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To provide optimal patient care, nurses require appropriate knowledge, skills and attitudes towards pain, pain assessment and its management. This must be based on the best available evidence to prevent patients from suffering harm (NMC, 2008 ). It is unacceptable for patients to experience unmanaged pain or for nurses to have inadequate knowledge about pain and a poor understanding of their professional accountability in this aspect of care (Dimond, 2002). Pain – The fifth vital sign

Pain has been identified as the fifth vital signs by Australian and New Zealand College of Anaesthetists and the Chronic pain Coalition in an attempt to facilitate accountability for pain assessment and management (Chronic Pain Policy Coalition, 2007; ANZCA, 2005). Education

Pre-registration nursing programmes should incorporate pain as a compulsory component, to equip future nurses with the knowledge, skills and attitude to carry out appropriate pain assessment and management from the start of their professional careers. This could result in all patients receiving a higher standard of pain assessment and management in the future and reduce the incidence of unnecessary suffering (Wilson, 2007). Why is assessment important?

Assessment of a patient’s experience of pain is a crucial component in providing effective pain management. A systematic process of pain assessment, measurement and re-assessment (re-evaluation), enhances the health care teams’ ability to achieve:

Pain is not a simple sensation that can be easily assessed and measured. Nurses should be aware of the many factors that can influence the patients overall experience and expression of pain, and these should be considered during the assessment process. Pain assessment and measurement

• – patients’ age, type and stage of illness (Hall-Lloyd and Larson, 2006) – older people are less likely to report pain despite evidence showing that they are more likely to experience at least one concurrent problem with pain, for example, musculoskeletal pain or pain associated with peripheral vascular disease (British Pain Society and British Geriatric Society, 2007);

Self-reporting can be influenced by numerous factors including mood, sleep disturbances and medications and may result in patients not reporting pain accurately (Peter and Watt-Watson, 2002). For example, they may fail to report their pain because of the effects of sedation or lethargy and reduced motivation as a consequence of sleep deprivation. Some may suffer in silence as they do not want to bother busy nurses.

Observational tools may be used with patients who are unconscious/sedated and cognitively impaired to assess physiological responses and/or behaviours, for example, facial expressions, limb movements, vocalisation, restlessness and guarding.

Global scales may be useful at the end of a pain management intervention to measure the patient’s perception of the overall effectiveness of an intervention. They examine the inconvenience or unpleasantness of the intervention and the personal meaningfulness of any improvement in the patient’s pain and function (ANZCA, 2005).