Podcast: Intermediate

Pain assessment
by Marie McCullagh & Ros Wright

A Note taking
Nursing lessons WORKSHEET

1. As you listen, write T (true) or F (false) next to the statements below.

a. The headaches tend to start in the evening.

b. The patient is very sensitive to strong smells and bright lights.
c. The patient also gets a pain in her shoulders.
d. The headaches always last up to 12 hours.
e. The painkillers are non-prescription drugs.
f. The patient is able to identify the cause of the migraines.

2. Listen to the dialogue again and make notes under the following headings.

Characteristics Notes
Type of pain
Intensity
Onset (starts, first started, possible triggers)
Duration
Location

3. The nurse uses two types of questions in the dialogue, closed and open. Closed questions restrict the
possible answers that can be given. Open questions allow any answer to be given. Look at the two
examples below and decide which is the open and which is the closed question.

1 Nurse: So what you’re saying is that it’s different to bad headaches?

2 Nurse: So, what happens when you get a migraine?

Listen to the dialogue again and try to find more examples of open and closed questions. Use the
transcript to check your answers and to identify any others.

B Colloquial language

1. The patient uses a number of colloquial expressions. Match the phrases to the definition.

1. feeling slightly off a. to make one miserable

2. pretty mild b. not being your usual self
3. to feel quite drowsy c. to trigger
4. to pinpoint d. to be sleepy
5. the odd one e. not intense
6. set it off f. cause
7. bring it on g. occasional
8. get me down h. to identify
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Nursing lessons / Pain assessment / Intermediate

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 Podcast: Intermediate

Pain assessment
by Marie McCullagh & Ros Wright

C Communication focus
Nursing lessons WORKSHEET

In each of the sentences below the nurse is trying to achieve one of the following objectives:
a) confirm what the patient is saying
b) clarify what the patient is saying
c) summarise what the patient is saying

Match the objective with the sentence.

1. Nurse: What do you mean catch it in time?
2. Nurse: So, what you’re saying is that it’s different to bad headaches?
3. Nurse: So, it starts off as a scratching pain over your left eye, extends down your neck and gets more intense
after a while?

D Follow-up

Your teacher will give you a card. You will need to fill in the missing words from your research on the
follow-up in Part A.
With a partner, take it in turns to play the part of nurse and patient. As the nurse you will need to ask the
patient what their pain symptoms are and make a note of them.
Patient 1 (Cardiac arrest)
Characteristics Patient 1 (Cardiac arrest)
Type of pain ?
Intensity severe
Onset (first started) five hours before he/she was admitted
Duration intermittent – lasting 10-15 minutes
Location ?

Patient 2 (Pleurisy)
Characteristics Patient 2 (Pleurisy)
Type of pain ?
Intensity intense
Onset (first started) three days before admitted
Duration persistent
Location ?

E Optional activity: Pronunciation

Group the following words under the correct word stress pattern.

trigger prescription drowsy sensitive migraine

dietary symptoms record pharmacist scraping culprits
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 Worksheet: Intermediate

Pain assessment
by Marie McCullagh & Ros Wright

A Pre-reading
Nursing lessons worksheet

Think about how you describe pain in your own language. What sort of words and expressions do
you use?

B Key words

Fill the gaps in the sentences using these words from the text.

subjective intensity duration evaluate objective

articulate onset radiates excruciating tenderness

1. ______________________ is the amount of time something lasts.

2. A pain is ______________________ when you cannot bear it.

3. A description is ______________________ when it is based on the individual’s experience or perceptions.

4. A patient who is ______________________ is able to explain things very well.

5. The ______________________ of a pain is when it begins.

6. A pain ______________________ when it spreads out from a central point.

7. The ______________________ of a pain describes the degree to which the patient feels it.

8. In order to ______________________ a patient’s pain, a nurse needs to know its characteristics.

9. Being ______________________ means relying on facts, rather than personal beliefs or feelings.

10. ______________________ on part of the body is when it is sore or uncomfortable to touch.

