Teaching presentations for use with

Integrating a Palliative Approach:

ESSENTIALS FOR PERSONAL SUPPORT WORKERS
Second Edition

by Katherine Murray
Edited by Ann-Marie Gilbert
Illustrations by Joanne Thomson©
Life and Death Matters©
Chapter 4 Supporting
Physical Comfort:
4D Pain
Remember, for all common symptoms

The role of the PSW is to:

1. Identify when a person is not
comfortable
2. Gather information, record and
report to the nurse/team
3. Implement comfort measures as
per care plan
Learning Outcomes
1. Explain that pain is a signal to the brain about tissue
damage, it is a whole person experience, and it is as
the person describes.
2. Demonstrate how to observe, gather, record and
communicate information about a person’s pain
using standardized tools, respecting cultural safety.
3. Discuss comfort measures to help alleviate pain
4. Identify medications that may alleviate pain.
Pain is a signal

Pain signals tell the brain that

tissues are damaged
• Pain is common with dying, because
tissues are deteriorating
• Pain is the most feared symptom of dying
“It’s not being dead but the dying
I fear”
What is pain?

Margot McCaffery - “Pain is whatever the person

says it is”

Dame Saunders identified the concept of “total

pain” as including physical, emotional, spiritual
and social parts of a person.
Pain is a whole person experience
Facts about pain
Pain is common in older adults
• Often musculoskeletal
• Nerve
• Pain from cancer

* Older adults at high risk for untreated pain because

they may not report or be able to report
Good pain management uses a team approach
PSWs Role:
• Observe and gather information about
changes that indicate the person is
uncomfortable
• Record and communicate with the team
PSWs Role
Barriers to providing pain management
Other people who may not receive pain management?

• A person with a hx of substance

• A person with cognitive issues
• A person whose cultural values restrict expression
of pain
• Underserved populations due to lack of location
access, other cultural barriers, and language
barriers
Pain management is part of providing culturally safe care

PSWs Role
• Be self-aware, avoid judging
• Address bias and racism
• Develop a trauma-informed approach for providing
care
Observe for indicators of pain
Facial expressions

Verbalizations and vocalizations

Body movements

Changes in interpersonal interactions

Changes in activity routines

Mental status changes

Pain behaviours may differ
Cultural values can affect how a person expresses
pain.
• It may be more difficult to observe behaviours that
indicate pain when a person’s cultural values affect
their expression of pain
Considering the person’s culture
What are the person’s cultural values
and beliefs?
Will their values and beliefs affect
their expression of pain or their
desire for pain treatment?
Consider the Indigenous Wellness Framework
PACSLAC II
The ESAS can indicate
the presence of
untreated, or
undertreated pain.
Using the Symptom Framework for PSWs
Quality – Can you describe the discomfort?
Region/Radiating - Use the body map
Severity – How severe is the pain?
Some people find it very difficult to identify
the severity of their pain
• Reassure the person that this is no
correct or incorrect answer.
• It is their perception of the pain that is
important.
What else?
What else do you want
me to know or do?
“Adapts
communication
and information
sharing…”
PAINAD
Determine presence or
absence of pain
• Does not assess
severity of pain
Repeated use identifies
changes in a person’s
status
When changes are observed
Record
• Describe how the behaviour is different from
normal
• Ask questions, if possible
PSWs role

• Observe
• Gather information
• Record
• Communicate with the
team
Comfort Measures
Preventive
1. Promote relaxed environment
2. Plan caregiving for when pain
medication is most effective
3. Position for comfort
4. Use mobility aids for safety
Positioning for Comfort
In the moment – comfort measures
Remember to individualize!
Distraction – chat, reminisce, watch video
Relaxation – massage, guided imagery,
music
Stimulation – heated flannel sheets, cold
cloths, lotions, massage,
position changes
Comfort Measures
For the Family
• Encourage participation

“What has worked in the past?”

• Prompt or guide as needed
Medications and Treatments
Follow
• Principles for Supporting Physical
Comfort
• Principles for Using Medications to
Support Physical Comfort
Palliation with medications
Pain medication
• Analgesics
• Adjuvants analgesics
Analgesics and Adjuvants
Adjuvants
Analgesics
Treat another symptom,
Treat pain secondary effect is
reducing pain

Non-opioids Steroids
Opioids
acetaminophen, NSAIDS
ibuprofen morphine, codeine
Antibiotics
Learning Outcomes
• Explain that pain is a signal to the brain about tissue
damage, it is a whole person experience, and it is as the
person describes.
• Demonstrate how to observe, gather, record and
communicate information about a person’s pain using
standardized tools, respecting cultural safety.
• Discuss comfort measures to help alleviate pain
• Identify medications that may alleviate pain.
Questions?
For more information

Visit www.lifeanddeathmatters.ca

Contact Kath at kath@lifeanddeathmatters.ca

Powerpoint™ Teaching Presentations to be used in conjunction with the text and workbook
“Integrating a Palliative Approach: Essentials for Personal Support Workers, Second Edition.”
Publisher: Life and Death Matters, 2020 All Rights Reserved ©