It is highly subjective to experience pain. Patients may experience it differently. Pain is defined by the International Association for the Study of Pain (ISAP) as “a sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.”
Despite its undesirable nature, pain serves an important physiological purpose. An important function of pain is to communicate certain stimuli and hazards, such as fire or piercing objects. Furthermore, pain often communicates internal illnesses in the body or their escalation. Pain sends this message to remind the patient to pursue medical care. Nursing staff and caregivers can observe pain in patients because the body responds to pain as a stress inducer.
Inadequate diagnosis
Multiple factors may contribute to the inefficiency of nursing diagnosis. Nursing diagnosis can be ineffective if the nurse’s superficial diagnosis does not match the final diagnosis. This violates the principle that the final diagnosis should be based on the patient’s assessment. In the case of a non-physical element like pain, nurses may use prior experience with pain to diagnose the present patient. The fact that pain is caused by multiple factors varies from patient to patient, so making the diagnosis based on an earlier incident or patient is likely to lead to a wrong diagnosis (Yass, 2015). Therefore, the patient should never be retrofitted to a diagnosis made before an assessment has been conducted. In response, the nurse should focus her attention on the pathophysiology of the disease process, which begins with an assessment of the patient.
As part of the patient’s assessment, information should be gathered so that it can be amalgamated and used to develop a diagnosis. Nursing staff may downplay a patient’s pain despite stressing the severity of the pain due to the invisibility of pain. Consequently, this situation results in oversight of the patient’s input (Twycross et al., 2014). This means that a nurse’s perception of a patient’s illness is influenced more by the diagnosis than by their intake. A diagnosis that ignores the patient’s input has a high likelihood of being incorrect because the patient’s input is a major source of information that can ensure a correct diagnosis.
Inadequate patient assessment
Improper patient assessment can also lead to inaccurate diagnoses. A nurse’s ability to diagnose an invisible condition like pain based on more direct sensory observations such as sight is greatly limited. The patient’s input is the most important guide to the diagnosis process in pain diagnosis. When assessing the patient, the nurse can determine important details such as the patient’s location, the intensity of the pain, and how it operates (Stein, 2015). The patient’s ability to significantly assess their pain determines whether a nursing diagnosis, including pain, will be successful or not. Assessing a patient should include questions such as whether he or she is experiencing pain, what they need to relieve the pain, and what they think is the most essential and urgent assistance (Monie et al., 2016). In addition to the patient’s history of painkiller use, the assessment questions should address the effect of painkiller use. When these questions are not asked, the nursing diagnosis is missing a significant source of information that can help localize the cause of pain and determine the best treatment approach.
Ineffective nursing diagnoses do not only miss these critical questions, but they also fail to notice the physical signs of pain and discomfort displayed by a patient. In addition to verbal input obtained from the patient, physical signs provide additional information. Grimacing and touching certain parts of the body are tell-tale signs of depression. If the nurse does not watch for these signs actively, she/he misses an opportunity to gain valuable information about the patient’s pain (Mohamed, 2016). A patient’s pain cannot be effectively described concisely, resulting in a far-fetched diagnosis that will have little effect. The presence of certain tell-tale signs can be extremely helpful when it comes to quantifying a patient’s pain and pinpointing its location on the body. In cases where the patient is verbally challenged, such as where they are old or disabled, it is crucial to observe the tell-tale signs of pain. It is also common for pain-causing diseases to lead to the inability to communicate verbally. Observation of signs of pain becomes the main method of diagnosing the patient’s pain in this circumstance.
The complexity of the Diagnostic Process
Ineffective nursing diagnoses can also be a result of complex diagnoses. Diagnostic procedures involve several steps and considerations. Symptoms of different diseases must be connected to a variety of possible causes without a one-to-one correlation between the signs and the causes. In a nursing diagnosis, therefore, a vast array of concerns and decisions need to be made in the face of often incomplete or non-descriptive symptoms. Due to this complexity, the wrong diagnosis may result, making the treatment ineffective. An inadequacy of nursing diagnosis is even more likely for a non-physical characteristic such as pain than for observable physical characteristics. Further decreasing the effectiveness of the diagnosis may be the high reliance on the patient’s explanation of his pain symptoms (Mercadante, 2014). Due to the likelihood of the patient supplying skewed, biased, or highly subjective information about their pain, this reduction in effectiveness occurs. Patient subjectivity leads to information being relayed that is not strictly factual, which results in incorrect and ineffective diagnosis.
In addition, the absence of a physical manifestation of pain may result in ineffective diagnosis when the patient provides input. A nurse may attribute this absence to the mildness of the pain-causing condition. The nurse may arrive at incorrect diagnostic findings if the patient also underrates the pain intensity due to being highly tolerant to such sensations (Managing pain., 2015). The existence of so many diseases and the limited number of symptoms of illness indicates how complex it can be to link a symptom with an illness. A headache, for instance, may be caused by a variety of factors ranging from solid sunshine to a brain tumour. It is because of this complexity that diagnosis is often difficult.
