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Pain and Comfort Clinical Guideline

The Joint Commission mandates that all individuals have the right to effective pain/symptom management. This mandate must be included in the delivery of basic clinical nursing care. The Agency for Healthcare Research and Quality asserts that institutions have the responsibility for pain management, and that this responsibility begins with the affirmation that patients should have access to the best level of pain relief that may be safely provided. Despite the availability of effective analgesics and new drug administration technologies, studies continue to cite suboptimal pain management.

A lack of understanding about basic pain management concepts continues despite more recent efforts to improve nurses’ knowledge of pain management. Inadequate education in the area of pain concepts fails to prepare nurses to effectively assess and control postoperative pain. Pain assessment is difficult due to the complex interactions which occur between patient and practitioner, and healthcare professionals may underestimate pain when performing clinical assessments.

ASPAN took a proactive leadership role to address these findings. This organization conducted a descriptive survey of perianesthesia nursing practice on pain and comfort management in April 2001. The multisite study used a convenience sample of 220 perianesthesia nurses. These nurses practiced in multiple settings: preadmission testing (PAT), preop/holding, nontraditional anesthetic areas, and all phases of postanesthesia care. The results of this study showed that during the preoperative phase, nurses identified the patient’s desired pain level at a frequency of 21%. The study also showed that during this preoperative phase, the patient’s desired comfort level was identified at a frequency of 20%. The highest frequency of assessment was seen during the admission process. This frequency of assessment ranged from 40% to 75%. At discharge from PACU Phase I, 66% of the patients rated their pain level as moderate by using a numerical scale. Findings were shared with perianesthesia nurses nationally.

As a result of these findings, the ASPAN leaders made a renewed commitment to uphold their mission statement “to advance nursing practice through education, research and standards.” This commitment was seen through ASPAN’s development of a strategic plan that included a major project to design the Perianesthesia Pain and Comfort Clinical Guideline. The identified outcomes for this project were 2-fold: to provide educational support for perianesthesia nurses and to provide optimal pain comfort management for perianesthesia patients. The ASPAN Perianesthesia Pain and Comfort Clinical Guideline is designed to serve as a guideline for clinicians and multiple clinical practitioners. The guideline is packaged in a Pain and Comfort Resource Manual designed to provide needed pain and comfort information for practitioners as well as patients.


Click here to read the ASPAN Pain and Comfort Clinical Guideline. (pdf) 

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