Module 22. Managing Pain - PHI€¦ · Module 22. Managing Pain Goal The goal of this module is to...

HOMECARE AIDE WORKFORCE INITIATIVE (HAWI)

Trainer’s Manual—Page 22.1

Home Health Aide Training

Module 22. Managing Pain

Goal

The goal of this module is to prepare participants to assist clients in identifying their level of pain and in managing that pain.

Time 1 hour

Activities Teaching Methods Time

1. Understanding Pain and Pain Management

Individual exercise, interactive presentations, and brainstorming

30 minutes

2. Helping Clients to Describe Pain Brainstorming and interactive presentation

30 minutes

Supplies

Flip chart, markers, and tape

Pens and pencils



Trainer’s Manual—2.2

Learner’s Book 1. Acute and Chronic Pain 2. How Pain Protects Us 3. Pain Management 4. Describing Pain 5. Nonverbal Pain Indicators: Wong-Baker FACES Pain Rating Scale 6. Nonverbal Pain Indicators: National Institutes of Health Pain Intensity Observation Checklist

Worksheets Worksheet 1. Quiz: Understanding Pain

Handouts Handout 1. Key Terms

Handout 2. Summary of Key Information

Advance Preparation Review all the training instructions and learner’s materials for this module. Note that icons are used to remind the trainer of the following:

When you are presenting or covering Key Content in the discussion. (Key Content is also addressed in the Learner’s Book and the handouts, but we use the “key” icon only when it is covered elsewhere in the learning process.)

When it is important to ask a particular question to get participants’ input.

When it is time to refer to the Learner’s Book.

When it is time to distribute a worksheet.

When it is time to distribute and discuss a handout.




Copy all worksheets and handouts for participants. Gather all necessary supplies and equipment. Please note that the Key Content is meant to be background information for the trainer. DO NOT READ OUT LOUD TO PARTICIPANTS.

Activity 1. Understanding Pain and Pain Management

Prepare the following flip chart pages:

“Ways to Manage Pain” (Step 8)

Activity 2. Helping Clients to Describe Pain

Prepare the following flip chart pages:

“Describing Pain” (Step 2)




Activity 1. Understanding Pain and Pain Management

30 minutes Learning Outcomes By the end of this activity, participants will be able to:

Define key words and terms related to pain and pain management techniques. Discuss common beliefs about what pain is and why pain is important to our safety and well-being. Explain how pain can protect our body and mind. Explain the difference between acute and chronic pain. Describe the different treatment goals for acute and chronic pain. Explain the term “pain management.” Describe different approaches used to manage pain.

Key Content Acute pain is pain that comes on suddenly and lasts for hours or days. It disappears

once the underlying cause is treated. Acute pain has a clear cause. It can result from illness, trauma, or surgery or any other medical procedure. Examples of acute pain could be getting burned, breaking a bone, or having an infected tooth.

Chronic pain is pain that starts as an acute pain and continues beyond the normal time

expected. Chronic pain can be constant or it can occur over and over again at various times. Chronic pain by definition is pain that persists for more than six months. Some people with chronic pain conditions have symptoms for months or even years.




Chronic pain often limits everyday functioning and may lead to additional stressors

such as sleep problems, medication side effects, reduced capacity for working, financial hardship, and strain on significant relationships.

Estimates of the percentage of people in the U.S. who suffer from chronic pain vary widely, from a low of 10 percent to a high of 50 percent.

The key purpose of pain is to give a signal to our mind and body to protect us. A world without pain would be dangerous. By giving signals to the different parts of our body, pain tells us that we need to react and learn what to avoid or what we need to do to stay safe and well.

There are different treatment goals for acute and chronic pain:

The primary goal of acute pain treatment is to remove the cause of the pain.

The main goals for chronic pain are to reduce the pain, limit disability, and maximize the person’s physical and emotional functioning.

Pain management is treatment designed to ease chronic pain to enable a patient to have a better quality of life. It focuses on managing pain symptoms; it is not about looking for a quick fix. Pain management generally includes both medication and lifestyle changes (e.g. diet, exercise, stress management) for the best outcome.

People have different ideas about or attitudes towards medication for pain management. Some clients want to take as little as possible. Other people are grateful for medications that provide some comfort. And others are so debilitated by pain that they may overmedicate.

Pain medication works best when it is taken before pain has become severe.




