N.C., a 21-yr-old African American man, presents to the ED in sickle
cell crisis reporting excruciating pain. He is known to several of the
nurses and HCPs in the ED. A nurse remarks to you that it must be
time for his “fix” of pain drugs.
Ethical/Legal Points for Consideration
• The standard of care for pain management requires that (1) a pain
assessment is done based on the patient’s self-report, (2) the best
possible relief of pain is provided under the circumstances, and
(3) competent and compassionate care is provided to all patients.
• The pain assessment also includes reviewing the patient’s
medical record to determine if there are health care issues or
conditions (e.g., frequent ED visits to request pain medication)
that may affect the patient’s response to pain and pain
• You have a duty to notify the HCP of those issues or conditions.
Document patient behaviors related to pain management. Be
objective (factual observations) rather than subjective, such as
labeling (“the patient is in withdrawal”).
• When pain relief is inadequate, you must notify the HCP. Make
sure the HCP has assessed the patient and based the plan of care
on that assessment.
• Somnolence assessment is essential as part of your pain
1. How can you teach your peers about pain assessment and
2. What factors do you need to include in your assessment and
management of N.C.?
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