes exaggerates it greatly. In both cases, this threatens to distort the prescribed course of treatment.

Indicators indicating how much pain the patient is worried about have not yet been created. However, instruments have been developed that make it possible to assess the strength and character of discomfort sensations. About what pain intensity intensity worries the patient, you can learn from the observation of various indirect phenomena, such as:

  • Increased blood pressure;
  • Dilated pupils;
  • Quickening of breathing;
  • Redness or pallor of the face;
  • Muscle twitching;
  • Biting of the lips.

All this applies to subjective assessments that determine pain (types of pain). The nursing process in pain sets as its goal the elimination of the causes of its appearance, as well as the alleviation of human suffering.

Many understand that it is impossible to completely eliminate discomfort. An example of this can serve as chronic ailments. In such cases, the nursing process with pain will be directed not only at carrying out drug therapy according to the prescriptions of the doctor, but also to help the patient in overcoming this condition. It is possible to use heat or cold, grind or pat the pathological area, etc.

Assessment of pain

What are the methods that the nursing process implies at the first stage? When pain is the starting point, the patient's subjective sensations are taken. Then there is a reaction to it. Often the patient points to a fairly large area, arguing that it is here that he feels uncomfortable. Based on this story, a primary assessment of pain may become incorrect. To determine its location, it is necessary to conduct a more detailed inquiry. At the same time, the possible cause of unpleasant sensations, the time of their appearance, disappearances, duration, as well as strengthening and weakening factors, is elucidated.

The nurse's task is also to determine the main aspects that affect the sensation of pain, which can be:

  1. Physical , that is, a symptom of a disease, a complication of existing pathology, and also be a side effect of the treatment. In such cases, uncomfortable sensations can lead to the development of chronic fatigue and insomnia.
  2. Psychological . Sometimes the pain arises because of the patient's anger or his disappointment in the results of treatment. In such situations, a person can be driven to despair. He has a feeling of helplessness and a desire to be isolated from the outside world. In this case, there may be a constant fear of the appearance of pain, which causes a feeling of anxiety. And if friends are less likely to visit such a person so as not to bother him, he feels himself no longer needed and abandoned.
  3. Social . A person, realizing that this or that part of the body hurts constantly, realizes that he can not perform his usual work. Thus there is a feeling of own uselessness with simultaneous loss of self-confidence. All this reduces the quality of life and self-esteem of the patient.
  4. Spiritual . Constant and frequent pain causes fear of death. This is especially true in cancer patients. There is a fear even before the process of passing away from life. A person has a feeling of guilt before others because he causes them excitement. In this case, the patient loses all hope for the future.

Intensity of pain

What else is the first stage in the nursing process? With pain, it is important to know its intensity. This indicator is determined on the basis of the patient's feelings. It is recommended that you use the pain score scale in scores. The rating of uncomfortable sensations is determined in this way:

  • Absence of pain during movement, and at rest - 0 points;
  • Slight discomfort when moving, leaving at rest - 1 point;
  • Moderate sensations of pain during movement and mild discomfort at rest - 2 points;
  • Severe discomfort when walking, moderate at rest - 3 points;
  • Severe pain in any condition - 4 points.

Information about the patient's condition is collected and during observations. This method often uses the nursing process in pain, when there is no possibility of verbal communication with a person. It can be, for example, with a cloud of consciousness, etc.

An example of a nursing process in such cases is the establishment of severe pain over the pallor of the skin, rapid breathing, increased sweating, biting the lower lip and gnashing of teeth. Sometimes the reaction to this state is a groan.

The nature of pain

What else should the nurse determine when assessing the patient's discomfort? At this stage of work, it is important to clarify the types of pain that indicate its nature. For example, dull or sharp, compressive or burning, stitching, etc. At the same time it is necessary to find out from the patient how he suffered a similar pain earlier.

Based on the results of the primary evaluation, the nurse must draw certain conclusions. It is necessary that they are based not only on the results of the examination of a person and his behavior. It is important to determine the nature and types of pain that torment the patient, relying on his words and feelings. All this becomes especially useful in those cases when the person himself takes an active part in monitoring his condition. In this case, the first stage of the nursing process gives all the prerequisites for carrying out effective measures that contribute to the easing of pain.

Definition of goals

How does the nursing process take place, when it is determined that it hurts and with what intensity? The main goal of patient care in this case is to eliminate the causes that cause discomfort. This will alleviate the suffering of man.

Nurse Intervention

In order to achieve the goals and evaluate the effectiveness of pain relief measures, representatives of nursing staff should clearly know the whole complex of phenomena associated with uncomfortable sensations. The nursing duties include control over the correctness of the use of drugs prescribed by the doctor (under the tongue or through the mouth), as well as the administration of medications (intravenously, intramuscularly or subcutaneously). And here it is important to know how the used painkiller acts. Only in this case the nurse, together with the patient, is able to indicate the adequacy of the drug.

Evaluation of results

How successful was the process of nursing with pain? To evaluate the results of the work of paramedical personnel, it is important to apply objective criteria. One of them is the intensity of pain at the beginning and after the end of the therapeutic course. For this purpose, a special scale has been developed, indicating the characteristics of the easing of discomfort sensations.

It takes into account how the pain has changed:

  • Completely disappeared;
  • Left partially;
  • Significantly decreased;
  • There are no noticeable changes.

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