Medical Staff Knowledge & Attitudes

Pain Survey

 

 

 

 

Dartmouth-Hitchcock Medical Center

Lebanon, New Hampshire

 

 

 

 

 

 

Developed by:

Marie Whedon, RN, MS, AOCN

Hematology/Oncology Clinical Nurse Specialist

 


 

 

 

DARTMOUTH HITCHCOCK MEDICAL CENTER

Medical Staff Knowledge & Attitudes Pain Survey - Demographic Data

 

1. Age _____

2. Male [ ]1 Female [ ]2

3. Level of Professional Activity: (please check one)

[ ]1 Intern [ ]2 Resident [ ]3 Fellow [ ]4 Attending Staff

4. In what specialty are you certified or training? (please check one)

 

[ ]1 Anesthesiology

[ ]2 Vascular Surgery

[ ]3 General Surgery

[ ]4 Dental Surgery

[ ]5 Gynecologic Surgery

[ ]6 ENT Surgery

[ ]7 Neurosurgery

[ ]8 Orthopedic Surgery

[ ]9 Plastic Surgery

[ ]10 Cardiac & Thoracic Surgery

[ ]11 Urologic Surgery

[ ]12 Obstetrics

[ ]13 Other (specify)

5. How many years of experience do you have in caring for post-operative patients? (include graduate training) (please check)

[ ]1 0-5 [ ]2 6-10 [ ]3 11-15 [ ]4 16-20 [ ]5 21 or more

6. What proportion of your working week is spent attending to patients? (please check)

[ ]1<33% [ ]2 33-66% [ ]3 66-100%

7. How frequently are you involved in the management of post-operative pain? (please check)

 

[ ]1 almost never

[ ]2 less than once per week

[ ]3 several times each week

[ ]4 daily

[ ]5 more than once each day

8. Please rate the adequacy of the training you received in post operative pain management in each of the following settings (please check)

Setting

Poor

Fair

Good

Excellent

NA

Medical School

[ ]1

[ ]2

[ ]3

[ ]4

[ ]5

Residency elsewhere

[ ]1

[ ]2

[ ]3

[ ]4

[ ]5

Residency MHMH

[ ]1

[ ]2

[ ]3

[ ]4

[ ]5

Fellowship elsewhere

[ ]1

[ ]2

[ ]3

[ ]4

[ ]5

Fellowship MHMH

[ ]1

[ ]2

[ ]3

[ ]4

[ ]5


DARTMOUTH HITCHCOCK MEDICAL CENTER

Medical Staff Knowledge and Attitudes Pain Survey

1. Which one do you think is the most common problem with patients' reports of pain?

[ ]1 Failure to report pain. [ ]2 Understating the severity of pain. [ ]3 Exaggerating severity of pain.

2. In your experience, what percentage of post-operative patients actually achieves satisfactory pain relief?

[ ]1 0-25% [ ]2 26-50% [ ]3 51-75% [ ]4 76-100%

3. What is the most common problem resulting in inadequate pain management?

[ ]1 There is not an adequate dose of analgesic ordered.

[ ]2 There is not an adequate dose of analgesic administered.

[ ]3 Adequate analgesic is ordered/administered but the patient has excessive side effects.

4. To what extent would you agree that the following are barriers to the effective management of pain for post-operative patients at MHMH?

  Strongly Disagree Disagree Agree Agree Strongly
Patient reluctance to take analgesics [ ]1 [ ]2 [ ]3 [ ]4
Medical staff reluctance to prescribe analgesics. [ ]1 [ ]2 [ ]3 [ ]4
Nursing staff reluctance to administer analgesics. [ ]1 [ ]2 [ ]3 [ ]4
Excessive federal regulations about opioid prescription. [ ]1 [ ]2 [ ]3 [ ]4
Inadequate staff assessment of pain and pain relief. [ ]1 [ ]2 [ ]3 [ ]4
Inadequate staff knowledge of pain management principles [ ]1 [ ]2 [ ]3 [ ]4
Delayed staff response to patient's report of pain. [ ]1 [ ]2 [ ]3 [ ]4

5. In the management of post-operative pain, please indicate if you are familiar enough with each of the following medications to use them in your routine management of post-operative pain?

