Ineffective Pain Management Nursing Diagnosis.
Pain is an unwanted sensation that is highly subjective. A patient may feel that. The International Association for the Study of Pain (ISAP) defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.”
Despite the unwanted nature of pain, pain serves an essential purpose in the body. The critical importance of pain is communicating certain stimuli and hazards, such as fire or piercing objects. Pain also communicates internal illnesses in the body or escalation of the same. By sending this communication, pain reminds the patient to pursue medical assistance. Caregivers and nurses can observe pain in a patient due to the patient’s body responding to pain as a stress inducer.
Poorly informed diagnosis
There exist multiple aspects that may lead to the ineffectiveness of nursing diagnosis. One reason for ineffective nursing diagnosis fits the nurse’s superficial diagnosis to the final diagnosis. This leads to non-adherence with the principle that the patient assessment should be the primary source for the final diagnosis. Especially with a non-physical element like pain, nurses may use previous experiences with pain to diagnose present patients. Since pain is caused by multiple and unique factors, basing diagnosis on an earlier incident or patient has a high probability of leading to the wrong diagnosis (Yass, 2015). Therefore, under no situation should retrofit the patient to a diagnosis arrived at before patient assessment occurs. Thus, the nurse should stick to the pathophysiology of the disease process, which begins with the assessment of the patient as the first and foremost step.
During the patient’s assessment, data collection should occur where important patient input is recorded for amalgamation and development of the diagnosis. Due to the invisibility of pain, some nurses may downplay a patient’s pain despite stressing the magnitude of the pain. This situation results in oversight occurring about the patient’s input (Twycross et al., 2014). Thus, the nurse’s perception of the patient’s illness rather than the patient’s intake is consequently led by the diagnosis. All diagnoses where the patient’s input is overlooked have a high potential of ineffectiveness since the patient’s input forms the most significant source of information for ensuring correct diagnosis.
Improper patient assessment
Another source of incorrect diagnosis comes from improper patient assessment. In an invisible condition like pain, the nurse is greatly limited in diagnosing the patient based on more direct sensory observations like sight. In pain diagnosis, the patient’s input is the most critical input that can guide the nurses on the diagnosis process. By properly assessing the patient, the nurse can deduce important information such as the location, intensity of pain, manner of action of the pain, and other essential details (Stein, 2015). Therefore, how the patient has significantly assessed counts towards the success or failure of a nursing diagnosis, especially pain. Questions such as whether the patient is having pain, what the patient feels they need to help with the pain, and what they think is the most essential and urgent assistance should feature prominently on the nurse’s assessment questions (Monie et al., 2016). The effect of painkillers, if the patient has used any, should also feature prominently in the assessment questions. If these questions are not asked, the nursing diagnosis misses a critical information source that would help significantly localize the reason for pain and the best response strategies.
Apart from missing these critical questions, ineffective nursing diagnosis also misses observing the physical signs of pain and discomfort portrayed by a patient. These physical signs are essential and can help to complement the verbal input obtained from the patient. These tell-tale physical signs include grimacing or touching certain body parts. By failing to watch out for these signs actively, the nurse misses another avenue to obtain valuable input to characterize the pain (Mohamed, 2016). Failure to concisely represent a patient’s pain leads to a far-fetched diagnosis which is highly ineffective. Some tell-tale signs can significantly aid the quantification of the patient’s pain and the location of the pain to a specific body part. Observation of tell-tale signs of pain is essential where the patient is verbally challenged, for example, by old age or impairment. Some pain-causing diseases also manifest in the deterioration of a patient’s ability to communicate verbally. In this case, observation of signs of pain becomes the primary method for diagnosing the patient’s pain.
The complexity of the Diagnostic Process
An ineffective nursing diagnosis may also stem from the complex nature of the diagnosis. The diagnostic process involves many steps and many considerations. Multiple symptoms must be connected to various possible causes with no set one-to-one correlation of sign to cause. Therefore, a myriad of concerns and decisions must be effected in a nursing diagnosis against often incomplete or non-descriptive symptoms. Amid this complexity, the wrong diagnosis may result, which is ineffective in its application. For a non-physical attribute like pain, the inadequate nursing diagnosis might be even more probable than for physically observable inputs. The high dependence on the patient’s explanation of his pain symptoms might also further decrease the effectiveness of the diagnosis (Mercadante, 2014). This reduction in effectiveness results from a high probability that the patient delivers skewed, biased, and highly subjective input regarding the pain they are experiencing. This subjectivity leads to the patient’s relaying information that is not strictly factual, leading to erroneous and ineffective diagnosis.