Activity Steps Individual Exercise—5 minutes 1. Introduce activity. Explain that this activity will help participants see what they

already know about managing pain and increase their understanding of pain. Tell participants that you are going to make a series of statements about managing pain. After each statement, you will ask them to write down whether they think the statement is true or false. Then you will discuss the correct answer.

2. Distribute Worksheet 1. Quiz: Understanding Pain. Explain that this “quiz” will not be turned in, so it does not matter whether they get the answers right or wrong. It is only meant to help them focus on key information.

3. Read each question aloud. Then give participants a few moments to circle their answer.

Interactive Presentation—15 minutes

4. Discuss answers to the first statement. Ask for a show of hands of which participants marked the statement “True” and then which marked it “False.” Ask for one or two volunteers to say why they thought the statement is true, and for one or two other volunteers to say why they felt the statement is false.

Teaching Tip If a statement is true and no participant chose “False” for their response (or vice versa), you can ask for two volunteers to say why they thought it was true or false and congratulate all for having the correct response.

5. Give the correct answer and discuss. Discuss the correct response with a short explanation and example.




Teaching Tip The correct answers are found below, with brief explanations in Key Content. Explain to participants that the quiz is meant to introduce them to topics that will be discussed in more detail later, so you are providing only short explanations at this time.

6. Define “acute pain” and “chronic pain.” Refer to 1. Acute and Chronic Pain in the Learner’s Book.

7. Explain the purpose of pain. Refer to 2. How Pain Protects Us in the Learner’s Book. Emphasize the role of pain to help us know when something is wrong and the importance of being able to describe pain.

Brainstorming—5 minutes

8. Give instructions for brainstorming. Ask participants to think of someone they know who has (or had) a painful illness or condition. (They can include themselves and their own pain experiences, too.) Ask them to think of all the ways the person tried to manage the pain they were experiencing. Ask one person to begin by sharing one way; then go to another person to share another way; and so on. Write their ideas on the flip chart paper.

Flip Chart

WAYS TO MANAGE PAIN




Teaching Tip The intention of this exercise is to provide an opportunity for participants to share their different awareness and experiences with individual pain management approaches (i.e. medication, surgery, alternative medicine such as acupuncture/ chiropractic treatment, exercise, relaxation techniques, therapy, etc.).


9. Discuss pain management. Refer to 3. Pain Management in the Learner’s Book. Note any similarities with their flip chart list. The key point to emphasize after reviewing the information is that pain management is not about “fixing (curing) a condition or illness”—it is about managing pain symptoms to help clients have a better quality of life.




Correct answers to “Quiz: Understanding of Pain.” Question 1. Almost 75% of people in the United States live with chronic pain that interferes with their mood, sleep, ability to work, and enjoyment of life. False Question 2. Pain can cause a person to feel angry and frustrated. These emotions can make the pain feel worse. True

Question 3. There are many common diseases such as arthritis, multiple sclerosis, and diabetes where pain is caused by physical damage that can’t be seen. The pain involved is chronic with acute episodes. True Question 4. The main purpose of pain is to give a signal to our mind and body to protect us. True Question 5. To avoid overuse of medication, it is better for a person to wait until the pain is severe before they take medication. False Question 6. It is easy for a person in pain to describe their pain. False

Question 7. Sometimes medication is not enough to help a person be pain-free. True




Activity 2. Helping Clients to Describe Pain 30 minutes

Learning Outcomes

By the end of this activity, participants will be able to:

Explain two ways home health aides can learn about the client’s pain experience. Explain verbal and nonverbal tools and techniques that home health aides can use to observe, record, and report clients’ pain experience.

Key Content Pain can be expressed verbally by the client or observed through behavior.

Sometimes, when a person has chronic pain, it can feel so overwhelming that they

describe themselves as always being in pain. This may be true, but the quality of their pain may not always be the same. Helping clients to describe their pain will help them think about it differently. That may help them experience it differently and learn how to manage their pain more effectively.

Some people talk freely about pain. Others are embarrassed to admit that they are in

pain and that it is affecting their quality of life. Others simply cannot speak due to their illness or disabling condition, or are too tired to express themselves verbally.

There are many different ways—verbal and nonverbal—to help a client describe pain.

Home health aides can use observation and active listening skills (asking open-ended questions and paraphrasing) to help the client more accurately identify the specific type and level of pain they are experiencing.