Morphine [ ]1 yes [ ]2 no Amitriptyline(Elavil) [ ]1 yes [ ]2 no
Meperidine (Demerol) [ ]1 yes [ ]2 no Ketorolac (Toradol) [ ]1 yes [ ]2 no
Hydromorphone (Dilaudid) [ ]1 yes [ ]2 no      
Fentanyl [ ]1 yes [ ]2 no      
Oxycodone compounds (e.g. Percocet/Percodan) [ ]1 yes [ ]2 no Codeine Compounds(e.g. Tylenol #3) [ ]1 yes [ ]2 no
Ibuprofin (Motrin) [ ]1 yes [ ]2 no      

9/95

6. In your practice, how much of a priority is the management of post-operative pain compared to other aspects of post-operative recovery?

[ ]1 Much less of a priority [ ]2 A lesser priority [ ]3 An equal priority

7. How comfortable are you in your ability to manage each of the following aspects of post-operative pain therapy?

  Not at all Slightly Moderately Extremely
Assessment of the cause of the pain. [ ]1 [ ]2 [ ]3 [ ]4
Assessment of the severity of the pain. [ ]1 [ ]2 [ ]3 [ ]4
Use of non-opioid analgesics for mild pain [ ]1 [ ]2 [ ]3 [ ]4
Management of somnolence or confusion in patients receiving opioids [ ]1 [ ]2 [ ]3 [ ]4
Managment of nausea in patients receiving opioids. [ ]1 [ ]2 [ ]3 [ ]4
Selecting a starting dose for post-operative analgesia [ ]1 [ ]2 [ ]3 [ ]4
Titrating the opioid dose in patients with poor pain control. [ ]1 [ ]2 [ ]3 [ ]4
Use of "rescue" doses [ ]1 [ ]2 [ ]3 [ ]4
Dose calculation when switching between the oral and parenteral routes of opioid administration. [ ]1 [ ]2 [ ]3 [ ]4
Management of opioid withdrawal symptoms [ ]1 [ ]2 [ ]3 [ ]4
Use of combinations of opioids and non-steroidals. [ ]1 [ ]2 [ ]3 [ ]4
Patient controlled analgesia. [ ]1 [ ]2 [ ]3 [ ]4  

8. Is there adequate CME on post-operative pain management available at DHMC? [ ]1 yes [ ]2 no

9. If there was a CME program on post-operative pain management available offered at DHMC, would you attend?

[ ]1 yes [ ]2 no Please suggest topics ______________________________________________________

10. How do the following patient responses influence your decision to initiate interventions for pain relief? Please rate each of the following:

 

  No Influence Small Influence Moderate Influence Great Influence
Facial expression [ ]1 [ ]2 [ ]3 [ ]4
Sleeping [ ]1 [ ]2 [ ]3 [ ]4
Vital signs [ ]1 [ ]2 [ ]3 [ ]4
Increased movement [ ]1 [ ]2 [ ]3 [ ]4
Decreased movement [ ]1 [ ]2 [ ]3 [ ]4
Patient report of pain using a pain measurement tool [ ]1 [ ]2 [ ]3 [ ]4
Family report of patient's discomfort [ ]1 [ ]2 [ ]3 [ ]4
Nurses report of patient's discomfort [ ]1 [ ]2 [ ]3 [ ]4
    No Influence Small Influence Moderate Influence Great Influence
11. To what degree has a recent personal experience with pain influenced your decisions about pain management? [ ]1 [ ]2 [ ]3 [ ]4

 

