What Does A Rehabilitation Nurse in Pain Management Do?

Rehabilitation nurses play a critical role in assessing and managing acute and chronic pain. In this role, the rehabilitation nurse

• Serves as a coordinator of care and a patient advocate to facilitate a self-management plan
• Provides pain management information and educates patients and families to promote wellness, in order to improve functional abilities
• Has a clinical understanding of physiology, pathophysiology, psychosocial factors, and uses pharmacological and non-pharmacologic methods to prevent, identify, and alleviate pain
• May pursue additional education and certification in areas of pain management. Specialized advanced practice nursing roles in pain management can influence and educate best practices for rehabilitation nurses.

Definition of Pain Management for Rehabilitation Populations

The definition of pain (Mersky, 1979) adopted in 1986 by the International Association for the Study of Pain is ''an unpleasant sensory or emotional experience associated with actual or potential tissue damage." Pain is also "what the patient defines it to be" (McCaffrey, 1979). The rehabilitation nurse's role is to respond to those affected by pain with appropriate patient-centered interventions and compassion.

Establishing Goals for Pain Management

The goal of pain management for rehabilitation patients is to maximize the level of functioning and the quality of living. Roles and functions of the pain management rehabilitation nurse.

Settings

As pain addressed in settings throughout the continuum of care, rehabilitation nurses may play a role in pain management in any health care setting.

Competencies of a Rehabilitation Nurse in Pain Management

Nurse-Led Interventions

• Determine origin and type of pain (orthopedic, neurologic, surgical, musculoskeletal, etc.)
• Uses evidenced-based guidelines and standards for pain management in rehabilitation patient populations
• Appropriately administer pharmacologics by selecting appropriate analgesics and effective dosage schedules
• Implement noninvasive pain management modalities (massage, ice, heat, positioning, pressure or vibration, etc.)
• Implement holistic and homeopathic pain management strategies when appropriate (deep breathing, relaxation, distraction and imagery, music and pet therapy, acupuncture, and aromatherapy, etc.)
• Trend the patient's pain levels and responses to pain interventions – verbal and nonverbal reactions to pain management strategies

Promotion of Successful Living

• Establish rapport with patient to observe non-verbal and verbal pain cues
• Assist the patient to establish an acceptable pain goal to enable maximal function
• Coach the patient to effectively cope with the negative effects of pain
• Address the family's role in managing a patient's pain in the home environment
• Educate the patient and family on safe use of pharmaceuticals for pain management (e.g. side effects and management of constipation for opioid use)
• Provide recommendations for community reintegration activities, which may include return to work
• Coordinate the follow up plan to optimize the patient's care transition
• Offer resources for specialized pain management support services in the community

Leadership & Interprofessional Care

• Collaborate with the patient, family, and interprofessional team to establish patient-centered pain management goals
• Coordinate the plan of care to address barriers of pain and optimize patient carryover of learning from other disciplines (therapy, nutrition, respiratory, etc.)
• Anticipate pain control needs to maximize therapy activities (e.g. premedicate for therapy or wound care; ice or heat post-therapy)
• Advocate for the revision to the pain management plan if pain is not appropriately controlled

References

Association of Rehabilitation Nurses (2014). ARN Competency Model for Professional Rehabilitation Nursing. Chicago, IL.

Association of Rehabilitation Nurses (2014). Standards & Scope of Rehabilitation Nursing Practice, (6th ed.). Chicago, IL.

McCaffery, M. (1979). Nursing management of the patient with pain (2nd ed.), Lippincott, Williams & Wikins.

Merskey, H. (1979). Pain terms: a list with definitions and notes on usage. Pain Journal - Iss6. (pp. 249-252).

Monsivais, D.B. (2011). Acute and chronic pain. In C.S. Jacelon (Eds.). The Specialty Practice of Rehabilitation Nursing: A Core Curriculum. (Ch. 15. pp. 383-396) Glenview, IL: Association of Rehabilitation Nurses.

Nursing Association [and] American Society for Pain Management Nursing (2005). Pain Management Nursing: Scope and Standards of Practice. Silver Springs, MD: American.

This role description was originally developed by the Pain Special Interest Group of the Association of Rehabilitation Nurses in 2002. Subsequent revisions were made in 2011, 2015.