Nonverbal pain indicators include asking participants to point to a facial expression

drawn on a page or observing the client’s body language and behavior.




Activity Steps Brainstorming—10 minutes

1. Introduce discussion about describing pain. Tell participants that they will now learn about some tools and techniques they can use to help identify the type and level of pain to record and report.

2. Invite participants to share their experience with pain. Ask participants to think about their own experience of pain and what words they would use to describe it. Ask for a few volunteers who are willing to talk about their own experience with pain. Ask the volunteers to name the particular pain experience (e.g., a burn, childbirth, a broken bone, back pain, etc.) and to describe the pain by pretending they’re speaking with someone who had never experienced the same pain. Write their descriptions on the prepared flip chart page.

Flip Chart

DESCRIBING PAIN

3. Explain why describing pain is an important step in managing the pain. After several volunteers have shared their experience, explain that sometimes when a person has chronic pain, it can feel so overwhelming that they describe themselves as always being in pain. This may be true, but the quality of their pain may not always be the same. Helping clients to describe their pain will help them think about it more clearly. This may help them experience it differently and learn how to manage their pain more effectively.





4. Review 4. Describing Pain in the Learner’s Book. Refer back to the words/language that participants used when describing their pain experiences.

5. Discuss differences in clients’ ability to describe pain. Emphasize that some people talk freely about pain. Others are embarrassed to admit that they are in pain, and that it is affecting their quality of life. And still others may feel uncomfortable talking about their pain because it is not part of their culture to do so. Some people may not speak the same language as the worker and may not be able to describe their pain to her. And there are also people who simply cannot speak due to their illness or disabling condition, or who are too tired to express themselves and would prefer to use pictures.

6. Introduce nonverbal pain indicator tools. Point out that there are many different ways—verbal and nonverbal—to help a client describe pain. Two common aids are used in medical practice to help clients indicate their pain level. Review 5. Nonverbal Pain Indicators: Wong-Baker FACES Pain Rating Scale and 6. Nonverbal Pain Indicators: National Institutes of Health Pain Intensity Observation Checklist in the Learner’s Book.

7. Summarize the module. Distribute and review Handout 1. Key Terms and Handout 2. Summary of Key Information. Ask participants if they have any questions.


Learner’s Book—Page 22.1

Learner’s Book


Activity 1. Expanding Pain and Pain Management 1. Acute and Chronic Pain 2. How Pain Protects Us 3. Pain Management Activity 2. Helping Clients to Describe Pain 4. Describing Pain 5. Nonverbal Pain Indicators: Wong-Baker FACES Pain Rating Scale 6. Nonverbal Pain Indicators: National Institutes of Health Pain Intensity Observation Checklist




1. Acute and Chronic Pain ACUTE PAIN:

Acute pain comes on suddenly. It can last for hours or for days.

It has a clear cause. It can result from illness, trauma, surgery, or any painful medical procedure.

The focus of treatment is to remove the cause of pain.

Acute pain disappears once the underlying cause is treated.

CHRONIC PAIN:

Chronic pain starts as acute pain and continues beyond the normal time expected.

Any pain that persists for more than six months is considered chronic.

It can be constant or can occur over and over again at various times. Some people with chronic pain conditions have symptoms for months or even years.

The focus of treatment is on reducing the pain to give relief, to limit disability, and to improve physical and emotional functioning.




2. How Pain Protects Us

Injury Illness

Skin, organs, bones, or wherever injury occurred sends alarms to spinal cord and brain

Spinal cord and brain send message to all body areas for help:

Endocrine System and Nervous Systems—stress hormones (to make us alert).

Blood Pressure and Heart Rate—increase. Immune System—gets ready to defend body

by moving blood cells where needed.

Body feels tense, on edge, vulnerable, prepared for action

Nervous system “takes notes” to learn and remember.

The body wants us to remember the experience in order to protect us—by avoiding the physical pain or fixing it!




3. Pain Management PAIN MANAGEMENT:

Pain management is designed to ease chronic pain. It enables a client to have a better quality of life.

Pain management focuses on managing pain symptoms—not on a quick fix or cure for the underlying cause!

Pain management generally includes both medication and lifestyle changes (in diet, exercise, stress management, etc.) for the best outcome.

MEDICATION AND PAIN MANAGEMENT:

People have different ideas and attitudes about medication. Some want to take as little as possible. Other people are grateful for medication that may provide some comfort. And others are so debilitated by the pain that they may overmedicate.

