Event 5: Interdisciplinary Pain Center Assessment

Medical Assessment

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Cross-Cultural Considerations

Who does Ava talk to about health concerns before she goes to the doctor/clinician?

Does Ava feel comfortable with her OB? Does she have any special worries regarding the pregnancy?

What does Ava;s husband think? Is there any strain on their dynamic? Is he tuned in or out?

What prompted Ava to come in today? Did she talk to her mother or husband before coming in?

What does AVa try before she goes to the doctor? (E.G.: home remedies, etc.)

“What do you think is going on?”

Nursing Assessment Considerations

1. Access to Healthcare
2. Gaining entry into the health care system
3. Getting access to sites of care that attend to health care needs
4. Finding providers who meet individualized patient care needs and who also can develop a relationship based on mutual trust and communication

Consideration for Access

• Accessible? Location, easy to get to, free parking, on a mass transit line
• Acceptable? Patient-centered care, culturally competent, pleasant receptionist/nurses/medical assistant, open and respectful dialogue with provider
• Affordable? Accepts a range of insurance plans, standard versus sliding scale co-pay, can the patient afford health care?
• Timely? Delay in receiving services once the need is identified, the time spent waiting

Activities of Daily Living (ADLs)

Ability to:

1. Bathe self
2. Dress self
3. Toilet self
4. Feed self
5. Ambulate
6. Maintain continence

Instrumental Activities of Daily Living (IADLs)

• Ability to use the telephone
• Ability to shop
• Ability to perform food preparation
• Ability to complete housekeeping
• Ability to do laundry
• Ability to drive
• Ability to take own medications
• Ability to handle finances

Caregiver Roles

• In families, caregiving tasks typically fall to the daughter(s)
• Caregiving tasks may include:
  • ADLs (any/all six)
  • IADLs (any/all eight)
  • Medical/Nursing tasks of care
  • Maintaining safety
  • Companionship
• Role demands in addition to the caregiving role
  • Raising children
  • Home maintenance
  • Employment outside of the home
  • Civic obligations
  • Maintaining intimacy with spouse/partner

Patient Safety

Intimate Partner Violence is associated with:

• Chronic pain syndromes
• Delayed prenatal care
• Preterm delivery
• Pregnancy difficulties (low birth weight, perinatal deaths)
• Unintended pregnancy

The Danger Assessment consists of 20 questions and identifies risk factors that have been associated with increased risk for homicide

Women are asked to indicate approximate date(s) during the past year in which they were abused by their partner/ex-partner

• Slapped, pushed; no injuries or lasting pain
• Punched, kicked; bruises, cuts and/or continued pain
• “Beaten up”; severe contusions, burns, broken bones
• Threats to use weapon; head injury, internal injury, permanent injury
• Use of weapon; wounds from weapon

Test Your Knowledge

True or false? Nearly one in four women over the age of 18 have experienced physical violence by an intimate partner.

Clinical Psychology Assessment

Stressors and Risk Factors

• Depression is found in 8%-50% of chronic pain patients.
• Anxiety and/or depression exacerbate pain outcomes.
• Pain-related anxiety is associated with greater genito-pelvic pain intensity 3 months postpartum.
• Catastrophizing is a robust predictor of negative pain-related outcomes.
• Catastrophizing: rumination, magnification, and helplessness
• Catastrophizing is a risk factor for negative mood and vice-versa

Cultural Considerations

• Pain and pain management throughout the course of labor is a major topic.
• Cultural awareness of the interpretation of pain experience across cultures is an important factor.
• Personal bias is important to consider.
  • Healthcare providers need to be aware of their personal beliefs regarding pain and pain management.
  • It’s important not to impose one’s values on patient.
• It’s important for healthcare providers to be aware of cultural differences and attitudes toward the use of pain-relief strategies.

Pain and Sleep

• Sleep disturbance and pain are interrelated.
  • Upwards of around 80% of chronic pain patients experience sleep disturbance.
• Poor sleep results in increased pain sensitivity/amplified nociceptive response to noxious and non-noxious stimuli.
• Pregnancy-related physiologic changes may negatively impact sleep.
• Sleep continuity disruption is common.
• Sleep should always be assessed.
• Improved sleep has been associated with improvement in clinical pain.

Pharmacy

Medication Safety

1. Right patient
2. Right medication
3. Right dose
4. Right time
5. Right route
6. Right (appropriate) storage

Insurance needs

1. Does the patient have insurance?
2. What is covered by the plan?
3. Can she afford the co-pay?
4. Are prior authorizations needed for certain medications?
5. What services might she be eligible for?
6. Contributes to adherence.

Health Literacy

• Determinant of adherence
• Impacts health care outcomes and increases healthcare costs

Reference

Duell P, Wright D, Renzaho AM, et al. Optimal health literacy measurement for the clinical setting: A systematic review. Patient Educ Couns. 2015; 98:1295-1307.

New Vital Sign (NVS)

• Assessment case: Nutrition label for ice cream
• 3 minutes to administer
• Assessing comprehension and numeracy

Test of Functional Health Literacy in Adults – short version (S-TOFHLA)

• Reading comprehension
• No numeracy
• 7 minutes to administer Adherence

Assess health care literacy

• Adding questions such as, “Who writes out the information?”
• How does the patient like to receive information?
  • Visual, written, oral
• Teach back model
  • Restate what was just explained to them.
• Ask me 3
  • “What is my main problem?”
  • “What do I need to do?”
  • “Why is it important for me to do this?”
• Medication education, management, and counseling
  • Often waived by patients
• Telephone follow-ups
  • Literature support
• Text messaging
• Mobile applications
• Patient support programs
  • Literature support
• Motivational interviewing

Test Your Knowledge: Pharmacy Assessment

Which of the following is not one of the ‘rights’ of medication safety?

Rehabilitation

Assessment

Some pain provocation tests can be self-administered including:

• Painful palpation of the pubic symphysis
  • Sensitivity: 0.96; Specificity: 0.85
• MAT Test
• While standing, the woman performs a movement of hip abduction and adduction simulating the movement to pull a floor mat
• POSITIVE test if pain is reproduced in the symphysis pubis area
• Sensitivity: 0.85; Specificity: 0.89

Reference

Fagevik Olsen M. Gutke A, Elden H, et al. Self-administered tests as a screening procedure for pregnancy-related pelvic girdle pain. Eur Spine J. 2009; 18:1121-1129.