Promoting Client Well-

Being, Pain
Management, and Sleep

PW 1113
LA Week 4

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 Promoting Client Well-Being
 Providing good care requires a holistic approach:
 Support workers play a key role in promoting the well-being
of clients by understanding their psychosocial needs and
knowing ways to help them feel safe, comfortable, and
relaxed.
 Psychosocial health is well-being in the social, emotional,
intellectual, and spiritual dimensions.

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 Promoting Client Comfort and Well-
Being (1 of 6)

 Comfort is a feeling of contentment.

 The client has no physical or emotional pain.
 The client is calm and at peace.
 Comfort is affected by:
 Age, illness, and activity
 Temperature, ventilation, noise, odours, and lighting

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Promoting Client Comfort and Well-Being
(2 of 6)
 Temperature and ventilation
 Most healthy people are comfortable when the room
temperature is between 20–23C (68–74F)
 Infants, older persons, and people who are ill may need higher
temperatures for comfort
 To protect infants, older persons, and people who are ill
from drafts:
 Make sure they wear the proper clothing.
 Offer lap robes to those in chairs and wheelchairs.
 Provide enough blankets for warmth.
 Cover them with bath blankets when giving care.
 Move them away from drafty areas.

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Promoting Client Comfort and Well-Being
(3 of 6)
 Many odours occur in health care agencies
 Bowel movements, urine, draining wounds, and vomitus create
embarrassing odours.
 Odours from body, breath, perfume, and smoking may offend
others.
 Smoke odours present special problems.
 Clients, residents, and staff must follow agency policy.
 If you smoke, practise handwashing after handling smoking materials
and before giving care.
 If you smoke, give careful attention to your uniform, hair, and breath.
 Good care, ventilation, and housekeeping practices help prevent
odours.

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Promoting Client Comfort and Well-Being
(4 of 6)
 Noise
 Clients who are ill and many older clients are sensitive to
noises and sounds.
 Clients want to know the cause and meaning of new sounds
(unknown noise may cause fear).
 To decrease noise:
 Control your voice.
 Handle equipment carefully.
 Keep equipment in good working order.
 Answer phones, signal lights, and intercoms promptly.

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Promoting Client Comfort and Well-Being
(5 of 6)
 Lighting
 Good lighting is needed for safety and comfort.
 Adjust lighting to meet the client’s changing needs.
 Always keep light controls within the client’s reach.
 This protects the client’s right to personal choice.
 Some clients may request night lights or want TVs left on
all night.

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Promoting Client Comfort and Well-Being
(6 of 6)
 Feelings of safety
 Minor illness can cause fear and anxiety.
 Clients must feel protected.
 Clients may be fearful of procedure, equipment, or
pain or discomfort.
• Client must understand the procedure:
 Why is it being done?
 Who will do it?
 How will it be performed?
 What feelings/sensations should be expected?

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 Pain
 Pain or discomfort means to ache, hurt, or be sore.
 Comfort and discomfort are subjective.
 You must rely on what the person says.
 Pain is personal.
 If a person complains of pain or discomfort, the person has
pain or discomfort.
 Body language can often reveal if a client is feeling
discomfort or pain (if client is unable to verbalize).

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 Pain and Its Impact on a Client’s Well-
Being

 The total person is affected by comfort, rest, and sleep

problems.
 Discomfort and pain:
 Can be physical, emotional, social, or spiritual
 Affect rest and sleep
 Decrease function and quality of life
 May not be reported—client may think these experiences
are a normal part of aging

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 Types of Pain
 Acute pain
 Is felt suddenly from injury, disease, trauma, or surgery;
usually lasts less than 6 months
 Chronic pain
 Lasts longer than 6 months
 Radiating pain
 Is felt at the site of tissue damage and in nearby areas
 Referred pain
 Is felt in a part of the body separate from the source of pain
 Phantom pain
 Is felt in a body part that is no longer there

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Factors Affecting Pain (1 of 2)
 Many factors affect pain:
 Past experience
 Knowing what to expect can help or hinder how the client
handles pain.
 Anxiety
 Pain can cause anxiety.
 Anxiety increases how much pain the client feels.
 Reducing anxiety helps lessen pain.
 Rest and sleep
 Rest and sleep restore energy.
 Pain seems worse when the person is tired or restless.

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Factors Affecting Pain (2 of 2)
 Attention
 The more a person thinks about the pain, the worse it seems.
 The meaning of pain
 Pain means different things to different people.
 Support from others
 Pain is easier to deal with when family or friends offer comfort
and support.
 Culture and Age
 See textbook box: Respecting Diversity: Cultural Aspects of
Pain
 See textbook box: Focus on Older Persons: Pain Reactions

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Understanding the Signs and Symptoms
of Pain (1 of 2)
 Clients may verbalize their pain, or they may indicate
pain through their body language and behaviour.

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Understanding the Signs and Symptoms
of Pain (2 of 2)
 If the client is verbal, the support worker should report and
record using PQRSTU:
 P (Provoking cause) – what factors are causing the pain?
 Q (Quality of pain) – type and intensity of pain using visual tools
 R (Region of pain and if it radiates anywhere) – where is the
pain?
 S (Severity of the pain)- how uncomfortable a client is feeling?
 T (Timing of the pain) – duration of pain
 U (The client’s understanding of the pain) – does client
understand the cause of pain?

