​When patients with acute trauma-related pain enter emergency centres (ECs), the first healthcare personnel they encounter are professional nurses who must assess and manage their pain. As the frontline healthcare workers in ECs, nurses need proper guidelines about how to deliver this critical service that will improve the quality of care and increase patient satisfaction.

This is according to Dr Yolande Magerman from the Western Cape College of Nursing, who recently obtained her doctorate in nursing at Stellenbosch University.

Magerman developed a best-practice guideline for professional nurses in ECs in the Western Cape as well as an algorithm that provides a quick step-by-step method for the implementation of the guideline. She says that to date, there seems to be no guidelines available for these nurses to assess and manage acute trauma-related pain.

She points out that pain assessment helps to determine the type of pain, how it affects the patient's functioning, and what interventions are required. Pain management refers to the use of medical and non-medical interventions to control pain, and encompasses the patient's quality of life, as well as the ability to function productively at work, in the family and in society.

Magerman surveyed professional nurses and patients in five ECs in the province and also did an extensive review of relevant research literature to map the best available guidelines on pain management.

She points out that the key elements of the best-practice guideline are pain assessment, pain management and organisational support.

“The guideline indicates that self-report of the pain by patients should be included in the assessment process whenever appropriate, as pain is a subjective experience. Patients should be screened for the presence or risk of any type of pain by asking directly about it, rather than assuming the patient or their family members or caregivers will voluntarily disclose the information.

“The guideline also indicates that nurses should do a comprehensive pain assessment by obtaining sufficient, accurate information about the patient's pain, symptoms, clinical history, and functional status prior to deciding on both diagnosis and treatment. They should also explore the patient's beliefs, knowledge, and level of understanding of pain and pain management.

“In addition to using valid pain measurement tools to determine if the pain is mild, moderate, or severe, nurses should document the patient's pain characteristics and how they respond to the pain management plan."

Magerman adds that it is important to have an organisational structure in place that promotes close cooperation between all personnel involved in the care of the patient, as this is crucial for the proper assessment and management of pain.

She says the guidelines are important because while most of the nurses who participated in her study had adequate knowledge of the assessment and management of acute trauma-related pain, they felt that this knowledge was not up to date according to best practices in nursing.

“The practice of pain assessment and pain management was not consistent and standardised in the ECs. These centres are overcrowded, placing nurses in a very difficult situation to provide quality care to patients with acute trauma-related pain.

“The nurses agreed that best practice guidelines would provide them with the best evidence and informed recommendations regarding the assessment and management of acute trauma-related pain. This would ultimately improve patient outcomes.

“It is important to plan pain management together with the patient and to use strategies to manage pain with and without medication."

Regarding the algorithm that she developed, Magerman says it is in the form of a document that follows the steps of the best-practice guideline to allow quick and easy accessibility for nurses to refer to and to efficiently determine the level of severity of the patient's pain.

“The algorithm will be a quick reference guide for the assessment and management of pain in the EC which is often busy and overcrowded.

“It should first be placed in the triage room since this is the first port of entry in the EC where interaction with nurses takes place and where the first pain assessment is done. Thereafter, prominent areas with easy access for nurses should be identified in the EC where pain assessment can be done, such as waiting areas, or the patient's bedside."

Magerman says her study empowers nurses to take ownership of the acute pain of patients admitted with trauma-related injuries.

She emphasises the need for further research to implement and test the feasibility, appropriateness, meaningfulness, and effectiveness of the best practice guideline for professional nurses in ECs.

• Photo courtesy of Maxpixel.​