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 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?


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

Recent Decline in U.S. Opioid Prescriptions: Good News But Some Concerns

by frankieleon/ via flickr by frankieleon/ via flickr

It was widely reported in the past week that there have been steady declines in the number of opioid prescriptions in the U.S. for the past three years, with the declines the steepest in some of the states considered to have the worst opioid misuse crises.

This is good news, suggesting that efforts to address some problem areas like renegade pain clinics prescribing for profit, patients who go from doctor to doctor seeking opioid prescriptions, and the diversion of legitimate opioid prescriptions may be starting to bear fruit.

A balanced overview of the situation can be found in this New York Times article. The authors also acknowledge that patients in pain are now facing new hurdles to pain relief, quoting the director of one prominent medical school’s program on pain research education and policy: “The climate has definitely shifted. . . . It is now one of reluctance, fear of consequences and encumbrance with administrative hurdles. A lot of patients who are appropriate candidates for opioids have been caught up in that response.”

Much of the reporting on the opioid epidemic lumps all people who take opioids into one big statistical brew. While startling and alarming numbers about overdoses from legal and illegal opioids steal the headlines, little media and scholarly analysis focuses on the lower likelihood of opioid misuse or overdose seen in the large subset of patients who do not have a history of opioid misuse and/or mental illness, are not taking illegal opioids like heroin, and not using opioid medications that they were not prescribed.

Nurses owe it to themselves and their patients to have an informed, undogmatic understanding of opioids and their use. With this in mind, AJN has upcoming articles on opioids and their use with different patient populations, including a July CE that will take a comprehensive look at the appropriate and safe use of opioids in treating chronic pain. In the meantime, here are several recent articles of note about opioid medications.

A significant percentage of prescription opioid overdoses occur among people taking drugs for which they do not have documented prescriptions. Renee Manworren helps nurses understand and help prevent drug diversion in a recent CE article, “Nurses’ Role in Preventing Prescription Opioid Diversion. […]

Napping on the Night Shift: What a Pilot Study Revealed

By Sylvia Foley, AJN senior editor

Table 1. Guidelines for Hospital Nurses on Implementing Naps on the Night Shift (click to enlarge)Nurses who work the night shift often struggle with high levels of sleepiness. But while onsite napping is effectively used to counter worker fatigue in other safety-sensitive industries, the practice has yet to win wide acceptance in nursing.

Curious about why this is so, nurse researchers Jeanne Geiger-Brown and colleagues recently conducted a pilot study. They report their findings in this month’s CE–Original Research feature, “Napping on the Night Shift: A Two-Hospital Implementation Project” (for some night shift napping ground rules, see, at right, Table 1: Guidelines for Hospital Nurses on Implementing Naps on the Night Shift—click table to enlarge).

Here’s an overview:

Purpose: To assess the barriers to successful implementation of night-shift naps and to describe the nap experiences of night-shift nurses who took naps.

Methods: In this two-hospital pilot implementation project, napping on the night shift was offered to six nursing units. Unit nurse managers’ approval was sought, and further explanation was given to a unit’s staff nurses. A nap experience form, which included the Karolinska Sleepiness Scale, was used to assess pre-nap sleepiness level, nap duration and perceived sleep experience, post-nap sleep inertia, and the perceived helpfulness of the nap. Nurse managers and staff nurses were also interviewed at the end of the three-month study period.

Results: Successful implementation occurred on only one of the six units, with partial success seen on […]

Why I Like Nurses Week

Safety Plan Safety Plan/Plougmann/via Flickr

By Shawn Kennedy, AJN editor-in-chief

Here’s why I like Nurses Week. I’m sure some folks groan over the idea that for only one week out of the year, health care administrators actually think about all that nurses do and show their appreciation. My perspective is that at least we have one solid week with the spotlight on nursing, when we can toot our horns and make sure that people know the critical role of nursing in health care.

Sure, there are some people who will never “get” what nurses do beyond the old stereotype that nurses are doctors’ helpers. I’m always flabbergasted, though, when physicians—after so much time working alongside nurses as medical students, interns, and residents—still don’t have a more nuanced view of nursing.

In this month’s editorial, I address the American Nurses Association Nurses Week theme, “Culture of Safety: It Starts with You.” How many times, in the dead of night, have nurses called physicians to alert them to a critical change—or questioned an inappropriately ordered medication that, if given as ordered, could have had dire consequences? I also addressed this issue in a 2014 blog post about Arnold Relman, now deceased but then an emeritus professor of medicine at Harvard and a former editor of the New England Journal of Medicine, who wrote about the nursing care he experienced while recovering from a serious accident:

I had never before understood how much good nursing care contributes to patients’ safety and comfort, especially when they are very sick or disabled. This is a lesson all physicians and hospital administrators should learn. When nursing is not optimal, patient care is never good.”

After all his distinguished years in medicine, Dr. Relman may have only fully realized the value of nursing as a 90-year-old trauma patient.

Patient safety is on us. As I noted in my May editorial, we are “the sentinels, the around-the-clock watchers, detecting the changes that might herald a patient’s deterioration. Nurses are the ones that the system looks to—and often blames—when there’s a failure to rescue.”  […]