Numerous laboratory tests have been developed over time to reduce the likelihood of a wrong diagnosis. Through these tests, the cause of the symptoms can be determined. Clinical trials are, however, subject to many limitations. Some of these factors include the high costs associated with some laboratory tests, the time required for sample collection and testing, and the need to perform procedures like drawing blood that is not possible for every possible test. Due to this, most of the available tests are not practicable without the guidance of a medical professional. Diagnostic nurses recommend specific tests to be administered, which is a form of diagnosis in which the individual narrows down the scope of laboratory tests (Carpenito, 2016). Thus, only a small number of laboratory tests are usually performed, and they don’t reduce the complexity of the diagnostic process much. Diagnostic testing is also a step-by-step process that is prone to error at any point. In the event of an error at any point in the diagnostic process, the entire diagnosis is compromised and the chances of it being ineffective are strong.
Cognitive Errors
Even though cognitive errors are common in any line of work, they are particularly common in one as abstract as understanding another person’s pain. In cases where the patient has not adequately communicated their pain to the nurse, the nurse may make an incorrect diagnosis. It is especially common for nurses to make cognitive errors in pain management diagnosis when they do not pay close attention to the patient’s verbal and non-verbal cues. Additionally, in addition to assessing the patient orally, the nurse should also be highly attentive to any physical signals that the patient may give with regards to their pain (Gordon & North, 2016). These cues complement verbal information from the patient and allow the nurse to make a more informed diagnosis.
In addition to cognitive errors, misinterpreting the patient’s verbal or nonverbal input can cause nursing diagnosis errors. As an example, a nurse might interpret a patient’s apparent calmness as mild pain when it is more likely caused by acute pain, which limits motor activity. Misinterpretation can lead to inaccurate diagnosis. The fact that diagnostic results are derived from limited sources is an important factor that contributes to misunderstandings. There are times when the nurse jumps to conclusions without considering all associated aspects, largely because there might be another reason for the patient’s pain other than the first possible diagnostic finding (Lynda Juall Carpenito, 2017). Consequently, nurses should always strive to identify the underlying causes of symptoms rather than just the first one that appears, since some symptoms may be common to several illnesses.
Pain in the abdomen is an example of a symptom that is highly susceptible to ineffective diagnosis. A large percentage of patients with abdominal pain who were handled by nurses had problems with their gastrointestinal tract or urinary system leading to the pain. Because of this bias, the nurse may hurriedly form a conclusion based on what has happened before. The nurse jumps to the conclusion without a thorough investigation of the symptom, overlooking other possible causes of the pain, such as vascular and neurological conditions that are not as obvious as gastrointestinal issues (Pallavee, 2015). Cognitive errors are a major cause of nursing diagnosis errors. For pain management nursing diagnosis to minimize cognitive errors, it is necessary to take into account all possible causes to avoid overlooking less obvious but still possible causes.
When compared to other forms of diagnosis, pain management nursing diagnosis is ineffective because of the lack of technology to assess pain. In the absence of such technology, physicians have to rely solely on the patient’s diagnostic information, which can lead to misinterpretation of certain sensations (Kaplan & Beech, 2015). There are some cases in which patients report a toothache in the lower jaw when the pain is in fact in the upper jaw (Kreiner et al., 2020). This scenario causes the patient to be unable to distinguish between two locations that are very close. A diagnosis based on a nursing diagnosis might be ineffective if such limitations are present.
In conclusion, pain management nursing diagnosis is an intricate procedure that should be handled with absolute care by the nursing staff. It is more difficult to evaluate pain when compared to other diagnoses since it involves a nonphysical manifestation. Some nurses may find this manifestation abstract since they are used to seeing physical manifestations of illness. In pain diagnosis, a large portion is determined by the patient’s input, so errors in input and misinterpretations of information are frequently encountered, which are leading causes of ineffective nursing diagnosis (Quinlan-Colwell, 2017). For this reason, the nursing profession should not rely solely on the patient’s verbal input when diagnosing pain, but also consider the patient’s non-verbal cues. It should be noted, however, that the oral information provided by the patient should provide a solid foundation for the diagnosis and recommendations. Instead of jumping to conclusions based on previous experience or scant evidence, the nurse should consider all possible causes of the patient’s pain. Generally, the condition for which most of the patient’s verbal input, physical cues, and the nurse’s insights point to has a better chance of being the correct diagnosis.
References
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Carpenito, L. J. (2016). Nursing Diagnosis. Lippincott Williams & Wilkins.
Gordon, M., & North. (2016). Manual of nursing diagnosis : including all diagnostic categories approved by the North American Nursing Diagnosis Association. Jones And Bartlett.
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Kreiner, M., Okeson, J., Tanco, V., Waldenström, A., & Isberg, A. (2020). Orofacial Pain and Toothache as the Sole Symptom of an Acute Myocardial Infarction Entails a Major Risk of Misdiagnosis and Death. Journal of Oral & Facial Pain and Headache, 34(1), 53–60. https://doi.org/10.11607/ofph.2480
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Pallavee, P. (2015). Misdiagnosis of Abdominal Pain in Pregnancy: Acute Pancreatitis. JOURNAL of CLINICAL and DIAGNOSTIC RESEARCH. https://doi.org/10.7860/jcdr/2015/9003.5389
Quinlan-Colwell, A. (2017). A Multidisciplinary Multi-modal Approach to Managing Pain in Trauma Patients. Pain Management Nursing, 18(2), 68. https://doi.org/10.1016/j.pmn.2017.02.182
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