    No Influence Small Influence Moderate Influence Great Influence
12. To what degree has a recent experience with a family member in pain influenced your decisions about pain management? [ ]1 [ ]2 [ ]3 [ ]4

 

    Not at All Slighlty Moderate Extreme
13. When ordering narcotic analgesics, to what degree do the following inhibit your practice?        
  Too busy with other patients or duties. [ ]1 [ ]2 [ ]3 [ ]4
  Fear of opioid addiction. [ ]1 [ ]2 [ ]3 [ ]4
  Lack of knowledge about analgesics. [ ]1 [ ]2 [ ]3 [ ]4
  The desire to prevent/avoid side effects of analgesics. [ ]1 [ ]2 [ ]3 [ ]4

14. The goal of giving narcotic analgesics during the first 48 hours post-operative is to:

[ ]1 relieve the pain completely

[ ]2 relieve enough pain for the patient to function

[ ]3 relieve pain to a level at which the patient can just tolerate it

[ ]4 relieve as much pain as possible

15. The recommended route of administration of opioid analgesics to patients with brief, severe pain of sudden onset, e.g. trauma or post-operative pain is:

[ ]1 intravenous [ ]2 intramuscular [ ]3 subcutaneous[ ]4 oral

16. Your patient has used approximately 2mg IV Morphine/hr PCA over the last 24 hours. The patient is now tolerating oral medication. What dose of Percocet is considered equianalgesic?

[ ]1 2 Percocet Q4-6 hr[ ]2 1 Percocet Q4 hrs[ ]3 2 Percocet Q3-4 hrs [ ]4 1 Percocet Q6-8 hrs

17. Analgesics for post-operative pain should initially be given:

[ ]1 by the clock on a fixed schedule x 48 [ ]2 only when the patient asks for the medication

18. The most accurate judge of the intensity of the patient's pain is:

[ ]1 the treating physician [ ]3 the patient
[ ]2 the patient's primary nurse [ ]4 the patient's spouse or family

19. What is the incidence of addiction resulting from treatment of post-operative pain with opioid analgesics?

[ ]1 <1% [ ]2 1-5% [ ]3 6-25% [ ]4 >25%

20. The most likely reason for why a patient with post-op pain would request increased doses of pain medication is:

[ ]1 The patient is experiencing increased pain [ ]3 The patient is requesting more staff attention

[ ]2 The patient is experiencing increased [ ]4 The patient's requests are related to anxiety or depression addiction

Agree Disagree

21. The most common side effect of morphine is

respiratory distress.

      [ ]1 [ ]2  

22. Midazolam (Versed) provides rapid pain relief.

 

      [ ]1 [ ]2  

23. In equipotent doses fentanyl is more sedating than morphine.

      [ ]1 [ ]2  

24. When a patient receives intraspinal morphine at

the end of surgery IV morphine will usually

need to be limited for 12-18 hours.

      [ ]1 [ ]2  

25. Cutaneous stimulation techniques that may

reduce the intensity of pain include the

application of hot and cold compresses.

      [ ]1 [ ]2  

26. When cutaneous stimulation such as

cold or massage is used for

pain relief, it must be used in the area of pain.

      [ ]1 [ ]2  

27. Giving aspirin, acetaminophen or

non-steroidal anti-inflammatory agents,

along with other narcotics, is a logical method

of improving pain relief.

      [ ]1 [ ]2  

28. Research shows that promethazine (Phenergan)

is a reliable potentiator of narcotic analgesics.

      [ ]1 [ ]2  

29. Sleep or sedation can be equated with pain relief.

      [ ]1 [ ]2  

30. The potency of pain relief measures selected

for the patient should be determined based

on the type of surgery rather than on the

patient's report of pain intensity.

      [ ]1 [ ]2  

31. If the patient can be distracted from his pain

this usually means that he does NOT have

high pain intensity.

      [ ]1 [ ]2  

32. Comparable stimuli in different people produce

the same intensity of pain.