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 Determining Pain in Clients Who Cannot
Communicate

 Clients who live with dementia may not be able to

communicate.
 Accurate observation and assessment skills must be
utilized to determine if the client is comfortable.
 Use tools, such as Pain Assessment in Advanced
Dementia Scale (PAINAD).

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 Slide
17

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 Pain Reactions (1 of 2)
 Pain reactions in children
 Children dealing with pain may not understand pain
because they have had few experiences with it.
 Caregivers must be alert for behaviours and situations that
signal pain in children.
 Use tools, such as Northern Pain Scale for children.

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Pain Reactions (2 of 2)

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 Measures to Relieve Pain
 Nursing measures to relieve pain:
 The nurse uses the care planning process to promote
comfort and relieve pain.
 Other measures include distraction, relaxation, and guided
imagery.
 Distraction means to change the client’s
centre of attention.
 Relaxation means to be free from mental and
physical stress.
 Guided imagery is creating and focusing on an
image.

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 Rest and Sleep (1 of 6)
 To be rested means to be calm, at ease, relaxed, and
free from anxiety or stress.
 You promote rest by meeting basic needs:
 Meeting thirst, hunger, and elimination needs
 Helping to relieve pain or discomfort
 Providing a comfortable position and good alignment
 Providing a quiet setting
 Providing a clean, dry, and wrinkle-free bed
 Providing a clean, neat, and uncluttered room

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 Rest and Sleep (2 of 6)
 Unmet love and belonging needs can also affect rest.
 Visits or telephone calls from friends and family may
promote relaxation
 Plan for client to rest without interruption
 Those with injuries or illness need to rest often– particularly
during or after receiving care.

 See textbook box: Providing Compassionate Care:

Helping Clients to Rest

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 Rest and Sleep (3 of 6)
 Sleep is a basic need.
 It lets the mind and body rest.
 The body saves energy.
 It slows down body functions.
 During sleep, vital signs are lower than when awake.
 Tissue healing and repair occur.
 It lowers stress, tension, and anxiety.
 The person regains energy and mental alertness.

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 Rest and Sleep (4 of 6)
 There are two phases of sleep:
 NREM (non-REM) sleep is the phase of sleep where there is
no rapid eye movement
 Normal adult passes through 4-6 cycles of NREM.
 The rapid eye movement phase is called REM sleep.
 See textbook Table 23.1: Average Sleep Requirements
 See textbook box: Focus on Older Persons: Sleep

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 Rest and Sleep (5 of 6)
• Factors affecting sleep:
 Illness increases the need for sleep.
 Signs and symptoms of illness can interfere with sleep.
 Treatments and therapies can interfere with sleep.

 Nutrition
 Foods with caffeine prevent sleep.
 The protein tryptophan (found in milk, cheese, and beef) tends
to help sleep.

 Exercise
 Exercise makes people tired and helps them sleep.
 However, exercise before bedtime interferes with sleep; allow at
least 2 hours between exercise and bedtime.

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 Rest and Sleep (6 of 6)
 Factors affecting sleep
 Environment
 Most people sleep better in their own bed and familiar
surroundings.
 Promote a quiet environment.
 Medications can promote sleep.
 Alcohol disrupts normal sleep patterns.
 Change and stress disrupts sleep.
 Emotional problems
 Fear, worry, depression, and anxiety affect sleep.
 Nocturia
 The need to urinate at night disrupts sleep.

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 Sleep Disorders
 Sleep disorders involve repeated sleep problems.
 The amount and quality of sleep are affected.
 Insomnia is a persistent condition in which the person
cannot sleep or stay asleep all night.
 With sleep deprivation, the amount and quality of sleep is
decreased.
 Sleep is interrupted.
 With sleepwalking, the person leaves the bed and walks
about.

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 Slide
28

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 Promoting Sleep (1 of 2)
 Promoting sleep
 The nurse assesses the client’s sleep patterns.
 Your role in promoting sleep:
 Report signs and symptoms of sleep disorders.
 Follow the care plan for measures to promote sleep.
 Report your observations about how the client slept.
 See textbook Box 23.7: Measures to Promote Sleep

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 Promoting Sleep (2 of 2)
 Follow the clients’ bedtime rituals and routines.
 e.g., eating a bedtime snack, watching television, reading a
book, etc.
 Sleep disturbances are common with some types of
dementia.
 Confusion and restlessness increases at night.
 Wandering is common.

