Pain assessment in the forensic population

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I recall one time a Psychiatrist told me; “trust and believe in the psychiatric patient until that trust is broken”. That is very much paraphrased from the actual content of that conversation that occurred oh so many years but that has been a motto that I have used throughout my nursing career. To me this mean to treat the patient with respect, dignity and to value where they are at that moment.
That preamble leads me to pain assessment. JCAHO implemented their pain standards in early 2000 for multiple reasons two of which are; 1. customer satisfaction & 2. healthcare was doing a very bad job at assessing, and providing intervention for pain. My posture is; that in caring for the forensic mental health population we continue to not meet the basic premises of pain management. We judgmentally scoff that the patient is “drug seeking”, we discount that this recovering mentally ill person with co-morbid substance usage issues could ever legitimately have pain. On the flip side of that we dole out acetaminophen without the blink of an eye.
On one hand the “drug-seeking” patient no doubt has not been adequately assessed for acute or chronic pain and the acetaminophen-ingesting patient is probably just trying to obtain some attention.
I have a desire to make change in pain assessment and implementation of interventions at this organization where I work. I am a firm believer that health promotion and health maintenance are vital in the area of pain management and all too often we either ignore the patient or far to readily administer medication. I seek suggestions for the promotion of non-pharmacologic interventions, solid assessment techniques that are tried and proven, and any other insight into being a change agent in this area.

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