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Prioritizing Assessment of Postoperative Movement-Evoked Pain

It hurts to move.

Staja Booker, PhD, RN

It’s 10:00, 15 hours postoperative, and your patient has eaten breakfast and is resting comfortably in bed. You ask the patient, “On a scale of zero to 10, how much pain are you having right now?” The patient replies “zero, as long as I don’t move.” The nurse documents the pain score as 0/10 and continues their rounds.

Most nurses are happy when patients report no pain. What is the nurse missing? The contextual factor called movement.

Several years ago, a research participant told me, “Ain’t no sense in getting up to hurt.” A very simple yet powerful statement began my quest to shift how we understand and assess the dynamics between pain and movement.

The realities are:

  • Movement increases acute pain postoperatively, and most patients are afraid to move even when the importance of ambulation is known.
  • Most patients need some type of pain medication or non-pharmacological intervention to engage in mobility-related activities.
  • Movement and mobility enhance recovery and rehabilitation.
  • Movement-evoked pain is as a major barrier to participating in activity-based interventions.

Movement-evoked pain is an important pain characteristic that describes pain and discomfort during active or passive motion of the affected area. Yet, despite awareness among nurses of the importance of setting function-related pain goals, most of our pain assessments are performed […]

2023-07-31T09:32:18-04:00July 31st, 2023|Nursing, patient engagement, patient experience|0 Comments
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Why I Practice Dying: A Nurse’s Perspective

author Diane SolomonI’ve been fascinated by death as long as I remember.

Just before I turned eight, my Grampa Lewis died. The event left a lasting impression on me. He had gone to the hospital, puffy and deteriorating from kidney disease, at age 56. I remember that Dad parked the station wagon with faux wood paneling in the hospital lot and we all got out and stood there in cold December sunlight. Strict visiting hours prevailed then, and no kids were allowed, period. Dad pointed up to Grampa’s window, where he waved down at us through the glaring glass as we waved back. The youngest of four children, I was too embarrassed to admit I couldn’t locate him in the anonymous grid of windows.

At the funeral, I grappled with whether or not to look into the casket. Both available options seemed horrible—be forever haunted by a vision of dead Grampa, or guilt-ridden because I hadn’t respected him enough to look.

As a parent, I know no child should feel alone with that type of decision. But this was the 60s, when feelings weren’t discussed. Although neither an open casket or an embalmed body are traditionally Jewish, Granny must have decided she wanted it this way. At the last minute, as […]

2023-07-19T11:42:15-04:00July 19th, 2023|end of life, Nursing, nursing perspective, palliative care|1 Comment
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The Face of Burnout in Nursing: My Personal Story and Lessons Learned

Woman looking at ocean at sunset Photo by Artem Kovalev on Unsplash

Two-and-a-half years ago, I experienced severe burnout in my role as a night shift charge nurse in a cardiovascular ICU. This blog post shares my personal story, highlighting the common ingredients of burnout and the challenges I faced. Through this experience, I learned valuable lessons that can benefit both nurses and the health care industry as a whole.

Where it All Began

Transitioning from a clinical nurse educator to a night shift charge nurse in a new cardiovascular ICU was an exciting opportunity for me. However, it soon became overwhelming due to various factors. These included a surgeon I didn’t see eye-to-eye with, moral and ethical dilemmas in patient care, staffing challenges, and a hostile work environment created by lateral violence from coworkers.

Strained to the Breaking Point

As my anxiety grew, I struggled to meet expectations each night. While prioritizing patient care and my night shift team, I feared for our patients’ well-being. Frequently, we were overloaded with acute post-cardiothoracic surgery patients. Despite my efforts to manage admissions responsibly, I faced constant pressure. Doubts crept in, and I lost trust in myself and my ability to provide safe care.

The emotional toll […]

2023-07-13T11:32:42-04:00July 13th, 2023|career, Nursing, nursing career, nursing stories, patient safety|3 Comments
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Comfort in the Midst of Grief: A Spiritual Care Journey

A mother’s grief.

Photo by Khamkéo Vilaysing on Unsplash

As a member of the spiritual care team, I received a request one morning to visit Ms. L, a patient who had just received devastating news: her son had unexpectedly died the previous night. Ms. L was recovering from a major surgery and in the process of being discharged from the hospital. The details surrounding her son’s death were unclear, but they only added to the profound sadness of the situation.

It was evident that the bond between Ms. L and her son was incredibly strong and loving. They had faced numerous physical challenges together, overcoming obstacles that strengthened their deep connection.

When I entered her room, there was a sense of familiarity about Ms. L, though I couldn’t quite place it. After I introduced myself, Ms. L turned to me, tears streaming down her face, and asked the agonizing questions that often arise in times of tragedy. “Why did this happen? Why were we subjected to so much pain? What had we done to deserve this punishment from God?” Ms. L, a devoted Catholic actively involved in her church, had always drawn strength from her religious beliefs for herself and her son.

In […]

2023-07-11T11:29:59-04:00July 11th, 2023|Nursing, nursing roles, patient engagement, patient experience, Patients|2 Comments
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QR Codes for Rapid Responses: Improved Clinical Operations and DEI Insight

Improving data collection of RRTs for quality improvement

The method we use to track rapid response team (RRT) data has evolved on our health campus at Mount Sinai Queens. Just a few years ago we were using paper logs; now we use electronic logs accessed by a QR code. The goal initially has been to become paperless and collect data to analyze our rapid responses for clinical insight. The greater data collection with the QR code process has in turn allowed for analysis, including a closer examination of diversity, equity, and inclusion (DEI) variables. 

About our rapid response team

Our RRT consists of the ICU charge nurse, ICU attending, respiratory therapist, and the nurse manager or the evening/night nursing administrator. They are called upon when there is a significant change in a patient’s condition that requires critical care expertise at the bedside. After hearing the overhead call for a rapid response, the responding ICU RN scans the RRT QR code using a smart phone. The QR code is displayed within the ICU nurses station for easy access. Depending on the type of rapid response, the responding RN can enter data into the RRT electronic log as care progresses and/or at the conclusion of the response.

2023-06-14T17:12:55-04:00June 14th, 2023|equity, Nursing, Quality improvement, Technology|0 Comments
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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