Pain Competency Self-Assessment
Pain Competency Self-Assessment
Name:
Competency outcome 1: The student appropriately performs and documents pain screenings, assessments, and reassessments.
Competency outcome 2: The student teaches the patient and family about pain control.
Competency outcome 3: The student collaborates with the patient, the family, and the healthcare team to develop a pain management plan and define pain relief goals.
| Competencies 1–3 | Competent Y or N | |
| Asks all patients, in initial evaluation and routinely as part of a health assessment, about the presence of pain | ||
| If pain is present, assesses critical characteristics, including location, quality, intensity, temporal characteristics, alleviating and aggravating factors, impact of pain, past interventions, and responses | ||
| Utilizes simple and reliable pain intensity scales appropriate to age and cognitive status | ||
| Teaches patients how and when to report pain, including side effects or adverse effects of pain treatment, roles in helping to manage pain, realistic pain relief goals, and how to utilize pain interventions | ||
| Discusses realistic goals with patients | ||
| Communicates and collaborates appropriately with physician, team members, unit pain resource nurse, inpatient pain consult services, acute pain service, anesthesiology, and others | ||
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Competency outcome 4: The student safely and effectively administers a pain treatment plan (including pharmacologic and nonpharmacologic interventions).
| Competency 4 | Competent Y or N | ||
| Administers prescribed analgesics as appropriate (combinations of analgesics, scheduled versus prn, and titration to meet individual needs) Pain Competency Self-Assessment | |||
| Assesses patients’ responses to interventions and documents reassessments within the time frame indicated by the unit’s pain procedures | |||
| Proactively manages side effects of opioid analgesics | |||
| Utilizes a variety of nonpharmacologic strategies to promote pain relief, including distraction, relaxation, imagery, massage, heat, cold, and positioning | |||
Competency outcome 5: The student accurately programs and utilizes a patient-controlled analgesia (PCA) pump.
| Competency 5 | Competent Y or N | ||
| Demonstrates setup and use of designated IV pump | |||
| Follows policy and procedure when caring for patients with IV PCA, including appropriate documentation on pain infusion flow sheet |
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| Defines and recognizes opioid-induced respiratory depression and implements appropriate interventions | |||
