Clinical Reasoning and Pain Assessment in Nursing: NURS2010 Essay

This essay delves into the critical aspects of pain assessment within a nursing context. It begins with a brief explanation of pain and its different types, including nociceptive, neuropathic, and inflammatory pain, as well as acute and chronic classifications. The essay emphasizes the importance of pain assessment by nurses, highlighting its role in understanding a patient's condition and guiding appropriate interventions. It outlines a comprehensive strategy for assessing and responding to an adult patient's pain experience, including pre-assessment planning, the application of the OLDCART mnemonic (Onset, Location, Duration, Characteristics, Aggravating factors, Relieving factors, Treatment) for detailed pain evaluation, and post-assessment actions. Furthermore, the essay integrates relevant Nursing & Midwifery Board of Australia (NMBA) Professional Standards to support the proposed pain assessment strategy, underscoring the importance of culturally safe practice, therapeutic communication, and patient-centered care. The essay stresses the significance of pain assessment for nurses and its implications for providing the best possible care.

Running head: PAIN ASSESSMENT 0
pain Assessment
Essay
APRIL 22, 2019
Student
[Company address]

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Pain Assessment
Pain is actually the uncomfortable feeling that enables a person to understand that
something is wrong inside the body. It can be categorised as steady, throbbing, stabbing, aching,
pinching or other forms (Bourke, 2014). Acute pain is actually severe and short term and is
commonly signal that the body has been injured. It can also be associated with different types of
disorder of infections like in angina the patient experience chest pain and in food poisoning, the
patient may experience stomach pain. Pain assessment is essential for patients with specific
disorder of infections to understand the actual condition or stage of the particular disorder
(Williams, & Craig, 2016). Assessment of open is usually considered as the fifth vital indication
in relation to healthcare as is it accepted in the healthcare sector that pain is the objective
sensations like other vital signs and nit subjective. Nurses play a key role in assessing the pain in
patients with different types of health issues. In this particular essay, type of pain, why the pain
assessment is performed, and to respond to the adult patient’s pain will be discussed. How a
nurse plan for pain assessment, use of OLDCART, and should be done after pain assessment will
also be discussed.
Pain is the distressing feeling that is often caused by intense or harmful stimuli. It is
defined as the unpleasant sensual and emotional experience linked with the actual or possible
tissue impairment or, recognised in terms if such type of pain. Pain encourages the person to
remove from damaging situations, to defend a damaged part of the body while it heals, and to
escape a similar situation in future. It does not originate at the affected sit as most people think, it
is generated by the brain so that a person can protect the pat in danger (Shueb, Nixdorf, John,
Alonso, & Durham, 2015).

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Pain can be categorised by different types such as on the basis of its intensity, duration,
and site of pain. The common types of pain include; nociceptive, neuropathic, and inflammatory
pain. Nociceptive type of pain represents the common response to the noxious damage of tissues
like skin, muscles, bones, organs, or joints. Neuropathic type of pain starts or caused by the
primary lesion or the disorder in the somatosensory nervous system (Kumar, & Elavarasi, 2016).
Sensory aberrations range from the deficits perceived as the numbness to hypersensitivity, and to
the paresthesias like tingling. Inflammatory type of pain is the result of initiation and
sensitization of the nociceptive pain passageways by the range of mediator secreted at the
location of tissues inflammation. On the basis of intense pain can be categorized as mild,
moderate, and severe (Dansie, & Turk, 2013). The pain is also classified on the basis of pain
duration; acute, chronic and acute-on-chronic pain. Acute pain remains for 3 to 6 months.
Chronic pain lasts for 3 to six months or persisting beyond the course of the acute disorder, or
afterwards, the tissue healing is complete (Shueb, Nixdorf, John, Alonso, & Durham, 2015).
Nurses play a key role in pain assessment and managing pain related problem faced by
the patients. According to the nursing and Midwifery Board of Australia the nurse meet the
professional standard in order to provided services in Australia. Nurses are the core member of
the team assigned to a particular patient (Kumar, & Elavarasi, 2016). Nurses spend most of their
time with the patient, therefore they are more familiar with the patient's condition and make
therapeutic communications with them in order to build a good therapeutic relationship. Pain
assessment is one of the main nursing assessments that need to be done at different time
intervals. They use different methods to analyse the pain intensity like using scale and
questionnaires. It has been estimated that one in five Australian lives with a chronic type of pain
(Wager, Atlas, Lindquist, Roy, Woo, & Kross, 2013). And every day numerous individuals