Another aspect in which the patient’s input might result in ineffective diagnosis is the absence of a physical manifestation of pain. The nurse may equate this absence to the mildness of the condition causing the pain. If the patient also underrates the pain intensity due to being highly tolerant to such sensation, the nurse may reach wrong diagnostic findings that are ineffective (Managing pain., 2015). An illustration of the complexity of connecting a symptom to an illness is the vast number of diseases that exist compared to the very few signs of illness that exist. For example, a headache may be caused by many factors ranging from solid sunshine to brain tumors. This complexity is a significant cause of ineffective diagnosis.
To reduce the possibility of the wrong diagnosis are the numerous laboratory tests developed over time. These tests help discover the cause of the symptom. Trials are limited by many factors, though. These factors include the high costs associated with some laboratory tests, the considerable time required for sample collection and testing, and the requirement to carry out procedures like drawing blood, which is not possible for the whole spectrum of possible tests. Therefore, despite the considerable number of available tests, only a few may be practically carried under the medical professional’s guidance. The role of the diagnosing nurse in advising that specific tests be administered is in itself a form of diagnosis where the individual narrows down the scope of laboratory tests (Carpenito, 2016). Therefore, only a handful of laboratory tests are usually carried out, and they don’t serve much in terms of reducing the complexity of the diagnostic process. The process of diagnostic testing is also a stepwise one in which errors are prone at any step. If an error occurs at any stage, the entire diagnosis is compromised and strongly potent of ineffectiveness.
Cognitive errors are possible in any line of work and especially in one as abstract as understanding the pain within another person’s body. Due to the possible incomplete communication by the patient to the nurse about their pain, the nurse may make an erroneous diagnosis. Cognitive errors are especially likely in pain management diagnosis where the nurse is not keen and attentive to the patient’s verbal and non-verbal cues. As aforementioned, apart from the oral assessment of the patient, the nurse must be highly alert to physical signals that the patient might give with regards to their pain (Gordon & North, 2016). Such cues complement the verbal input from the patient and allow the nurse to make a more informed diagnosis.
Another source of cognitive errors in nursing diagnosis is a misinterpretation of the patient’s input, verbal or observed. The nurse might, for example, interpret a patient’s observable calmness for mild pain while it might be caused by acute pain, which limits any motor activity. Misinterpretation leads to biased diagnostic findings. A particular factor for misunderstanding is the reliance on limited information sources for arrival at final diagnostic results. Sometimes the nurse jumps to conclusions without considering all associated aspects, primarily not because there might exist another reason for the patient’s pain apart from the first possible diagnostic finding (Lynda Juall Carpenito, 2017). Therefore, nurses should always look beyond the first likely diagnostic finding since some symptoms may be shared across multiple illnesses to ensure accurate and effective diagnosis.
An example of a symptom in which ineffective diagnosis is highly possible is abdominal pain. A large percentage of abdominal pain patients whom the nurse has handled might have gotten the pains from a problem within the gastrointestinal tract or urinary system. Therefore, the nurse may rush into a biased conclusion based on the location of the pain sensation and from previous experiences. By quickly jumping to the conclusion without adequate investigation of the symptom, the nurse overlooks other possible causes of the pain, such as vascular and neurological conditions that are not as apparent as the gastrointestinal tract (Pallavee, 2015). These cognitive errors are significant causes of error in nursing diagnosis. To minimize cognitive errors in pain management nursing diagnosis, evaluation of all possible causes must occur adequately to avoid overlooking possible but lesser apparent causes.