      [ ]1 [ ]2  

33. Non-drug interventions (e.g. heat, music,

imagery, etc.) are very effective for

mild-moderate pain control but are rarely

helpful for more severe pain.

      [ ]1 [ ]2  

34. Patients with a history of substance abuse should

not be given opioids for pain because they are

at high risk for repeated addiction.

      [ ]1 [ ]2  

35. Elderly patients cannot tolerate strong

medications such as opioids for pain.

      [ ]1 [ ]2  

36. Based on a patient's religious or cultural

beliefs, he/she may think that pain

and suffering is necessary.

      [ ]1 [ ]2  

37. After the initial recommended dose of

opioid analgesic, subsequent doses

are adjusted in accordance with the

individual patient's response.

      [ ]1 [ ]2  

38. Allowing patients to administer their own

pain medication (e.g., PCA) is a superior

way to provide analgesia.

      [ ]1 [ ]2  

39. If a patient is a clock watcher and asks

for his/her medication each time he/she

knows it's due, after several days of this

behavior, he/she is likely becoming addicted.

      [ ]1 [ ]2  

40. Elderly patients require less pain medication

to make them comfortable.

      [ ]1 [ ]2  

41. A pain rating scale (e.g. 0-10) is a reliable

method for patients to use to communicate

their pain intensity.

      [ ]1 [ ]2  

42. The patient with post-operative pain

should be encouraged to endure as

much pain as possible before resorting

to a pain relief measure.

      [ ]1 [ ]2  

 

Case Studies

Patient A: Andrew is 25 years old and this is his first day following abdominal surgery. As you enter his room, he smiles at you and continues talking and joking with his visitor. Your assessment reveals the following information: BP = 120/80; HR = 80; R = 18; on a scale of 0 to 10 (0 = no pain/discomfort, 10 = worst pain/discomfort) he rates his pain as 8.

43. On the patient's record you must mark his pain on the scale below. Circle the number that represents your assessment of Andrew's pain.

0 1 2   3 4 5 6 7 8 9 10

-----------------------------------------------------------------------------------------------

No pain/discomfort Worst pain/discomfort

44. Your assessment, above, was made two hours after he received morphine 2 mg IV. Half hourly pain ratings following the injection ranged from 6 to 8 and he had no clinically significant respiratory depression, sedation, or other untoward side effects. He has identified 2 as an acceptable level of pain relief. His current order for analgesia is Amorphine IV 1-3 mg q 1 hr PRN pain relief.@ Check the action you will take at this time:

____a1) Administer no morphine at this time.

____b2) Administer morphine 1 mg IV now.

____c3) Administer morphine 2 mg IV now.

____d4) Administer morphine 3 mg IV now.

____5) Other (explain) ________________________________________________________________

Patient B: Robert is 25 years old and this is his first day following abdominal surgery. As you enter his room, he is lying quietly in bed and grimaces as he turns in bed. Your assessment reveals the following information: BP = 120/80; HR = 80; R = 18; on a scale of 0 to 10 (0 = no pain/discomfort, 10 = worst pain/discomfort) he rates his pain as 8.

45. On the patient's record you must mark his pain on the scale below. Circle the number that represents your assessment of Robert's pain.

0 1 2   3 4 5 6 7 8 9 10

----------------------------------------------------------------------------------------------

No pain/discomfort Worst pain/discomfort

46. Your assessment, above, was made two hours after he received morphine 2 mg IV. Half hourly pain ratings following the injection ranged from 6 to 8 and he had no clinically significant respiratory depression, sedation, or other untoward side effects. He has identified 2 as an acceptable level of pain relief. His order for analgesia is Amorphine IV 1-3 mg Q1 hr PRN pain relief.@ Check the action you will take at this time:

