As a professional or family caregiver, there are times when you may find yourself working with an individual who struggles with or cannot express pain or discomfort verbally. There are different reasons a person may not be able to express pain verbally. For example, individuals might be suffering from cognitive impairment (such as Dementia or Alzheimer’s), or a person with a traumatic brain injury may have trouble communicating. When these individuals are unable to express their pain, there is an imperative need to be able to identify possible pain indicators nonverbally. A common tool used in hospitals, nursing homes, and by in home care professionals and/or caregivers is the Checklist of Non-Verbal Pain Indicators. As noted on the indicator, this assessment tool is often used and proven with reliable and valid results in patients in critical care units and adults with dementia.
There are many examples of this checklist available for use (which may vary slightly in the language used on the form), but the indicators to look for are always the same: verbal expressions/vocal expressions, facial expressions, bracing, restlessness, and rubbing. A home care professional scores the client according to each indicator while at rest and while moving. Let’s take a closer look at each of the indicators, and what a caregiver will want to look for when determining pain level for a patient who is unable to respond verbally.
Verbal expressions of pain often present through the following: moaning, saying “ow”, groaning, grunting, crying, gasping, or sighing. A patient may or may not make movements while verbally expressing pain. If they are gesturing at a specific area and making any one of the verbal expressions, this can be a clear indicator that he or she is signifying to you that they have pain or suffering.
They say you can often read a lot about what a person is thinking by looking at their face, and similarly you can generally tell that a person is in pain or suffering when looking at their facial expressions. If a patient is grimacing or wincing, perhaps their brow is furrowed, or their lips are tightened and/or clenching their jaw, this is a good indicator that the person is in pain. He or she may make any of the previously mentioned verbal expressions in addition to the facial expressions.
Sometimes a person will brace themselves, clutching something nearby like bedside rails, or a table. A patient may clench their hands together and or possibly brace, rub, touch, or hold a specific area that is causing them discomfort. At other times they may simply be restless, constantly changing their position, moving their hands, or altogether unable to sit still. These indicators may present alone or combine with verbal expressions or facial expressions of pain.
It is important to clearly observe a patient when looking for nonverbal indicators of pain. The Checklist of Non-Verbal Pain Indicators, or CNPI is a useful tool to assess whether or not a person is in pain. The checklist is meant to observe the person at rest and with movement, and to help caregivers note which behaviors are observed. In doing so, you can isolate or identify pain in a non-verbal patient and supply the necessary help or support needed.
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