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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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 […]

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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Honoring the Personhood of Brain-Dead Patients: A Delicate Approach

A dandelion alone in a field suggests the fragility of life. Photo by RIDVAN AYRIK/ Pexels

In the past month, we had a couple of patients in our pediatric ICU who had suffered tragic neurological injuries and were declared medically brain-dead. In the state of California as in most states, a pronouncement of brain death is equal to a legal pronouncement of death, and the medical team then possesses legal permission to remove mechanical support from the physical body that has remained under intensive care.

In both of these cases in our ICU, the parents struggled to accept the terminal implications of brain death and pushed back to varying degrees for more time to see if their children might still somehow find a way to recover. In these types of cases, the actual moment-by-moment practice of bedside nursing care becomes complicated. How do we honor the personhood of the patient as we provide intensive care for the body prior to removing mechanical support, and at the same time gently help the parents accept that their child has medically died?

The potential for misunderstanding nursing care

The interactions nurses have with family members as we care for their brain-dead child present many opportunities for […]

2023-06-21T13:06:54-04:00June 21st, 2023|end of life, Ethics, family experience, Nursing|1 Comment
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Just One Braid: The Power of Small Gestures to Restore Patient Dignity

Have you ever found yourself walking around your unit, overwhelmed by the prospect of managing your ever-growing workload? It sometimes feels like a never-ending cycle of assessments, medications, admissions, and discharges. I believe I’m not the only nurse who has experienced this frustration.

It is difficult to admit that, when COVID-19 entered our hospital doors, these thoughts consumed me. We witnessed the first casualties—not just of lives, but also of hope and intimacy—as we struggled to provide care and overcome our own anxieties amidst a scarcity of personal protective equipment (PPE).

Over time, we all learned a great deal about adapting to and managing a pandemic, and I have become more aware of my role within our flawed health care system. Focusing on my own fears and needs was valuable, of course, but these years opened my eyes to the injustices patients face. A significant proportion of the lives lost from COVID-19 due to ill-prepared infrastructure were from vulnerable communities. These realities transformed my perception of these injustices from distant awareness to concrete urgency.

Braiding a patient’s hair, restoring a sense of self.

The question of injustice brings to mind a recent encounter with a patient that deeply impacted me. This particular patient was young […]

2023-05-25T12:20:32-04:00May 25th, 2023|Nursing, nursing stories, patient experience|1 Comment
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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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