The absence of technology to assess pain is a factor in the ineffectiveness of pain management nursing diagnosis compared to other forms of diagnosis. The lack of such technology causes sole reliance on diagnostic information on the patient, who is also prone to misinterpretation of some sensations (Kaplan & Beech, 2015). For example, some patients may report toothache on the lower jaw while the bad is actually on the upper jaw (Kreiner et al., 2020). In such a scenario, the patient cannot discern between the two very close locations. Such limitations within the scope of nursing diagnosis might result in an ineffective diagnosis.
Conclusively, pain management nursing diagnosis is an intricate procedure that should occur under the nursing personnel’s absolute keenness. Evaluation of pain is more complex as compared to other diagnostic processes since it involves a non-physical manifestation. This manifestation may seem abstract to some nurses who are used to physical manifestations of illness. Since a large part of pain diagnosis revolves around the patient’s input, erroneous input or misinterpretation of information are highly prevalent, which are leading causes of inefficient nursing diagnosis (Quinlan-Colwell, 2017). Therefore, while conducting pain management diagnosis, the nursing profession should not rely solely on the patient’s verbal input but also observable non-verbal cues. That notwithstanding, the patient’s oral information should form a solid basis for the diagnostic findings and recommendations since it is the most important input source. The nursing professional should also consider all possible causes of the patient’s pain instead of jumping to conclusions based on previous experience or scanty evidence. The condition for which most of the patient’s verbal input, physical cues, and nurse’s insight points towards has a higher probability of being the correct diagnostic finding.
Ackley, B. J., Ladwig, G. B., Makic, M. B. F., Martinez-Kratz, M., & Zanotti, M. (2020). Nursing diagnosis handbook : An evidence-based guide to planning care (12th ed.). Elsevier.
Carpenito, L. J. (2016). Nursing Diagnosis. Lippincott Williams & Wilkins.
Gordon, M., & North. (2016). Manual of nursing diagnosis : including all diagnostic categories approved by the North American Nursing Diagnosis Association. Jones And Bartlett.
Kaplan, G., & Beech, D. (2015). Total recovery : solving the mystery of chronic pain and depression : how we get sick, why we stay sick, how we can recover. New York Rodale Books.
Kreiner, M., Okeson, J., Tanco, V., Waldenström, A., & Isberg, A. (2020). Orofacial Pain and Toothache as the Sole Symptom of an Acute Myocardial Infarction Entails a Major Risk of Misdiagnosis and Death. Journal of Oral & Facial Pain and Headache, 34(1), 53–60. https://doi.org/10.11607/ofph.2480
Lynda Juall Carpenito. (2017). Nursing diagnosis : application to clinical practice (15th ed.). Wolters Kluwer.
Managing pain. (2015). Reader’s Digest.
Mercadante, S. (2014). Managing Difficult Pain Conditions in the Cancer Patient. Current Pain and Headache Reports, 18(2). https://doi.org/10.1007/s11916-013-0395-y
Mohamed, A. (2016). Epigastric Pain in an AIDS Patient; a Case of Misdiagnosis. Journal of Gastroenterology, Pancreatology & Liver Disorders, 3(4), 01–02. https://doi.org/10.15226/2374-815x/3/4/00165
Monie, A. P., Fazey, P. J., & Singer, K. P. (2016). Low back pain misdiagnosis or missed diagnosis: Core principles. Manual Therapy, 22, 68–71. https://doi.org/10.1016/j.math.2015.10.003
Pallavee, P. (2015). Misdiagnosis of Abdominal Pain in Pregnancy: Acute Pancreatitis. JOURNAL of CLINICAL and DIAGNOSTIC RESEARCH. https://doi.org/10.7860/jcdr/2015/9003.5389
Quinlan-Colwell, A. (2017). A Multidisciplinary Multi-modal Approach to Managing Pain in Trauma Patients. Pain Management Nursing, 18(2), 68. https://doi.org/10.1016/j.pmn.2017.02.182
Stein, T. (2015). The everything guide to integrative pain management : conventional and alternative therapies for managing pain. Adams Media.
Twycross, A., Dowden, S., & Stinson, J. (2014). Managing pain in children : a clinical guide for nurses and healthcare professionals. John Wiley And Sons Ltd.
Yass, M. T. (2015). The pain cure Rx : the Yass method for diagnosing and resolving chronic pain. Hay House, Inc.