nursing assessment of the new chronic pain patient sr christine wakefield
DESCRIPTION
Lecture given to the North British Pain Association on 16th May 2008 by Sr Christine Wakefield. In this talk, Sr Wakefield discusses the role of the nurse specialist in the assessment of the newly-referred patient with chronic pain. www.nbpa.org.ukTRANSCRIPT
Nursing Assessment of the Nursing Assessment of the New Chronic Pain PatientNew Chronic Pain Patient
Sr. C WakefieldSr. C Wakefield
Clinical Nurse specialistClinical Nurse specialist
In Chronic Pain In Chronic Pain managementmanagement
Baguley Pain Unit- Baguley Pain Unit- Wythenshawe HospitalWythenshawe Hospital
University Hospitals University Hospitals of South of South Manchester NHS Manchester NHS Foundation TrustFoundation Trust
BackgroundBackground
Sister on NSU Hope Hospital for 12 yearsSister on NSU Hope Hospital for 12 years
Trained as Associate Pain Nurse Specialist Trained as Associate Pain Nurse Specialist
for Neurosurgeryfor Neurosurgery
Acute Pain Sister at Warrington Gen 3yearsAcute Pain Sister at Warrington Gen 3years
CNS Chronic Pain at NMGH for 3yearsCNS Chronic Pain at NMGH for 3years
CNS Chronic Pain present post for 4 yearsCNS Chronic Pain present post for 4 years
My Role - ManagerMy Role - Manager
Coordinator of MDTCoordinator of MDT
Manage day to day running of unitManage day to day running of unit
Nurse Manager – team 6 nursesNurse Manager – team 6 nurses
Manage administrative team Manage administrative team
Assist with budget/target/waiting list Assist with budget/target/waiting list managementmanagement
My Role - ClinicalMy Role - Clinical Run 2 nurse led drug/procedure Run 2 nurse led drug/procedure
review clinicsreview clinics
Run opiate review clinicRun opiate review clinic
Run primary care based chronic Run primary care based chronic pain service – Tier 2pain service – Tier 2
First contact for patients and First contact for patients and hospital staffhospital staff
Audit research and educationAudit research and education
New Patient Triage – Tier 2New Patient Triage – Tier 2
All primary care referralsAll primary care referrals
Directory Services Directory Services
Triage new patientsTriage new patients
Direct referrals from other Tier 2 Direct referrals from other Tier 2
servicesservices
Links with GP’s Links with GP’s
Tier 2 - LimitationsTier 2 - Limitations
Limited treatmentsLimited treatments
Lone practitionerLone practitioner
No PsychologistNo Psychologist
Limited review appointmentsLimited review appointments
Tier 2 philosophy treat and Tier 2 philosophy treat and
dischargedischarge
Nurse Assessment of New Nurse Assessment of New PatientsPatients
ControversialControversial
Based Good TriageBased Good Triage
Not dissimilar to consultant Not dissimilar to consultant
assessmentassessment Good explanationGood explanation Treatment goalsTreatment goals HonestHonest Accept own limitationsAccept own limitations
AssessmentAssessment
Structured AssessmentStructured Assessment
Back to front Back to front
Patient understands reasons for ?Patient understands reasons for ?
More openMore open
Personally - get more out of patients Personally - get more out of patients
Continuity of careContinuity of care
Social HistorySocial History
Relationship statusRelationship status Family statusFamily status Hobbies & interestsHobbies & interests WorkWork Social lifeSocial life Alcohol & SmokingAlcohol & Smoking Recreational DrugsRecreational Drugs
24hr Day24hr Day
Time awakeTime awake Time upTime up Activities of daily livingActivities of daily living Spend day Doing?Spend day Doing? Housework CookingHousework Cooking Retire to bedRetire to bed Sleep patternSleep pattern
Previous Medical HistoryPrevious Medical History
Illness’s Illness’s
OperationsOperations
Long term conditionsLong term conditions
Family historyFamily history
Current medicationsCurrent medications
Psychological HistoryPsychological History
History of depressionHistory of depression
Family history of depressionFamily history of depression
History of anxiety disordersHistory of anxiety disorders
Significant events Significant events
Personality disordersPersonality disorders
Previous medicationPrevious medication
Psychological scoresPsychological scores
Pain HistoryPain History
How longHow long Onset of Pain/ CauseOnset of Pain/ Cause DescriptionDescription VAS score – best & worseVAS score – best & worse Better withBetter with Worse withWorse with Past treatmentsPast treatments
RED Flags!RED Flags!
Previous history Previous history caca
Night sweatsNight sweats Age <20 & > 55Age <20 & > 55 Bladder & BowelBladder & Bowel Thoracic painThoracic pain OnsetOnset
Weight lossWeight loss Co-morbidityCo-morbidity Recent Recent
infectioninfection Progressive Progressive
neurological neurological deficitdeficit
TraumaTrauma
ExaminationExamination
PosturePosture
Range of movementRange of movement
PowerPower
ReflexesReflexes
Sensory changesSensory changes
Obvious abnormalitiesObvious abnormalities
DiscussionDiscussion
Patients model for their painPatients model for their pain
Clinicians modelClinicians model
Explanation nature chronic painExplanation nature chronic pain
Pacing goal setting and exercisingPacing goal setting and exercising
Treatment optionsTreatment options
Tier 2 - TreatmentsTier 2 - Treatments
Education and CounsellingEducation and Counselling
Physiotherapy – acupuncture, Physiotherapy – acupuncture,
hydrohydro
TENSTENS
Pharmacological txPharmacological tx
Direct list to secondary care for Direct list to secondary care for
injections/MDT/PMPinjections/MDT/PMP
Tier 2 TreatmentsTier 2 Treatments
Referral PsychologyReferral Psychology
Referral to other tier 2 servicesReferral to other tier 2 services
Referral to other specialitiesReferral to other specialities
Follow up and supportFollow up and support
Refer on to secondary careRefer on to secondary care
CNS CompetenciesCNS Competencies
No Clear GuidanceNo Clear Guidance
BPS guidelines 2002 - withdrawnBPS guidelines 2002 - withdrawn
Job description/titleJob description/title
Key Skills framework Key Skills framework
New Guidelines 2008 BPS RCN New Guidelines 2008 BPS RCN
CNS CompetenciesCNS Competencies
RGN RGN
Post reg courses relevant to Post reg courses relevant to
subjectsubject
3 yrs experience senior level 3 yrs experience senior level
Masters level degree ? PainMasters level degree ? Pain
?Nurse prescribing?Nurse prescribing
Management experienceManagement experience
ConfidentConfident