CNA · Activities of Daily Living · 7 min read
Comfort, Pain Relief, Rest and Sleep
- Identify verbal and nonverbal signs of pain and describe the nurse aide's role in measuring and reporting pain to the nurse.
- Describe physical comfort measures and non-pharmacological interventions that nurse aides provide within the care plan.
- Explain the components of evening care and identify environmental factors and sleep disruptions that must be reported to the nurse.
Understanding Pain and Pain Rating Scales
Pain is a deeply personal, subjective experience, which means that pain is whatever the resident says it is. Because each person feels and expresses discomfort differently, the resident is always the primary authority on their own comfort. Some CNA textbooks and facilities refer to pain as a fifth vital sign; follow facility procedures for asking about, recording, and reporting pain. When a resident experiences pain, it can alter their physical capabilities, emotional state, and overall quality of life. As a nurse aide, your role is to observe for discomfort, ask about it, listen to the resident, and report findings to the nurse promptly.
To help residents express how much pain they are feeling, healthcare teams use standardized rating tools. A zero-to-ten numeric scale is commonly used for residents who can understand and use numbers. On this scale, zero represents having no pain at all, while ten represents the most severe pain possible. When communicating with a resident who can use this scale, ask them to select the number that best matches their current discomfort level.
Not all residents are able to use a numeric scale, particularly those who have difficulty with abstract numbers or language processing. For residents who cannot use numbers but can understand the FACES scale, use it as directed by the nurse; observe and report signs of discomfort when a resident cannot self-report. The Wong-Baker FACES pain rating scale uses facial drawings to help residents identify their pain level. Ask the resident to point to the face that best shows how much they hurt, rather than how happy or sad they feel.
Nurse aides must always remember the strict boundaries of their role regarding pain relief. Nurse aides do not administer pain medications or adjust medication delivery pumps under any circumstances. If a resident requests pain medication, the nurse aide must relay the request to the nurse promptly. After a resident receives pain medication from the nurse, the nurse aide continues to play an important observational role: observe and report the resident's statements about relief and any noticeable changes in comfort or behavior.
Common mistakes
- Assuming a resident is comfortable simply because they do not verbally complain of pain, overlooking nonverbal cues like grimacing, clenching fists, or withdrawal.
- Raising bed side rails to prevent an anxious or restless resident from getting up without a specific order in the care plan.
- Applying warm or cold compresses independently or forgetting to check the skin frequently for redness and blisters during application.
- Ignoring loud snoring, gasping, or breathing pauses during sleep instead of reporting them promptly to the nurse.
Key points
- Pain is subjective, it is whatever the resident says it is, and some CNA textbooks and facilities call it a fifth vital sign; observe and report pain promptly to the nurse.
- As directed by the nurse, nurse aides ask residents who can use a numeric scale or the Wong-Baker FACES scale to indicate their pain level, then report the response and the resident's own description.
- Nonverbal indicators such as grimacing, moaning, restlessness, pacing, guarding, clenching fists, and sudden behavioral changes must be reported to the nurse.
- Comfort interventions include repositioning, supportive pillows, clean wrinkle-free linens, prompt incontinence care, oral care, gentle back rubs, warm blankets, and distraction.
- Nurse aides never give pain medications, adjust pumps, or apply hot/cold compresses without authorization; skin must be checked frequently during compresses for redness or blisters.
- Evening care (P.M. care) prepares the resident for sleep through toileting, washing face and hands, oral care, and clean, loose-fitting sleepwear.
- Promote rest by reducing hallway noise, dimming lights, offering light snacks or caffeine-free drinks if permitted, keeping the bed low, and reporting breathing pauses, nighttime wandering, or excessive daytime sleepiness.
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