Pain medication works best when it is taken before pain has become severe.




4. Describing Pain

Page 1 of 3 Some people talk freely about pain. Others are embarrassed to admit that they are in pain and that it is affecting their quality of life. And still others may feel uncomfortable talking about their pain because it is not part of their culture to do so. And there are also people who simply cannot speak due to their illness or disabling condition, or who are too weak to express themselves. There are many different ways—verbal and nonverbal—to help a client describe pain. Home health aides can use their communication skills—asking open-ended questions, paraphrasing, and observing body language—to assist clients in managing their pain. One verbal technique the home health aide can use is to ask questions that help the client more accurately identify the specific type and level of pain they’re experiencing. There are several specific categories described below that a home health aide can use when trying to assist a client in describing pain.

1. LOCATION Question: WHERE do you feel the pain? Common Responses:

“All over,” “Just in my right elbow.”

“Starts at my shoulder, and goes down the whole arm.” 2. WHAT KIND OF PAIN Question: WHAT does your pain feel like? Common Responses:

“Like someone is stabbing me with a knife.”

“My calf muscle feels hard as a rock.”

“Very sore when I touch it.”




4. Describing Pain

Page 2 of 3 3. INTENSITY Question: HOW MUCH pain are you in? Common Responses:

“It’s killing me.” or “I’m in agony.” (Very intense)

“So-so.” (Moderately intense)

“I feel it only a little bit.” (Mild intensity)

4. PHYSICAL IMPACT Question: How does your pain affect WHAT YOU CAN DO today? Common Responses:

“Every time I step down on my foot, I get a sharp pain.”

“I’m so weak, I don’t want to get out of the bed.”

“The pain in my shoulder is better. I think I can make myself a cup of tea.”

5. PATTERN OF PAIN Question: How long does the pain last? How often does it come? What kinds of activities are you doing when you feel the pain? Common Responses:

“It feels like my leg wants to give out on me whenever I try to stand. If I hold on to the chair for a couple of minutes, it goes away.”

“It just seems to come out of nowhere, and lasts about ten minutes.”

“Right after I walk up the stairs, I feel pain in my knee. Once I sit down, it’s gone.”




4. Describing Pain

Page 3 of 3 6. ACCOMPANYING FACTORS (THINGS THAT ALSO HAPPEN DURING THE PAIN

EXPERIENCE) Question: What else happens when you have this pain? Common Responses:

“The pain’s right above my stomach, and yesterday I had a little diarrhea.”

“I had a terrible headache and a little cough during the night, but now this morning I started feeling chills.”

“My right leg was throbbing earlier and now I’m feeling tingling in my toes.”




5. Nonverbal Pain Indicators: Wong-Baker FACES Pain Rating Scale

Sometimes a client cannot speak due to illness or another disabling condition, or is too tired or weak to express themselves. And some clients may not speak the same language as the worker, and may not be able to describe their pain to you. There are many different ways to help a client describe pain. Here is one common tool used by many health care professionals.




6. Nonverbal Pain Indicators: National Institutes of Health Pain Intensity Observation Checklist1

Page 1 of 2

Checklist of Non-Verbal Indicators (CNVI)

1 National Institutes of Health, Warren Grant Magnuson Clinical Center, Pain Intensity Instruments, July 2003.

With Movement

At Rest

Nonverbal Vocal Complaints -- expressions of pain, such as moans, groans, grunts, cries, gasps, sighs.

Facial Grimaces and Winces -- furrowed brow, narrowed eyes, tightened lips, dropped jaw, clenched teeth, distorted expression.

Bracing -- clutching or holding onto siderails, bed, tray table, or affected area during movement.

Restlessness -- constant or intermittent shifting of position, rocking, intermittent or constant hand motions, inability to keep still.

Rubbing -- massaging affected area. Verbal Vocal Complaints -- expressions of pain using words, such as “ouch” or “that hurts”; cursing during movement; or uttering exclamations of protest, such as “stop,” or “that’s enough.”

TOTAL SCORE



Learner’s Book—.10

6. Nonverbal Pain Indicators: National Institutes of Health Pain Intensity Observation Checklist2

Page 2 of 2 The NIH Pain Intensity Observation Checklist is used with clients who:

Are not able to describe their pain on a “0 to 10” scale. Are not able to use the Wong-Baker FACES Pain Rating Scale.