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experience acute pain, occurring after the surgery or form accidents like burns and fractures.
According to NMBA standard, the nurses and midwives must make the therapeutic relationship
with the patient (Nursing and Midwifery Board of Australia, 2018). Effective assessment of pain
is crucial or important for patients care (Tse, & Ho, 2014). Not only does the controlled pain
enhance the patient’s comfort level, but also improves the different other areas of their
wellbeing, counting their psychological and bodily function. This is why it is essentials for all
the health professionals to be capable to complete the accurate pain assessment and implement
the successful pain management approaches. NMBA suggest nurses show empathy to the
patients as they already in pain. Pain affects the patients bodily and emotional conditions,
therefore, identifying their pain level can help the nurses to examine the actual intensity of pain
and to ultimately help them to assess the stage of a particular disease or health adverse condition
(Nursing and Midwifery Board of Australia, 2018). This will allow hem to understand what type
of interventions can be beneficial for them (Wager, et al., 2013).
Pain assessment is the most important step in order to provide patients with nursing
interventions. I must plan before assessing a patient’s pain. Before applying pains assessment
methods I will make sure that they are assessing the right patient, as it happens when there are
different patients with pain. NMBA suggests the nurses deal with the client respectfully and they
should also ask for consent form before providing any type of health services. I should ensure all
the documentation about assessment methods and what should be done after the assessment
(Hur, & Roh, 2013). The nurse must pre-plan for interventions he or she is going to use after the
assessment of pain. I must plan for what type of pain aspects they should consider such as pain
intensity, pain quality, location or site of the pain, duration and onset, aggravating and alleviating
aspects, and impacts of the pain on the patient. The nurse must examine the history and physical

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symptoms. According to NMBA standards, Nurse must understand that the patients belong to
different cultures and beliefs, therefore nurses should deal with them respectfully and
empathetically (Nursing and Midwifery Board of Australia, 2018). Culturally safe and the
respectful practice needs having information of how the nurse’s own culture, morals, attitudes,
expectations and beliefs affect their connections with persons and families, the civic and
colleagues (Rimmasch & Ravert, 2013). The nurses must be familiar with the pain terminologies
before assessing the patient. The individuals admitted to hospitals or clinics often use some terms
like an ache, hurt, and discomfort to describe their pain. NMBA recommends nurses includes
patients and their family in the decision making the process for their treatment process (Fink, &
Brant, 2018). The nurses should also identify the significance of family, communal, partnership
and teamwork in the healthcare decision-making in case of Aboriginal and/or Torres Strait
Islander individuals, for both deterrence plans and care delivery.
Nurses should be prepared and skilled in differentiating those terms and observe the
patient carefully (Nursing and Midwifery Board of Australia, 2018). The nurse should also
prepare pain assessment tools before assessing the patient’s pain. Some of the tools that are
beneficial in pain assessment include Numeric scale for pain intensity, Wong-Baker faces scale,
FLACC scale, Cries scale, and neonatal infant pain scale. The nurse should also prepare the
question will be asked to the patients before the process. The nursing planning must also include
preparing the patient record sheet to note all the observation. Nurses must ensure that the
delivery of health services are of the best quality and safe for the patient (Gordon, 2015).
OLDCART stands for the Onset location Duration Characteristics Aggravating Factors
Relieving Factors Treatment. OLDCARD is an effective tool helpful for nurses to assess the
patient's pain. According to me, this tool will be the most effective tool for me to understand the