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Nursing lessons / Pain assessment / Intermediate

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 Worksheet: Intermediate

Pain assessment
by Marie McCullagh & Ros Wright

Pain assessment
Nursing lessons worksheet

Assessing pain can be complicated as the physical and physiological

aspects of the patient all need to be considered. Because the experience
of pain is very subjective, the nurse needs to be able to use some
objective criteria to evaluate the location, nature and intensity of the pain
so a diagnosis can be made. One of the most widely accepted definitions
of pain was put forward by McCaffery (1979, p.18), who suggests that
pain is ‘whatever the experiencing person says it is and exists whenever
he says it does’.

Assessments of the patient’s pain experience

When identifying the characteristics of the patient’s pain it is essential the nurse considers
the following:

• The type of pain: is it crampy, stabbing, sharp? The patient’s description of the pain may help
in diagnosing its cause. Myocardial (heart) pain is often described as stabbing, but liver pain as
cramping or aching.

• Its intensity: is it mild, severe or excruciating? This can be described by using a pain
assessment scale. The nurse asks the patients to rate the pain on a scale of 0 to 10; zero
being no pain and 10 being excruciating pain. With children, a range of pictures showing a child
changing from happy to sad can be used. Colour charts with a series of colours from black
through grey to yellow and orange can be used, especially with patients who have difficulty
grasping numbers or articulating exactly what their pain is like.

• The onset: was it sudden or gradual? Find out when it started and in what circumstances. What
makes it worse? What makes it better? What was the patient doing immediately before
it happened?

• Its duration: is it persistent, constant or intermittent?

• Its location: ask the patient to be as specific as possible, for example, indicating the site
by pointing.

• Changes in the site: there may be tenderness, swelling, discolouration, firmness or rigidity. With
appendicitis, a classic sign is the movement of pain to the right and downwards. In a myocardial
infarction (a heart attack), pain classically radiates down the arm, and with liver pain it can
radiate to the shoulder.

• Any associated symptoms: Some of the common symptoms of disease that can influence the
response to pain are anorexia, constipation, cough, inflammation, anxiety and fear, dryness of
the mouth.

• Signs such as redness, swelling or heat.

Adapted from Foundations of Nursing Practice (3rd Edition), edited by Richard Hogston and Barbara A.
Marjoram: Palgrave Macmillan (2008). Reproduced with permission from Palgrave Macmillan.
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Nursing lessons / Pain assessment / Intermediate

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 Worksheet: Intermediate

Pain assessment
by Marie McCullagh & Ros Wright

C Comprehension check
Nursing lessons worksheet

Read the text below and write T (true) or F (false) next to each of the statements.

1. Assessing pain is a straightforward process.

2. Pain is an objective experience.
3. It is important for a nurse to use objective criteria to measure the level of pain.
4. Colour ‘mood’ charts are only useful for children.
5. The first step for a nurse is to identify characteristics of the patient’s pain.

D Vocabulary development

1a. On the line below there are some words which describe the effect of pain on a patient. Group the
words in the word wheels under the appropriate headings.

dull excruciating intense intolerable

stabbing mild tolerable

bearable unbearable
________________ ________________
________________ ________________
________________ ________________
________________

1b. Match the following expressions of duration with the equivalent phrase.

constant not often

frequent all the time
intermittent keeps coming back
persistent often
infrequent from time to time

2. Some words which describe pain also have a more general meaning in English. Match the adjectives to
the pictures.

shooting gnawing stabbing burning stinging

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Nursing lessons / Pain assessment / Intermediate

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 Worksheet: Intermediate

Pain assessment
by Marie McCullagh & Ros Wright

E Discussion
Nursing lessons worksheet

Can you see any similarities and differences between the description of pain in your own language and
descriptions in English you have seen here?

F Follow-up

Use a search engine or a reference book to look up the symptoms of the following conditions. Make a note
of the kind of pain associated with each of them. Keep a record of where you have found the information.

• Heart attack (Myocardial Infarction)

• Cystitis
• Migraine
• Pleurisy

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Nursing lessons / Pain assessment / Intermediate

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