____a1) Administer no morphine at this time.

____b2) Administer morphine 1 mg IV now.

____c3) Administer morphine 2 mg IV now.

____d4) Administer morphine 3 mg IV now.

____5) Other (explain) ________________________________________________________________

Med Staff Pain Survey.doc

September 1, 1995

 

 


DARTMOUTH HITCHCOCK MEDICAL CENTER *Answer Key

Medical Staff Knowledge & Attitudes Pain Survey - Demographic Data

* The unanswered questions are "attitudinal or opinion-institution-specific

1. Age _____

2. Male [ ]1 Female [ ]2

3. Level of Professional Activity: (please check one)

[ ]1 Intern [ ]2 Resident [ ]3 Fellow [ ]4 Attending Staff

4. In what specialty are you certified or training? (please check one)

 

[ ]1 Anesthesiology

[ ]2 Vascular Surgery

[ ]3 General Surgery

[ ]4 Dental Surgery

[ ]5 Gynecologic Surgery

[ ]6 ENT Surgery

[ ]7 Neurosurgery

[ ]8 Orthopedic Surgery

[ ]9 Plastic Surgery

[ ]10 Cardiac & Thoracic Surgery

[ ]11 Urologic Surgery

[ ]12 Obstetrics

[ ]13 Other (specify)

5. How many years of experience do you have in caring for post-operative patients? (include graduate training) (please check)

[ ]1 0-5 [ ]2 6-10 [ ]3 11-15 [ ]4 16-20 [ ]5 21 or more

6. What proportion of your working week is spent attending to patients? (please check)

[ ]1<33% [ ]2 33-66% [ ]3 66-100%

7. How frequently are you involved in the management of post-operative pain? (please check)

 

[ ]1 almost never

[ ]2 less than once per week

[ ]3 several times each week

[ ]4 daily

[ ]5 more than once each day

8. Please rate the adequacy of the training you received in post operative pain management in each of the following settings (please check)

Setting

Poor

Fair

Good

Excellent

NA

Medical School

[ ]1

[ ]2

[ ]3

[ ]4

[ ]5

Residency elsewhere

[ ]1

[ ]2

[ ]3

[ ]4

[ ]5

Residency MHMH

[ ]1

[ ]2

[ ]3

[ ]4

[ ]5

Fellowship elsewhere

[ ]1

[ ]2

[ ]3

[ ]4

[ ]5

Fellowship MHMH

[ ]1

[ ]2

[ ]3

[ ]4

[ ]5


DARTMOUTH HITCHCOCK MEDICAL CENTER

Medical Staff Knowledge and Attitudes Pain Survey

1. Which one do you think is the most common problem with patients' reports of pain?

[ ]1 Failure to report pain. [ ]2 Understating the severity of pain. [ ]3 Exaggerating severity of pain.

2. In your experience, what percentage of post-operative patients actually achieves satisfactory pain relief?

[ ]1 0-25% [ ]2 26-50% [ ]3 51-75% [ ]4 76-100%

3. What is the most common problem resulting in inadequate pain management?

[ ]1 There is not an adequate dose of analgesic ordered.

[ ]2 There is not an adequate dose of analgesic administered.

[ ]3 Adequate analgesic is ordered/administered but the patient has excessive side effects.

4. To what extent would you agree that the following are barriers to the effective management of pain for post-operative patients at MHMH?

  Strongly Disagree Disagree Agree Agree Strongly
Patient reluctance to take analgesics [ ]1 [ ]2 [ ]3 [ ]4
Medical staff reluctance to prescribe analgesics. [ ]1 [ ]2 [ ]3 [ ]4
Nursing staff reluctance to administer analgesics. [ ]1 [ ]2 [ ]3 [ ]4
Excessive federal regulations about opioid prescription. [ ]1 [ ]2 [ ]3 [ ]4
Inadequate staff assessment of pain and pain relief. [ ]1 [ ]2 [ ]3 [ ]4
Inadequate staff knowledge of pain management principles [ ]1 [ ]2 [ ]3 [ ]4
Delayed staff response to patient's report of pain. [ ]1 [ ]2 [ ]3 [ ]4

5. In the management of post-operative pain, please indicate if you are familiar enough with each of the following medications to use them in your routine management of post-operative pain?

