An article I recently discovered in Fatigued RN magazine:
In emerging healthcare news physician and nurse researchers are working fervently to fix the flaw in the pain assessment system. Even now they are working both day and night to develop a new scale where the patient’s response to questioning more closely coincides with the assessment of the questioner.
The need for a more appropriate pain scale comes due to the growing confusion of healthcare providers everywhere who are left perplexed as they leave the bedside of a patient experiencing 10/10 pain, but who is snoring in a deep sleep when the nurse returns with a syringe of Dilaudid (since they are allergic to Morphine).
A recent interview with just such a confused RN quotes her as saying, “I just don’t get it. I asked him to tell me his pain level on a scale of 1-10, with 10 being the absolute worst pain he’s ever had in his whole life. He quickly answered an 11 as he took another large bite of the Whopper Junior his girlfriend brought him hidden in her purse.”
It’s not just on MedSurg or ICU floors where the scale is being found to be flawed either. Even in the ER, where pain relief management is easily maintained due to the low level of visitors seeking pain control, practitioners there are finding it difficult to treat their patient’s pain adequately with such erroneously constructed pain scales.
A seasoned ER Nurse Practitioner recently voiced his concerns. “We’re finding that on a scale of 1-10 most ER patients are located right around the number 10. We’re also finding the higher the number of visits to the ER in the past month, the more likely the patient’s pain will be rated as a 10. This seems to coincide with the incidence of benign stomach pain without findable cause, as well as the incidence of positive drug abuse history, which only more confounds the issue. I mean, people with such an intimate relationship with pain should definitely understand pain levels. Obviously the scale is to blame!”
Hospital administrators everywhere are discovering these faulty pain scales are to blame for undeserved, low, patient satisfaction scores. Complaints are flooding in from patients whose pain is not being adequately brought to a zero according to the pain scales available. Not even a 1.
Such was the case with this recent survey from a rural hospital. The patient, whose name will remain anonymous, stated, “I take two Hydro tens at home for my chronic back pain, and all they wanted to give me was morphine, but only every two hours since my blood pressure was 90/50. I told them that stuff don’t work for me, and it makes me sick. But they gave me Zofran instead of Phenergan. I can’t rest with that! My pain was 10/10. You can ask my sister. We were laughing at a story about her neighbor’s cat the whole time I was dying of pain. Plus I couldn’t breathe! I told them that!”
A new nurse graduate was written up promptly for her behavior towards the aforementioned patient. It was discovered by her supervisor that she treated the patient’s pain level according to presentation rather than what the patient rated it on the pain scale. She didn’t think the scale meant what the patient thought it meant.
The supervisor responded to the incident. “I told her pain is subjective. If the patient says it’s a 10, even if they’re slurring their words or nodding off to sleep, then it’s a 10. She should know this! A new scale needs to be implemented that is more in-line with the patient’s needs. I think a 1-11 scale might work.”
But rest assured, due to the seriousness of such a misunderstood scale currently in use top researchers are hitting the grindstone to design something more fitting to objective, assessment perception verses subjective, patient vocalization.
One physician working with an influential group of medical professionals to perfect the pain scale has said, “Our goal is to have a scale where a presentation similar to the Wong-Baker smiley face cannot be an option to be what’s now called a ten on the 1-10 numeric scale. Basically this face 😵 should be a ten on the scale we are perfecting. We hope this will alleviate current confusion with nurses.”
Stay tuned. We’ll keep you up to date as new scales are implemented. Until then, remember that pain is subjective. It’s a 10. Even if they’re whistling Dixie and doing the Electric Slide.
*I love being a nurse. Many aspects of the job are quite challenging, and often times due to the difficulty of performing well in such a stressful and taxing environment nurses enjoy laughing and joking about some of the harder aspects of the field. We’ll use satire and poke fun as a way to reduce work-related stress and forge camaraderie amongst one another. All jokes aside, I can honestly say that there is no greater joy in nursing than to alleviate pain and make a patient feel better.