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Communicable Diseases (1 of
2)
 A communicable disease is caused by
microbes that spread easily and can be
transmitted from one person to another.
 Communicable diseases are spread in
many ways:
 Direct contact
 Indirect contact
 Airborne transmission
 Vehicle transmission
 Vector transmission

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 Slide
32

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 Slide
33

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Communicable Diseases (2 of
2)
 Three possible outcomes of exposure to a pathogen:
 Immune system destroys the pathogen
 The immune system does not destroy the pathogen, but no
infection develops
 An infection develops sometime after exposure to
pathogen

 See textbook Table 33.1: Other Communicable Diseases:

Care and Immunization

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 Vaccinations as a Preventative Measure
(1 of 2)
 Vaccines are proven to prevent communicable illnesses
from developing into more serious illness.
 Pandemic
 Disease or infection spreads quickly throughout a country,
or even worldwide.
 See box: Think About Safety: COVID-19 and Its Effect
on the World

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 Vaccinations as a Preventative Measure
(2 of 2)
 Recommended or Required Vaccinations for Health Care
Workers
 Health care agencies require workers to have all routine
vaccinations up to date before they start work
 Yearly influenza vaccination
 Hepatitis B vaccination
 Hepatitis A vaccination
 Skin testing to check for tuberculosis (TB)

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Common Communicable Diseases (1
of 10)
 COVID-19
 Highly contagious communicable disease
 Spread through close physical contact by people within 2 m
(6 ft) of each other.
 Spread occurs mainly through exposure to respiratory
droplets.
 Adverse effects of COVID-19
 Organ damage to heart, lungs, and brain
 Blood clots and blood vessel problems
 Problems with mood
 Fatigue

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Common Communicable Diseases (2
of 10)
 Hepatitis
 An inflammation of the liver
 Is considered a communicable disease
 It can be mild or cause death
 Protect yourself and others
 Follow Standard Practices
 Assist the person with hygiene and handwashing as needed
 There are three major types of viruses that cause hepatitis in
Canada:
 Hepatitis A, B, and C
 Hepatitis A and B are present in the blood and body fluids of infected
persons.

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 Common Communicable Diseases (3 of
10)
 Acute hepatitis
 Often lasts less than 1 or 2 months
 Signs and symptoms:
 After 2 weeks, dark urine and jaundice develop in some, but not
all, clients
 Light-coloured stools
 Muscle pain
 Drowsiness, irritability
 Itching
 Diarrhea
 General ache in joints

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 Common Communicable Diseases (4 of
10)
 Hepatitis A
 Spread by the fecal–oral route
 Causes include:
 Poor sanitation
 Crowded living conditions
 Poor nutrition
 Poor hygiene
 Hepatitis A does not cause chronic hepatitis.

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 Common Communicable Diseases (5 of
10)
 Hepatitis B and C:
 Far more infectious that HIV
 Hepatitis B can be prevented by a vaccine—in Canada, all
provinces/territories have free immunization programs for
children and certain groups of adults to protect against this
infection.
 Both are spread through contact with infected blood and
body fluids, including semen and vaginal fluid.

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 Common Communicable Diseases (6 of
10)
 Hepatitis B and C
 May be spread by:
 IV drug use and sharing needles
 Accidental needle sticks
 Sex without a condom
 Therefore, follow Standard Practices and Transmission-
Based Practices when contact with blood or body fluids is
likely.
 Hepatitis B and C can cause chronic hepatitis.

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 Common Communicable Diseases (7 of
10)
 Herpes Simplex Virus
 Can be spread by sexual activity
 Can also be spread without sexual activity (e.g., by skin,
saliva or touch of the infected area)
 Symptoms will appear 3 days to 1 week after exposure.
 May experience before lesions appear; also fever, tiredness,
loss of appetite, localized pain/burning at the site

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 Common Communicable Diseases (8 of
10)
 Herpes Simplex Virus
 Two types:
 Herpes type 1 (HSV-1 or oral herpes, fever blisters or cold
sores)
 Sores occur above waist usually around mouth and lips
 Herpes type 2 (HSV-2 or genital herpes)
 Sores occur below the waist usually around genitals or rectum
 Researchers have concluded that HSV-1 can be introduced
to the genital area and HSV-2 can cause sores in the upper
part of the body.

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Common Communicable Diseases (9
of 10)
 Sexually transmitted infections (STIs)
 Are spread through sexual contact
 People may not have signs and symptoms.
 Some may not be aware of an infection.
 Some know but do not seek treatment because of
embarrassment.
 STIs occur:
 In the genital and rectal areas
 In the ears, mouth, nipples, throat, tongue, eyes, and nose

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Common Communicable Diseases (10 of
10)
 Sexually transmitted infections
 Using condoms helps prevent the spread of STIs
 Some STIs are also spread through skin breaks, by contact
with infected body fluids, and by contaminated blood or
needles.
 Standard Practices must be followed at all times
 See textbook Table 33.2: Common Sexually Transmitted
Infections

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 Supporting a Client Living With a
Communicable Disease
 Protect yourself from the contagious disease or
infection.
 Listen and use empathy when speaking to the client.
 Always obey the rules of confidentiality.
 Be non-judgemental.

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 Care Plan Review
Pain Management

Review this week’s Care Plan. Keep the following questions

in mind:

1) How do these interventions assist your client?

2) Why are some interventions only to be performed by
registered staff? What does this mean?
3) What are some signs and symptoms of pain? (review
Box 23.1 – p. 517 for assistance)
4) What basic observations might you make and report
when carrying out these interventions? (review Box 26.2 –
pp. 575-576 for assistance)
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