Morphine [ ]1 yes [ ]2 no Amitriptyline(Elavil) [ ]1 yes [ ]2 no
Meperidine (Demerol) [ ]1 yes [ ]2 no Ketorolac (Toradol) [ ]1 yes [ ]2 no
Hydromorphone (Dilaudid) [ ]1 yes [ ]2 no      
Fentanyl [ ]1 yes [ ]2 no      
Oxycodone compounds (e.g. Percocet/Percodan) [ ]1 yes [ ]2 no Codeine Compounds(e.g. Tylenol #3) [ ]1 yes [ ]2 no
Ibuprofin (Motrin) [ ]1 yes [ ]2 no      

9/95

6. In your practice, how much of a priority is the management of post-operative pain compared to other aspects of post-operative recovery?

[ ]1 Much less of a priority [ ]2 A lesser priority [ ]3 An equal priority

7. How comfortable are you in your ability to manage each of the following aspects of post-operative pain therapy?

  Not at all Slightly Moderately Extremely
Assessment of the cause of the pain. [ ]1 [ ]2 [ ]3 [ ]4
Assessment of the severity of the pain. [ ]1 [ ]2 [ ]3 [ ]4
Use of non-opioid analgesics for mild pain [ ]1 [ ]2 [ ]3 [ ]4
Management of somnolence or confusion in patients receiving opioids [ ]1 [ ]2 [ ]3 [ ]4
Managment of nausea in patients receiving opioids. [ ]1 [ ]2 [ ]3 [ ]4
Selecting a starting dose for post-operative analgesia [ ]1 [ ]2 [ ]3 [ ]4
Titrating the opioid dose in patients with poor pain control. [ ]1 [ ]2 [ ]3 [ ]4
Use of "rescue" doses [ ]1 [ ]2 [ ]3 [ ]4
Dose calculation when switching between the oral and parenteral routes of opioid administration. [ ]1 [ ]2 [ ]3 [ ]4
Management of opioid withdrawal symptoms [ ]1 [ ]2 [ ]3 [ ]4
Use of combinations of opioids and non-steroidals. [ ]1 [ ]2 [ ]3 [ ]4
Patient controlled analgesia. [ ]1 [ ]2 [ ]3 [ ]4  

8. Is there adequate CME on post-operative pain management available at DHMC? [ ]1 yes [ ]2 no

9. If there was a CME program on post-operative pain management available offered at DHMC, would you attend?

[ ]1 yes [ ]2 no Please suggest topics ______________________________________________________

10. How do the following patient responses influence your decision to initiate interventions for pain relief? Please rate each of the following:

 

  No Influence Small Influence Moderate Influence Great Influence
Facial expression [ ]1 [ ]2 [ ]3 [ ]4
Sleeping [ ]1 [ ]2 [ ]3 [ ]4
Vital signs [ ]1 [ ]2 [ ]3 [ ]4
Increased movement [ ]1 [ ]2 [ ]3 [ ]4
Decreased movement [ ]1 [ ]2 [ ]3 [ ]4
Patient report of pain using a pain measurement tool [ ]1 [ ]2 [ ]3 [ ]4
Family report of patient's discomfort [ ]1 [ ]2 [ ]3 [ ]4
Nurses report of patient's discomfort [ ]1 [ ]2 [ ]3 [ ]4
    No Influence Small Influence Moderate Influence Great Influence
11. To what degree has a recent personal experience with pain influenced your decisions about pain management? [ ]1 [ ]2 [ ]3 [ ]4

 

    No Influence Small Influence Moderate Influence Great Influence
12. To what degree has a recent experience with a family member in pain influenced your decisions about pain management? [ ]1 [ ]2 [ ]3 [ ]4