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patient’s pain more accurately and deliver my nursing intervention. The onset will help me to
identify when the pain began (Jeffries, 2015). I will ask the patient to discuss when the pain
started. It will also help me to identify how the pain intensity is increased or decreased.
Identifying the location of the pain is the most essential nursing assessment in order to provide
the right intervention to the patient (CARE, 2015). I will ask the patient that where does it hurt or
where are you feeling the pain. This will help me to identify the location of the pain so that I can
take care of it. Next essential aspect of OLDCART is durations that should be assessed before
providing nursing intervention. The patient will be asked, “how long your pain has been going
on”. Particular patients have the episodic type of pain, which indicates that it arises and goes.
Other diseased people have a constant type of pain.
Knowing the duration of the patient's pain helps us as a nurse to regulate the kind of
medicines and/or treatments for the finest pain assistance. Characteristics of the pain should also
be analysed. As the patient may feel chronic pain or acute pain they must be assessed on that
basis. Different numeric scale rating tools can be used to identify the level of pain. The client
will be asked to rate themselves from 0 to 10, where 0 means there is no pain, 1-2 means little
pain, 3-6 indicates mild pain, 7 to 8 means moderate and 9 to 10 shows that the patient is
experiencing extreme pain, and need immediate treatment (Rose, Haslam, Dale, Knechtel, &
McGillion, 2013).
Another aspect of OLD CART is the aggravating factor which allows the nurses to assess
the factor that led to the painful Situation. An aggravating factor is what that makes the patient's
pain worse, it is the main reason why the patient is continually feeling pain. The aggravating
factor can be associated with the particular organ like pain at specific pain or cut or burn at the
specific site of the body. I will ask some question to the patient such as how the pain occurs, and

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he or she might be examined for body diagnosis to identify the specific reason for pain. The
relieving factor is another aspect of OLD CART which indicates that nurses must understand
what the client has done to relieve the pain as this might also be the reason he or she
experiencing such pain. The patient will be asked about what primary treatment he or she applied
to reduce the pain (CARE, 2015). Last but not the least aspect of the old cart is treatment. After
examining every aspect of a patient's pain, the nurses and physician can implement the best
available treatment method for the patient. There are different treatment options for the pain that
are applied according to pain intensity. Some of the medications can be used are Nonsteroidal
Anti-inflammatory drugs and acetaminophen, Antidepressants, anticonvulsants, muscle relaxants
and opioids. There some physiotherapies available for Acute Pain. Although according to the
NMBA standards the health professionals must include the patient in the decision-making
process and through the treatment process (Nursing and Midwifery Board of Australia, 2018).
Pain is the uncomfortable feeling that allows the person to understand the individual that
something is not right his or her body. The pain is categorised on the basis of intensity, locations
of the pain, and duration of the pain. On the basis of intensity, the pain is categorised as acute
and chronic. Nursing assessment is the most critical or essential step before applying any type of
treatment to the patient. The nurses perform the pain assessment so that the best available
treatment can be provided to the person. Before assessing the patient's pain I will plan for the
assessment. I will prepare the documentation, and the tool will require for assessment like scale.
I will also observe if the patient is not sleeping or uncomfortable in any type of assessment for
now. I will also prepare the questions that will be asked to the patient for pain assessment. Pain
can be assessed by using different numerical scale tools like the FLACC scale and Cries scale.

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The patient will be asked by following the OLD CART method which includes Onset, location
of the pain, duration, characteristics, aggravating factor, relieving factor and treatment.

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References
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Fink, R. M., & Brant, J. M. (2018). Complex cancer pain assessment. Hematology/oncology
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Hur, H. K., & Roh, Y. S. (2013). Effects of a simulation-based clinical reasoning practice
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Nursing and Midwifery Board of Australia (2018). Professional Standards. Retrieved from:
https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-
standards.aspx

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