Nurses' assessment and management of pain at wound dressing changes

This case study examined the methods used by nurses to assess, manage and document pain at wound dressing changes. The sample consisted of four registered nurses working in acute surgical wards and the dermatology outpatient clinic at a large hospital. A theoretical framework was used to structure and focus the study. Data were collected through non-participant observation, semi-structured interviews and nursing documentation. Findings included the failure of nurses to assess patients' pain verbally or to use pain assessment tools. Reliance on nursing experience and non-verbal patient indicators of pain suggested inadequate assessment. Pharmacological agents were advocated to manage pain but were not used. Information was given to patients but no control over their pain was facilitated. Neither assessment nor management of pain at dressing changes was documented. Recommendations are suggested, including teaching strategies to develop a more sensitive approach which would include patient involvement in pain assessment before dressing changes, documented pain assessments and wider availability of nitrous oxide and oxygen (Entonox).