 

    Not at All Slighlty Moderate Extreme
13. When ordering narcotic analgesics, to what degree do the following inhibit your practice?        
  Too busy with other patients or duties. [ ]1 [ ]2 [ ]3 [ ]4
  Fear of opioid addiction. [ ]1 [ ]2 [ ]3 [ ]4
  Lack of knowledge about analgesics. [ ]1 [ ]2 [ ]3 [ ]4
  The desire to prevent/avoid side effects of analgesics. [ ]1 [ ]2 [ ]3 [ ]4

14. The goal of giving narcotic analgesics during the first 48 hours post-operative is to:

[ ] 1relieve the pain completely

[X ]2 relieve enough pain for the patient to function

[ ]]3 relieve pain to a level at which the patient can just tolerate it

[X ]4 relieve as much pain as possible

15. The recommended route of administration of opioid analgesics to patients with brief, severe pain of sudden onset, e.g. trauma or post-operative pain is:

[X ]1 intravenous [ ]2 intramuscular []3 subcutaneous[ ]4 oral

16. Your patient has used approximately 2mg IV Morphine/hr PCA over the last 24 hours. The patient is now tolerating oral medication. What dose of Percocet is considered equianalgesic?

[ ]1 2 Percocet Q4-6 hr[ ]2 1 Percocet Q4 hrs[X ]3 2 Percocet Q3-4 hrs [ ]4 1 Percocet Q6-8 hrs

17. Analgesics for post-operative pain should initially be given:

[X ]1 by the clock on a fixed schedule x 48 [ ]2 only when the patient asks for the medication

18. The most accurate judge of the intensity of the patient's pain is:

[ ]1 the treating physician [X ]3 the patient
[ ]2 the patient's primary nurse [ ]4 the patient's spouse or family

19. What is the incidence of addiction resulting from treatment of post-operative pain with opioid analgesics?

[X ]1 <1% [ ]2 1-5% [ ]3 6-25% [ ]4 >25%

20. The most likely reason for why a patient with post-op pain would request increased doses of pain medication is:

[X ]1 The patient is experiencing increased pain [ ]3 The patient is requesting more staff attention

[ ]2 The patient is experiencing increased [ ]4 The patient's requests are related to anxiety or depression addiction

Agree Disagree

21. The most common side effect of morphine is

respiratory distress.

      [ ]1 [X ]2  

22. Midazolam (Versed) provides rapid pain relief.

 

      [ ]1 [ X]2  

23. In equipotent doses fentanyl is more sedating than morphine.

      [ ]1 [ X]2  

24. When a patient receives intraspinal morphine at

the end of surgery IV morphine will usually

need to be limited for 12-18 hours.

      [ X]1 [ ]2  

25. Cutaneous stimulation techniques that may

reduce the intensity of pain include the

application of hot and cold compresses.

      [ X]1 [ ]2  

26. When cutaneous stimulation such as

cold or massage is used for

pain relief, it must be used in the area of pain.

      [ ]1 [X ]2  

27. Giving aspirin, acetaminophen or

non-steroidal anti-inflammatory agents,

along with other narcotics, is a logical method

of improving pain relief.

      [X ]1 [ ]2  

28. Research shows that promethazine (Phenergan)

is a reliable potentiator of narcotic analgesics.

      [ ]1 [X ]2  

29. Sleep or sedation can be equated with pain relief.

      [ ]1 [X ]2  

30. The potency of pain relief measures selected

for the patient should be determined based

on the type of surgery rather than on the

patient's report of pain intensity.

      [ ]1 [ X]2  

31. If the patient can be distracted from his pain

this usually means that he does NOT have

high pain intensity.

      [ ]1 [ X]2  

32. Comparable stimuli in different people produce

the same intensity of pain.

      [ ]1 [X]2  

33. Non-drug interventions (e.g. heat, music,

imagery, etc.) are very effective for

mild-moderate pain control but are rarely

helpful for more severe pain.

