Procedure Checklist: PAIN ASSESSMENT AND BASIC COMFORT MEASURES*

ASSESSMENT
1. Identify the patient using two identifiers.
2. Obtained relevant data from the patient’s chart.
3. Assessed the patient’s/family caregiver’s health literacy.
4. Assessed patient’s knowledge, prior experience with pain management, and
feelings about procedure.
5. If patient can self-report, ask if the patient is in pain. Ask significant others if
they believe the patient is in pain. Select pain measures according to patient’s
ability to communicate. Use a comprehensive approach for patients who are non-
verbal. Use terms, such as hurt or discomfort, or use a professional interpreter if
language difference exists.
6. Perform hand hygiene and apply gloves. Examine site of patient’s pain or
discomfort; when possible: inspect for discoloration, swelling, or drainage;
palpate for change in temperature, area of altered sensation, painful area, or
areas that trigger pain; assess range of motion (ROM) of involved joints. When
assessing the abdomen, always auscultate first and then inspect and palpate.
7. When patient self-reported pain, assess the physical, behavioral, and emotional
signs and symptoms, including non-verbal indicators of pain.
8. Assess for decreased gastrointestinal (GI) motility, constipation, nausea and
vomiting.
9. Assess for insomnia, anorexia and fatigue.
10. Assess the character of pain (Acute or chronic); location/s of the pain, pain
history, pain quality, pain type, pain duration (intermittent, constant, or
breakthrough), and pain intensity. Follow agency policy regarding frequency of
pain assessment. Use the PQRST pain assessment guide in collecting information
about a patient’s pain experience.
a) Provocative/palliative factors: considered patient’s experience with
the over-the-counter (OTC) drugs (including herbals and topicals) or
exercises that have helped to reduce pain in the past.
b) Quality: use open-ended question
c) Region//radiation: Has patient use finger (if possible) to point out
areas of pain.
d) Severity: Use valid pain rating scale appropriate to the patient’s age,
language skills, developmental level, and comprehension. Ask the
patient to rate pain at rest, before any intervention, and when he or
she is moving or engaged in care activity. In the case of patients with
dementia or those who have no verbal skills, use observational pain
assessment scales.
e) Timing: Ask the patient how long the pain has been present and how
often it occurred.
f) Ask how pain affected the patient’s activities of daily living (ADLs),
work relationships and enjoyment of life.

11. Assess the patient’s response to previous pharmacological interventions,

especially the ability to function. Determine if any analgesic side effects were
likely based on medication and patient’s previous responses.
12. Assess for allergies to medications, with focus on analgesics.

PLANNING
1. Determine expected outcomes following completion of procedure.
2. Set pain-intensity goal with patient (when able).
 3. Provide privacy.
4. Prepared patient’s environment.
5. Explained procedures to be used for pain relief and how patient can be involved.
6. Provided educational materials to patient and family caregiver.

IMPLEMENTATION
1. Perform hand hygiene and apply clean gloves (if indicated).
2. Teach patient how to use appropriate pain rating scale. Explain range of intensity
scores and how they related to measuring pain.
3. Prepare and administer appropriate pain-relieving medications per health care
provider’s order.
4. Remove or reduce pain stimuli.
a) Help patient to turn and reposition to a comfortable position in good body
alignment.
b) Smoothed wrinkles in bed linens.
c) Loosened constrictive bandages (if appropriate to the to purpose of
bandage) or loosened or removed devices.
d) Repositioned underlying tubes and equipment.
e) Use pillows as needed for alignment and positioning support.
5. Teach patient how to splint over painful site using either a pillow or hand.
a) Explain the purpose of splinting.
b) Place pillow or blanket over site of discomfort and help patient place
hands firmly over area of discomfort. Option: splinted using hands only.
c) Had patient splint area firmly while coughing, deep breathing and turning.
6. Reduce or eliminate emotional factors that increase pain experiences. Use
biopsychosocial treatments: cognitive-behavioral and /or behavioral therapies.
a) Offer information that reduce anxiety.
b) Offer patient opportunity to pray (if appropriate).
c) Spend time to allow patient to talk about pain and answer questions.
Listen attentively.
7. Before leaving, make sure the patient is on a comfortable position.
8. Raised side rails (as appropriate) and lowered bed to lowest position.
9. If used, remove and dispose gloves. Perform hand washing.
10. Place nurse call system in an accessible location within the patient’s reach.

EVALUATION
1. Based on the agency’s reassessment criteria, reassess patient’s pain after comfort
measures, using pain-intensity scale.
2. Compare patient’s current pain with personally-set pain intensity goal.
3. Compare patient’s ability to function and perform ADLs before and after pain
interventions. Initiate a nurse-patient dialogue about the effect of pain-relieving
interventions on function and ability to perform ADLs.
4. Observe patient’s nonverbal behaviors. Implement validated observational pain-
assessment tool with patients who were unable to self-report.

RECORDING
1. Recorded character of pain before and after an intervention, the pain-relief
therapies used, whether pain relief was achieved, patient or family education
provided, and patient response to interventions.
2. Documented evaluation of patient learning.

HAND-OFF REPORTING
 1. Reported inadequate pain relief (not reaching goal), a reduction in patient
function, and side effects and adverse effects of both pharmacological and
nonpharmacological pain interventions.

*Potter & Perry et al. 2022. Skills Performance Checklists Clinical Nursing Skills and
Techniques. 10th Ed. Singapore.