Unseen Struggles: When the Pain of Chronic Illness Meets Disbelief

A friend’s desperation.

Photo by Ben Blennerhassett on Unsplash

It was early in the morning when I received a call from my best friend, who was crying and
distraught. She frantically rattled off her symptoms: “My stomach is on fire, I can’t sleep, nothing is relieving the discomfort, and I’m in excruciating pain.” Although she’d been feeling discomfort for the previous two weeks, at first she’d thought the intensity of her current symptoms might be from food poisoning. Given her not always healthy diet, which she and I had discussed in the past, I too at first thought she might have eaten something that set the symptoms off.

“It hurts so badly I don’t think I can take it anymore,” she told me over the phone. “I can’t stop going to the bathroom.”

She said that despite the severity of her pain, her family just thought she was being dramatic. I could sense her desperation as she sobbed over the phone. Even though she did not want to seek medical attention, I begged her to go to the nearest clinic or hospital and told her I’d meet her there.

Crohn’s disease: When nurses doubt a patient’s pain.

In the emergency department (ED) where […]

2023-09-07T11:14:39-04:00September 7th, 2023|Nursing, nursing perspective, pain management, patient experience, Patients|1 Comment
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April Issue Highlights: Nurses’ Views on Substance Users, Decarbonizing Health Care, More

“I was always the strong one, the one with the answers, the one people came to for advice….” – from the April Reflections essay, “Take Off the Mask: Getting Real About Depression, Trauma, and Loss“

The April issue of AJN is now live. Here’s what’s new. Some articles may be free only to subscribers.

CE: How to Write an Effective Résumé

In today’s job market, nursing students and new graduate nurses need to develop an employer-focused résumé geared toward a specific job. This article can assist.

Nurses’ Self-Assessed Knowledge, Attitudes, and Educational Needs Regarding Patients with Substance Use Disorder

This research study’s findings indicate that, “in general, hospital nurses have negative attitudes toward patients with substance use disorder” and are in need of empathy-based education.

AJN Reports: Decarbonizing Health Care

Nurses can be involved in solutions to reduce greenhouse gas emissions in the health sector.

[…]

2023-03-27T08:10:27-04:00March 27th, 2023|climate change, environmental health, environmental health, family caregiving, Nursing, pain management|0 Comments
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Honoring the Moral Concerns of Caregivers Afraid of Giving Morphine

Joan’s breathing relaxes as the morphine starts working. Her son Travis, on the other hand, is clearly upset as we sit at her bedside where she is dying. Despite his mother’s intense respiratory distress before he gave her the morphine, he’s convinced that he’s just made a big mistake. “I’m sorry, mama,” he whispers.

He turns his head my way. “I wish you hospice folks had never brought that morphine out here,” he says. “Now she’s dead for sure and it’s my fault.”

A sometimes essential medication.

For caregivers with this level of fear about morphine, it’s a painful dilemma. If you don’t use the best, sometimes the only, medication we have for getting acute respiratory distress in terminally ill patients under control, both patient and caregiver suffer. But if giving morphine is freighted, as it is for Travis, with a belief that it causes death and/or signifies giving up on, even betraying, a loved one, it can intensify a caregiver’s distress.

The hospice nurse had already given the standard education, assuring Travis that in patients near the end of life morphine is safe and effective when used as prescribed. We had given him written information debunking some of the common myths about morphine—“it kills you”; “makes you crazy”; “it’s addictive”—when used appropriately with hospice patients who have active symptoms. We had […]

2018-01-22T10:19:38-05:00January 22nd, 2018|Ethics, family caregiving, Nursing, pain management|0 Comments
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A Closer Look at the Joint Commission’s New Guidelines for Pain Assessment and Management

Photo © Burger / Phanie / Science Photo Library.

Starting on January 1, 2018, the Joint Commission’s new and revised pain assessment and management standards for accredited hospitals will go into effect. Notably, the guidelines—as we report in a November news article—address safe opioid prescribing practices.

Among new requirements, the Joint Commission says hospitals should:

  • Designate a leader or team responsible for pain management and safe opioid prescribing.
  • Include patients in developing a pain management treatment plan—including realistic expectations and measurable goals—and educate them on discharge plans related to opioid adverse effects and safe use, storage, and disposal of opioids.
  • Use prescription drug monitoring program (PDMP) databases to identify patients at risk for opioid addiction.
  • Identify opioid addiction treatment programs for patient referrals.
  • Inform staff about consultation and referral services available for patients with complex pain management needs.
  • Collect and analyze data on pain assessment and management to identify areas in which safety and quality could be improved.

The full list of new and revised guidelines is available here. How might these changes affect life for nurses and patients? Comments are welcome below.

2017-12-13T15:23:52-05:00November 17th, 2017|Nursing, pain management, patient experience|8 Comments
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Managing Your Patients’ Pain: It’s Not Just about the Opioids

Before Pain Assessment Was the Norm

Some of the most difficult times I experienced as a nurse involved patients in pain. This was before the days of patient-controlled analgesia, when patients in acute pain were mostly managed with “Demerol IM q4h.”

I recall many incidents of paging and telephoning and beeping physicians and residents to get orders for pain medications and trying whatever non-pharma methods I could think of to allay pain. It was awful to see patients suffer needlessly.

Progress, But with a Cost

Then pain became a key part of assessment, as well as of patient satisfaction scoring, and clinicians heeded the need for managing pain. However, there has been too much reliance on the quick fix of strong opioids. A friend who recently had surgery was asked by a nurse to rate his pain. When he replied “eight,” she asked him if he wanted one or two oxycodone pills. His reply, “Well, what do people usually take?”

Revising the Approach to Pain Management

Thankfully, pain management is being revisited, and along with a renewed focus on not prescribing by the numbers (a patient’s pain rating should only be one factor in deciding the intervention), there is a greater understanding of pain and how it can become chronic, and there are more modalities at our disposal to manage it.

To […]

2017-04-05T10:34:01-04:00April 5th, 2017|Nursing, pain management|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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