Appropriate Use of Opioids in the Management of Chronic Pain

Painted by Martin Edwards as part of the Paint Your Pain program initiated by the Pain Management Center at Overlook Medical Center, Atlantic Health System, Summit, New Jersey. For artwork of other patients in the program, go to http://bit.ly/ 1Ns0PxL.The dangerous misuse of prescription opioids and drugs like heroin has been much in the news, but millions of patients continue to suffer both acute and chronic pain. For many, prescription opioids play a vital role in alleviating that pain. How can health care providers most effectively and safely use opioids in the treatment and management of chronic pain? Some answers can be found in a CE article in the July issue of AJN: “Appropriate Use of Opioids in Managing Chronic Pain.”

Related questions on opioids and chronic pain addressed in the article include:

  • What is the best way to assess chronic pain patients?
  • Which patients—for example the elderly, those with compromised renal or hepatic function, those with a history of substance abuse—may require special considerations when opioids are prescribed?
  • Which opioid medication or medications, if any, should you select for your patient?
  • And what are the legal and practical challenges to prescribing opioids?

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July 22nd, 2016|Nursing, pain management, patient safety|0 Comments

AJN’s Top Five Most-Emailed Articles

IMG_2151We are sometimes surprised by the articles our readers are most interested in. The articles shared most often among colleagues are not always the articles being read by the most people. Here are AJN‘s current top five most-emailed articles, many of which deal with essential practice topics such as pain management or nursing handoffs or with various workforce and educational issues:

We encourage readers to visit AJN and explore the wealth of collections, archives, podcasts, videos, and much more. Some articles, such as continuing education features and the monthly Reflections essays, are free access; some require a subscription. And of course, feel free to let us know about topics you’d like to learn more about.

Lastly, here’s a much longer list of AJN‘s most emailed articles.

July 20th, 2016|Nursing, nursing perspective|0 Comments

Moral Distress: An Increasing Problem Among Nurses

moral distress

An ICU nurse struggles to reconcile repeated surgeries and transfusions for a comatose patient who has little chance of recovery. An oncology nurse knows a patient wants to refuse treatment but doesn’t do so because his physician and family want him to “fight on.” A nurse on a geriatric unit knows she’s not giving needed care to patients because of poor staffing.

Situations such as these are all too common and can give rise to moral distress. Moral distress occurs when nurses recognize their responsibility to respond to care situations but are unable to translate their moral choices into action.

As explained in “Moral Distress: A Catalyst in Building Moral Resilience,” one of the CE articles in our July issue, this “inability to act in alignment with one’s moral values is detrimental not only to the nurse’s well-being but also to patient care and clinical practice as a whole.” […]

July 18th, 2016|Ethics, Nursing, patient safety|0 Comments

Sent Back: Imagining the Real Costs of a Family’s End-of-Life Decisions

Evelyn Simak/ via Wikimedia Commons Evelyn Simak/ via Wikimedia Commons

Editor’s note: This is a work of fiction. The characters are invented; the situation explored may be all too common.

Beep. Beep. Beep. There’s a slow, rhythmic sound next to my head. I’ve never heard a sound like it before. I hear a whoosh on the other side of me, and at the same time I feel pressure in my chest, like a balloon that on the verge of popping.

It only lasts a few seconds and the pressure is gone. My chest returns to normal and I immediately feel better. Something squeezes my left arm tight—so tight that I want to yell. But I can’t make any words come out.

Then, just as quick as the pressure in my chest came and left, so does the pinch around my arm. I don’t know where I am, but I feel like I’m being tortured.

“I know that it’s cold in here, but I’ll use this warm blanket to keep you warm,” says the strange voice, belonging to a person I can’t see.

Who are you, I try to ask. But just as the darkness around me persists, so does my inability to speak. I have no idea where I am, and I’m scared.

The voice comes back, “Ok, it’s time to roll on your side.” I feel someone tug on my left side and roll me onto my right. A new beeping starts: this one sounds angry, like something’s wrong. I want to ask but I can’t make the words come out. I feel what I think is water and a washcloth on my backside and I’m overcome with embarrassment.