Instructions:

1. Write a “0” if the behavior is not observed.

2. Write a “1” if the behavior occurred even briefly during activity or rest.

3. Add up total score, which will range between “0” and “6”.

4. The care team uses this to help decide what the client needs for

pain management. Reference Feldt, KS. (2000). The checklist of nonverbal pain indicators (CNPI). Pain Management Nursing 1 (1): 13–21.




Handouts

Handout 1. Key Terms Acute pain [1]

Pain that comes on suddenly. It has a clear cause. Chronic pain [1]

Chronic pain starts as acute pain and then continues. It can be constant or can occur over and over again at various times. Chronic pain can last for months or even years.

Pain management [3] This is any strategy desgined to ease chronic pain. It is focused on relieving pain symptoms.



Handouts

Handout 2. Summary of Key Information Page 1 of 3

Acute pain comes on suddenly. It can result from illness, trauma, surgery, or any painful medical procedure. Acute pain disappears once the underlying cause is treated.

The focus of treatment for chronic pain is on reducing the pain. This will give relief, limit disability, and improve physical and emotional functioning.

Pain protects us by alerting the brain that there is an injury or illness. Then

the brain can tell the rest of the body how to respond. This helps to fix the problem (as with illness) or to help the person avoid that situation in the future.

Pain management focuses on managing pain symptoms—not on fixing or

curing the underlying cause. For the best outcome, pain management generally includes both medication and lifestyle changes (diet, exercise, stress management, etc.).

Pain medication works best when it is taken before pain has become

severe.

There are verbal and nonverbal ways to help a client describe pain. Home health aides can use their communication skills—asking open-ended questions, paraphrasing, and observing body language—to assist clients in managing their pain.



Handouts


One verbal technique is to ask questions that help the client identify the specific type and level of pain they’re experiencing. These questions include: o Location: WHERE do you feel the pain? o What kind of pain: WHAT does your pain feel like? o Intensity: HOW MUCH pain are you in? o Physical impact: How does your pain affect WHAT YOU CAN DO

today? o Pattern of pain: How long does the pain last? How often does it come?

What kinds of activities are you doing when you feel the pain? o Other factors: What else happens when you have this pain?

If a client cannot speak or is too tired or weak to express themselves, they can use the “FACES Pain Rating Scale.” This involves showing the client a series of face drawings and letting the client point to the one that best expresses how they feel.



Handouts


You can also use the “Checklist of Non-Verbal Indicators”1 to describe the level of pain that a client is feeling. This is for clients who are not able to describe their pain on a “0 to 10” scale, or are not able to use the FACES pain rating scale. The home health aide observes the client and fills in the checklist.

Checklist of Non-Verbal Indicators (CNVI)


With Movement

At Rest

Nonverbal Vocal Complaints -- expressions of pain, such as moans, groans, grunts, cries, gasps, sighs.

Facial Grimaces and Winces -- furrowed brow, narrowed eyes, tightened lips, dropped jaw, clenched teeth, distorted expression.

Bracing -- clutching or holding onto siderails, bed, tray table, or affected area during movement.

Restlessness -- constant or intermittent shifting of position, rocking, intermittent or constant hand motions, inability to keep still.

Rubbing -- massaging affected area.

Verbal Vocal Complaints -- expressions of pain using words, such as “ouch” or “that hurts”; cursing during movement; or uttering exclamations of protest, such as “stop,” or “that’s enough.”

TOTAL SCORE



Worksheets

Worksheet 1. Quiz: Understanding Pain 1. Almost 75% of people in the United States live with chronic pain that interferes with

their mood, sleep, ability to work, and enjoyment of life. True False

2. Pain can cause a person to feel angry and frustrated. These emotions can make the

pain feel worse. True False

3. There are many common diseases such as arthritis, multiple sclerosis, and diabetes

where pain is caused by physical damage that can’t be seen. The pain involved is chronic with acute episodes.

True False

4. The main purpose of pain is to give a signal to our mind and body to protect us. True False

5. To avoid overuse of medication, it is better for a person to wait until the pain is severe before they take medication. True False

6. It is easy for a person in pain to describe their pain.

True False

7. Sometimes medication is not enough to help a person be pain-free. True False

Module 22. Managing Pain - PHI€¦ · Module 22. Managing Pain Goal The goal of this module is to...

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