title: Management of procedural pain: empowering nurses to care for patients through clinical nurse specialist consultation and intervention.
abstract: OBJECTIVE
  The purpose of this study was to assess the incidence of pain in inpatient and outpatient populations experiencing invasive procedures.
  
  
  BACKGROUND
  Nursing staff consulted the clinical nurse specialist regarding a patient they assessed who was not medicated appropriately and experienced significant procedural pain. As a result, a Procedural Pain Task Force was created to research the incidence of procedural pain and create evidence-based practice protocols.
  
  
  METHODS
  A convenience sample of 358 patients undergoing diagnostic or therapeutic invasive procedures (surgery excluded) was studied. Variables for analysis included demographic data, procedure type, medication, and perceived pain before, during, and after the procedures.
  
  
  RESULTS
  Patients who were not premedicated had lower mean pain scores (mean, 1.81) than patients who did receive medication before a potentially painful procedure (mean, 3.64). Age was negatively correlated with perceived pain; thus, the greater the patient age, the lower the pain score. Sex, premedication, and type of procedure were positively correlated with perceived pain scores. Sixty-three subjects reporting pain scores of 5 or greater during a procedure were further evaluated.
  
  
  CONCLUSIONS
  Results were used to develop procedural pain guidelines and a physician order set as well as a medication reference grid to assist clinicians in the management of procedural pain. Furthermore, nurses were empowered by the revised guidelines to advocate for relief of pain based on the nursing assessment.
authors.affiliation: Acute Pain Services, Miami Valley Hospital, Dayton, Ohio, USA. clrawe@mvh.org
authors.forename: Cheri
authors.initials: C
authors.lastname: Rawe
authors.forename: Cathy D
authors.initials: CD
authors.lastname: Trame
authors.forename: Gail
authors.initials: G
authors.lastname: Moddeman
authors.forename: Patricia
authors.initials: P
authors.lastname: O'Malley
authors.forename: Kathleen
authors.initials: K
authors.lastname: Biteman
authors.forename: Terri
authors.initials: T
authors.lastname: Dalton
authors.forename: Adrian
authors.initials: A
authors.lastname: Miller
authors.forename: Becky
authors.initials: B
authors.lastname: Sillaman
authors.forename: Shirley
authors.initials: S
authors.lastname: Walker
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000698:Analgesia / Q000379:methods / Q000706:statistics & numerical data; D019937:Diagnostic Techniques and Procedures / Q000009:adverse effects; D055317:Evidence-Based Practice / Q000458:organization & administration; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009720:Nurse Clinicians / Q000458:organization & administration*; D024802:Nurse's Role; D009730:Nursing Assessment; D017063:Outcome Assessment, Health Care; D010146:Pain / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D010147:Pain Measurement; D010348:Patient Care Team / Q000458:organization & administration; D017410:Practice Guidelines as Topic; D011292:Premedication / Q000379:methods / Q000706:statistics & numerical data; D017009:Professional Autonomy; D011367:Professional Staff Committees / Q000458:organization & administration; D012017:Referral and Consultation / Q000458:organization & administration*; D012720:Severity of Illness Index; D013812:Therapeutics / Q000009:adverse effects