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Checklist of Nonverbal Pain Indicators (CNPI) Cheat Sheet by

assessment     nursing     caregiver     pain     nonverbal

Introd­uction

Many nursing home and homecare patients that are demented and mentally impaired are inadeq­uately treated for pain due to their inability to commun­icate effect­ively with their caregiver. Assessing and uncovering pain in demented patients is a challenge, requiring observ­ation of the nonverbal indicators (hints) exhibited by the patient indicating their are experi­encing pain.

Checklist of Nonverbal Pain Indicators

Beha­vior
With Movement
At Rest
1. Vocal compla­ints: nonverbal - Sighs, gasps, moans, groans, cries
2. Facial Grimac­es/­Win­ces: Furrowed brow, narrowed eyes, clenched teeth, tightened lips, jaw drop, distorted expres­sions
3. Bracing: Clutching or holding onto furniture, equipment, or affected area during movement
4. Restle­ssn­ess­:­Con­stant or interm­ittent shifting of position, rocking, interm­ittent or constant hand motions, inability to keep still
5. Rubbing: Massaging affected area
6. Vocal compla­ints: verbal - Words expressing discomfort or pain [e.g., "­ouc­h," "that hurts"]; cursing during movement; exclam­ations of protest [e.g., "­sto­p," "­that's enough­"]
SubT­otals (number of boxes checked in each column)
_____
_____
Total boxes checked (With Movement + At Rest)
 
_____

Scoring:

Leave the checkbox empty if the behavior was not observ­ed.
Check off (place a check) if the behavior occurred even briefly during activity or at rest.
Total = The total number of indicators (boxes checked) is summed for the behaviors observed at rest, with movement, and overall.
There are no clear cutoff scores to indicate severity of pain; instead, the presence of any of the behaviors may be indicative of pain, warranting further invest­iga­tion, treatment, and monitoring by the practi­tioner.
 

Universal Pain Scale

Nonverbal Pain Assessment Scale

Beha­vior
Obse­rved
Score
Verbal
Positive comments
0
 
Whimpe­r/moan
2-4
 
Repetitive comment, crying
5-7
 
Screaming
8-10
Body Movement
Moves easily
0
 
Neutral, shifting, pacing
5
 
Tense not moving
10
Facial
Smiling
0
 
Neutral
2-4
 
Frown, Grimace
5-7
 
Clenched teeth, depressed brow line
8-10
Touching
No touching
0
 
Rubbing, Patting
5
 
Clenched tight muscles
10
This tool (table) is based on a pain scale of 1-10 and is intended to be a guide, when assessing nonverbal pain and not a definitive pain intensity rating scale

Download the Checklist of Nonverbal Pain Indicators (CNPI) Cheat Sheet

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