      [ ]1 [X]2  

34. Patients with a history of substance abuse should

not be given opioids for pain because they are

at high risk for repeated addiction.

      [ ]1 [X]2  

35. Elderly patients cannot tolerate strong

medications such as opioids for pain.

      [ ]1 [X ]2  

36. Based on a patient's religious or cultural

beliefs, he/she may think that pain

and suffering is necessary.

      [X ]1 [ ]2  

37. After the initial recommended dose of

opioid analgesic, subsequent doses

are adjusted in accordance with the

individual patient's response.

      [X]1 [ ]2  

38. Allowing patients to administer their own

pain medication (e.g., PCA) is a superior

way to provide analgesia.

      [X]1 [ ]2  

39. If a patient is a clock watcher and asks

for his/her medication each time he/she

knows it's due, after several days of this

behavior, he/she is likely becoming addicted.

      [ ]1 [X]2  

40. Elderly patients require less pain medication

to make them comfortable.

      [ ]1 [X]2  

41. A pain rating scale (e.g. 0-10) is a reliable

method for patients to use to communicate

their pain intensity.

      [X]1 [ ]2  

42. The patient with post-operative pain

should be encouraged to endure as

much pain as possible before resorting

to a pain relief measure.

      [ ]1 [X]2  

 

Case Studies

Patient A: Andrew is 25 years old and this is his first day following abdominal surgery. As you enter his room, he smiles at you and continues talking and joking with his visitor. Your assessment reveals the following information: BP = 120/80; HR = 80; R = 18; on a scale of 0 to 10 (0 = no pain/discomfort, 10 = worst pain/discomfort) he rates his pain as 8.

43. On the patient's record you must mark his pain on the scale below. Circle the number that represents your assessment of Andrew's pain.

0 1 2   3 4 5 6 7 X8 9 10

-----------------------------------------------------------------------------------------------

No pain/discomfort Worst pain/discomfort

44. Your assessment, above, was made two hours after he received morphine 2 mg IV. Half hourly pain ratings following the injection ranged from 6 to 8 and he had no clinically significant respiratory depression, sedation, or other untoward side effects. He has identified 2 as an acceptable level of pain relief. His current order for analgesia is Amorphine IV 1-3 mg q 1 hr PRN pain relief.@ Check the action you will take at this time:

____a1) Administer no morphine at this time.

____b2) Administer morphine 1 mg IV now.

____c3) Administer morphine 2 mg IV now.

_X___d4) Administer morphine 3 mg IV now.

____5) Other (explain) ________________________________________________________________

Patient B: Robert is 25 years old and this is his first day following abdominal surgery. As you enter his room, he is lying quietly in bed and grimaces as he turns in bed. Your assessment reveals the following information: BP = 120/80; HR = 80; R = 18; on a scale of 0 to 10 (0 = no pain/discomfort, 10 = worst pain/discomfort) he rates his pain as 8.

45. On the patient's record you must mark his pain on the scale below. Circle the number that represents your assessment of Robert's pain.

0 1 2   3 4 5 6 7 X8 9 10

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No pain/discomfort Worst pain/discomfort

46. Your assessment, above, was made two hours after he received morphine 2 mg IV. Half hourly pain ratings following the injection ranged from 6 to 8 and he had no clinically significant respiratory depression, sedation, or other untoward side effects. He has identified 2 as an acceptable level of pain relief. His order for analgesia is Amorphine IV 1-3 mg Q1 hr PRN pain relief.@ Check the action you will take at this time:

____a1) Administer no morphine at this time.

____b2) Administer morphine 1 mg IV now.

____c3) Administer morphine 2 mg IV now.

__X__d4) Administer morphine 3 mg IV now.

____5) Other (explain) ________________________________________________________________

Med Staff Pain Survey.doc

September 1, 1995