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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Overactive Bladder in Women: Nurses Can Improve Screening, Management of a Common Problem

“Whether due to discomfort with the topic or a lack of knowledge about treatment options, some women attempt to manage symptoms on their own, a decision that can lead to additional problems…”

Can Significantly Affect Daily Activities

Among women 18 to 70 years old, almost a third are “sometimes” affected by the symptoms of overactive bladder, according to the authors of this month’s CE feature, “Overactive Bladder in Women.” This rate is nearly twice that among men, and prevalence is known to increase in all adults as they age.

Overactive bladder can significantly affect daily activities, with many women altering their routines to ensure a bathroom is nearby. The “hallmark symptom of overactive bladder is urgency,” according to authors Mary H. Palmer, PhD, RN-BC, FAAN, AGSF, and Marcella G. Willis-Gray, MD. Women may experience urgency with urinary incontinence, stress urinary incontinence, or mixed urinary incontinence (in which a combination of these symptoms occurs).

A Tendency to Self-Manage

Despite the impact of this condition on everyday routines, patients often resist talking to their health care providers about symptoms—or do so as an afterthought, as the patient does in the hypothetical case study accompanying this article. Whether due to discomfort with the topic or a lack of knowledge about treatment options, some women attempt to manage symptoms on their own, a decision that can […]

2017-04-03T10:53:35-04:00April 3rd, 2017|Nursing|0 Comments
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The Limitations of Rating Nursing Care by Customer Surveys

Ink and collage on paper by Julianna Paradisi 2017

Either They Loved It or They Hated It

While toasting the same English muffin for the second time that morning and cursing that it would make me late for work, I conceded we need a new toaster. It doesn’t matter whether I set the darkness level on 1 or 4;  the muffin comes out barely tinged. Select 5 or beyond, the muffin is burnt, and sets off the smoke detector. It’s time to buy a new toaster.

I found one I liked, shopping online. It had been purchased by over 1,500 other people; 55% of them rated it 5 stars. The other 45% of ratings ranged between 1 and 4 stars. The comments, however, were evenly split, 50/50. People either loved it or hated it. There was no in-between.

This made me laugh.

As with Toasters, So with Nursing Care

Likewise, many hospitals, in an effort to improve care, send out satisfaction surveys asking patients to rate their nursing care. In my experience, the results are similar to the toaster’s ratings: about half the patients rave about their care. Some mention their nurses by name, elaborating on specific details about their experience.

The other half complain bitterly that their hospitalization. […]

2017-03-31T10:28:07-04:00March 31st, 2017|Nursing, nursing stories, patient experience|3 Comments
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The Buzz at Nursing Conferences about Quality and Healthy Work Environments

“I was struck by the preponderance of sessions dealing specifically with incivility and bullying (in both academia and practice settings).”

Recent back-to-back nursing meetings gave me a lot of food for thought. After attending conferences, I like to find the overall theme—not just from the scheduled topics, but from the posters and the exhibits and the general “buzz” from conversations. Here’s my take on the two meetings I attended this month.

ANA’s 2017 Translating Quality into Practice Conference

This conference started with an opening session focused on quality from a consumer point of view. Keynote speaker Harry Greenspun asserted that today “it’s the patient or family’s responsibility that the right thing happens at the right time by the right person.” Nurses, he said, are the group that needs to engage and empower consumers (who, he said, should only be called patients when they are receiving care) in improving care.

ANA president Pam Cipriano added that “nurses are the ones doing the work on quality—all the projects and quality improvement is being done on the backs of nurses.”

While some sessions focused on specific clinical practices (reducing hospital-acquired infections or falls, for example), many focused on broader aspects of quality improvement—how systems can support QI change and integrate new technology (mobile apps, simulation).

There was also discussion relating to staffing strategies and teams (though the cynic in me feels that much of the strategies […]

2017-03-29T13:31:16-04:00March 29th, 2017|Nursing|0 Comments
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AJN in April: Nurse Perceptions of Risk for Harm, Climate Change and Mental Health, More

The April issue of AJN is now live. Here are some articles we’d like to bring to your attention.

CE Feature: Original Research: Do Nurses or Electronic Assessment Tools Better Predict Risk for Harm?

In many hospitals, nurse-led “safety huddles” are used to relay patient safety information, although whether this effectively identifies patients at risk for harm has not been determined. New electronic risk assessment tools are designed to identify patients at risk for harm during hospitalization, based on specific markers in the electronic health record. The authors of this study compared the results of both methods, finding statistically significant differences in the way nurses and data mining software identify risk of harm. In many instances, factors that the software captured had been anticipated by the nurses or were already addressed in the plan of care.

CE Feature: Overactive Bladder in Women

This article provides an evidence-based review of the screening, assessment, and management of overactive bladder in women, many of whom do not seek help for the condition and try to self-manage its symptoms, which may inadvertently worsen them. Those with overactive bladder often experience related physical and psychological symptoms and report a poorer quality of life than other […]

2017-03-27T09:34:06-04:00March 27th, 2017|Nursing|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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