Why is this stranger washing me? I feel the sensation of rubber being dragged across my left side as I hear a different voice say, “Hey, I’m dropping her here. Are you almost done?” There’s a little push on my back and the rubber stops tearing at my left side.

The next order of business is a flash of cold across my back.

“Sorry, dear, I know it’s cold but we need to keep your skin moisturized. There will be no bedsores on my watch.” The cold gives way to a nice back rub. For a moment I’m relaxed and not worrying about where I am.

I hear someone knocking on the door. Oh, please, I think to myself, two people seeing me like this is bad enough. I pray that the voices don’t let anyone else in.

“Just a minute,” the second voice says, “We’ll be done soon.” I try to say thank you, but the words won’t come out.

I feel myself being rolled back and forth and I think that something underneath me is being removed and replaced. I roll over lumps and cold wet areas. When they finally stop moving me, I find myself lying partially on my right side and a sharp pain shoots through my body.

I try to tell them but I can’t. I try to move but my body won’t listen. I feel pressure against the left side of my back and admit defeat. Even if my body would listen, there’s some sort of barrier to keep me right where I am.

I feel someone opening my mouth. There’s a sudden sensation of pure joy. I didn’t realize just how dry my mouth was until this very second. I want to drink Niagara Falls. I try to tell them but I can’t, so I just enjoy the wet swab on my tongue.

The swab of happiness is removed from my mouth and I want to cry. Please, I try to plead, bring that back. But I can’t get a word out.

The door opens and I hear voice number one says, “Ok, you can come in now.”

I hear shuffling footsteps, but no one says a word. Finally I hear a familiar voice say, “Oh, mom!” […]

July 12th, 2016|Nursing|4 Comments

Daniel

jen promesJennifer L. Promes is a gerontological clinical nurse specialist and Magnet Program director in Omaha, Nebraska. In this post, she describes an experience she had early in her career while working as a certified nursing assistant in a nursing home’s memory support unit.

Daniel had a kind, mild-mannered disposition, but because of his advanced dementia he would sometimes become agitated and belligerent, especially at night. Most of the staff didn’t want to help him prepare for bed. I knew Daniel was much more cooperative if you distracted him by talking about his past, so one night I volunteered to help him with his personal care.

All of the residents had just finished their evening meal and were waiting patiently at their tables to be assisted back to their rooms for the night. As I approached Daniel–a short, stocky bald man in his late 80’s with thick-rimmed glasses, always dressed in a button-up flannel shirt, polyester slacks, and square-toed, diabetic shoes—I could tell he was “working on something.” He had a table knife in his hand and was prying at the seam between the two leaves of the table. He was quietly muttering something under his breath as he worked, his head nodding as he grew more tired.

Daniel would “fix” anything he could get his hands on. A farmer in his younger life, he had many years of experience with problem solving. After watching him for about a minute, I told him that he’d better get to bed so he could get up early in the morning to feed his cows. Seeming to accept my reasoning, he put the knife down.

I pushed his wheelchair into the bathroom in his room and suggested he wash his face and brush his teeth before bed. Expecting an agitated response, I was surprised when he agreed to my suggestion. I thought it would be best to continue to engage him in discussion about his farm while helping him get ready for bed. As we talked he didn’t seem to notice me helping him onto the toilet or helping him brush his dentures.

I guided him back into his wheelchair, took off his glasses, and washed his face with a warm washcloth. As I moved the washcloth over his cheeks he looked up at me and said, “That’s warm . . . that’s nice.”

In that moment I looked directly into his eyes, which were more grey than green and had pretty advanced cataracts. I had the sudden impression that I could see the dementia in his eyes. Looking past the cloudiness of his lenses deep into his eyes, I found nothing but a dark empty blankness. It was as though he didn’t see my face in front of him at all—his eyes didn’t deviate from their forward stare. An eerie feeling washed over me, as if I were standing in the presence of a ghost. […]