Pain, an Ever-Present Concern for Patients—and Nurses

Nurses at Ann and Robert H. Lurie Children’s Hospital of Chicago manage baby boy’s postoperative pain following heart transplant. Photo courtesy of Ann and Robert H. Lurie Children’s Hospital.

In my experience working with severely ill or injured patients, pain was what they talked about the most. They either asked about it prior to a treatment or intervention (“How much is this going to hurt?”), relived their history with it (“This pain isn’t as bad as the pain I had….”), or were consumed with fear that it would never end (“I can’t handle this—can’t they give me anything for it?”).

Post-op patients mostly had the same standard order, whether they were slightly built women or burly men: meperidine 25mg q3-4 h IM. I remember watching the time so I could administer the medication as soon as the clock would allow—and sometimes “fudging” the time a bit because the medication wasn’t “holding” the patient. It was one of the topmost issues for nurses in acute care—how to ensure patients were comfortable and pain free. As a nurse, not being able to provide pain relief for a patient left you feeling like a failure.

The evolving science of pain management.

Well, times have changed, and we’ve learned more about pain pathways and better ways of combining […]

2018-01-17T10:04:37+00:00 January 17th, 2018|Nursing|0 Comments

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+00:00 November 17th, 2017|Nursing, pain management, patient experience|3 Comments

Bullying Wars: Theresa Brown vs. ‘the entire physician profession’

By Maureen Shawn Kennedy, AJN editor-in-chief

On May 11, an op-ed piece written by nurse and New York Times blogger Theresa Brown on bullying by physicians caused some physicians to protest (full disclosure: Brown’s honest and moving ethical meditation on a very different topic, “Right Treatment, Right Patient?”, was just published in our June issue).

Notable among her critics was Kevin Pho of the popular blog, Kevin MD, who wrote that Brown “unfairly blames doctors for hospital bullying.” He claimed that Brown uses her writing outlet to “metaphorically bully the entire physician profession.” Another commentary (by physician Ford Vox, writing in The Atlantic Monthly) accused Brown of publicly “drawing and quartering” her colleagues.

Spare me, please. Brown used a recent personal encounter to illustrate a problem that is, unfortunately, commonplace in hospitals.  She used it as a lede and parlayed the story into an insightful piece about bullying in hospitals.  (From experiences I had and witnessed during my clinical years, I actually thought it was a fairly mild example.) Ironically, the strong language used to counter Brown’s commentary made it seem that physicians were trying to bully Brown into silence because she’d spoken out. As if to say: how dare a nurse challenge physician behavior?  […]