Principles of Pain Management

• Principles outlined regarding pain management state that all patients have the right to have relief of their pain to the greatest extent possible. A thorough nursing assessment should include both the subjective and objective descriptions of pain and any need for spiritual/psychosocial support identified. The risk of addiction to pain medications should not pose a barrier to pain relief. Coordination of care among the health care divisions is essential to effective and safe pain care management. Pain care management should continue even if a patient is unresponsive.
  
  

Guidelines

• Functions of appropriate pain management should include ensuring the person or their legal guardian can actively participate in their treatment plan and understands the treatment options available and their possible side effects. A patient should be assessed and monitored frequently as to their pain level and a plan of care developed to alleviate as much of the person's pain as possible. The nurse is responsible to administer medications and treatment exactly as prescribed and thorough documentation of medication administration, pain assessment, intervention and evaluation is essential.
  
  

Legal Issues

• The nurse is legally responsible, depending upon her scope of practice, for implementing pain management by utilizing her training and documented assessment of the patients needs. The nurse has the legal authority to adjust medication doses within the prescribed levels and dosage ranges set forth by the prescriber and according to their employer's specifications and procedures. If pain is not controlled by the current treatment plan, the nurse is responsible for documenting and reporting such findings to the prescriber.
  
  

Principles

• The nurse is liable for completing and documenting a thorough health history and physical examination in the patient's record. She should be involved in developing a written treatment plan. She should discuss both the benefits and risks associated with the use of controlled substances with the patient or their legal guardian. If the patient is determined to be at risk for addiction, the nurse is responsible to obtaining a written pain medication agreement from the patient.
  
  

Conclusion

• The Oregon State Board of Nursing has adopted these guidelines with the hope that it will play a major role in increasing nurses' knowledge, practices and beliefs concerning pain management.