Nursing of vulnerable patients has changed dramatically in the past decades, according to Professor Patricia Schofield, RGN, PhD, PGDipEd, DipN, of Abertay University (UK).
Schofield, who co-chairs the 2019 IASP Global Year Against Pain in the Most Vulnerable, leads numerous research grants on pain, ageing, and dementia. Her most recent programs focus on developing strategies for patient self-management of chronic pain, new technologies to support older people at home, and pain assessment in patients with impaired cognition.
Here, Dr. Schofield answers questions about the evolution and role of nurses in reducing pain in vulnerable populations.
IASP: In 1989, you were appointed as one of the first pain specialist nurses in the United Kingdom. How have you seen the clinical field of pain management change for vulnerable populations in particular during the past 20 years?
Schofield: “There have been major changes since I was appointed into the field. For example, it is now recognized that babies do feel pain, people are increasingly aware that people with learning disabilities feel pain, and older adults and survivors of torture are being recognized as feeling pain. This is all due to the increased research in these areas being carried out by pioneers and advocates for such vulnerable groups.”
Have you seen the role of nurses change as the assessment and treatment of pain have moved to a more effective multidisciplinary approach, and if so, what impact do you think this has had?
“Nurses are at the frontline of patient care, and the improvements in education of nurses has seen them assessing and managing pain more effectively, whilst being strong advocates for their patients when representing them in the multidisciplinary team (MDT). New understanding of pain has seen the roles of the MDT being recognized and their contributions being highlighted as important. Nurses are stepping up to the plate in coordinating this MDT approach.”
For your PhD work, you studied the use of a Snoezelen environment for the management of chronic pain as a potential nursing strategy–in palliative care, in particular. Can you talk more about this approach, and whether and how it might be used to improve assessments and treatments of vulnerable populations?
“This approach was originally developed to be used for people with learning disabilities and advocates a calm and peaceful environment in which the individual can relax or interact. Distraction and relaxation are well-documented as [benefiting] individuals with pain or nearing the end of life.
“The Snoezelen or ‘sensory environment’ provides the music, lighting, comfortable furniture, and pleasant aromas all designed to distract or enhance that relaxation experience, helping the individual to focus away from the pain.”
Vulnerable patients such as children, older adults, individuals with learning and psychiatric disorders, and survivors of war and torture often have difficulty communicating their pain well enough to enable health providers to adequately assess and treat them. What types of skills and knowledge do you think are most important for nurses to use in these patient cases?
“Assessment of pain requires an awareness of the individual patient. The skills that nurses possess as part of their general training are a good start, coupled with knowledge and understanding of the pain mechanisms and psychophysiology and … an awareness of the arsenal of pain scales and how to use them.”