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 Dream of Horses: An Aging Veteran’s Healing Encounter

“Let’s go for a ride,” I said to Joe as he lay expressionless on his bed, covered in blankets and staring at the ceiling. The room was stuffy with hot, stale air. No bigger than a walk-in closet, the space held the lifetime possessions, many of them scattered on the bed, floor, and windowsill, of a 75-year-old veteran residing in an assisted living facility. Joe appeared frail and bored in the silence of the room.

Illustration by Janet Hamlin for AJN.

That’s the start of the Reflections column, “A Dream of Horses,” in the January issue of AJN. Written by a nurse at the Department of Veterans Affairs, the short, moving essay describes a series of healing encounters between a frail older man, who seems to have given up on life, and the horses at a therapeutic equestrian barn.

The here and now.

The story told here reminds us how much we humans can cocoon ourselves against the more elemental forces of the natural world, and how healing it can be to encounter a magnificent animal that asks only that we be present in the here and now. The senses awaken. We look beyond our own habitual ways of thinking and feeling and acting. Maybe, something […]

Who’s to Blame for Poor Health?

We hear it over and over and probably say it to our patients: to be healthy, follow a proper diet, don’t smoke, and be active. And if diagnosed with an illness, adhere to the agreed-upon plan of care. Sounds simple—and when patients return time and again with the same issues, we often blame them (secretly, of course) for not taking care of themselves.

But for how many of our patients is what we’re asking them to do less a matter of personal choice than a function of the neighborhood in which they live and the limitations imposed by their socioeconomic circumstances?

Many people don’t live within walking distance of a grocery store that offers fresh vegetables and fruit. Or if they do, they may not be able to afford the more nutritious choices, which are often more expensive. Many urban areas lack playgrounds. Air pollution and substandard housing materials can cause asthma and heart disease. Being born into poverty can result in poor nutrition, contributing to poor health, as well as limited access to health care, education, and job opportunities.

Social determinants of health, before we called them that.

Nurse and social worker Lillian Wald understood this when she and colleague Mary Brewster established the Henry Street Settlement in New York City’s Lower East Side, where she offered health care, […]

A Nurse, a Purple Heart Medal, and the Pearl Harbor Attack

USS Arizona burning after Pearl Harbor attack

Tomorrow is National Pearl Harbor Remembrance Day, when we honor the more than 2,400 Americans who were killed in the attack on December 7, 1941, that led the United States to enter World War II. Many nurses were there that day, caring for the wounded and showing civilians how to be of assistance—just as they have been during wartime dating back to the American Revolution. They have served in the U.S. military since Congress authorized the Army Nurse Corps and Navy Nurse Corps in the first decade of the 1900s, and before that provided battlefield care as civilians.

A nurse honored for service during the Pearl Harbor Attack.

Some of these nurses are spotlighted by exhibits and web pages of the National Women’s History Museum, an online museum that aims to “show the full scope of women’s contributions to history” and thus highlights the histories of female-majority professions such as nursing. “The Bravery of Army Nurse Annie G. Fox at Pearl Harbor” tells the story of the first U.S. servicewoman to receive the Purple Heart medal. First Lieutenant Fox was the head nurse at Station Hospital at Hickam Field, on the naval base at Pearl Harbor, when the attack occurred. Nearly a year later, when she […]

2017-12-06T10:48:59+00:00 December 6th, 2017|Nursing, nursing history|0 Comments

Family Caregivers: Nurses by Default

Caregiver guides family member using safe stair-climbing technique. Photo courtesy of AARP Public Policy Institute.

We all know how compressed hospital stays are. Patients are frequently admitted and discharged within a few days, even for what used to be “big” surgeries. We dutifully send them home with discharge instructions—sometimes, pages of them—and often have only a few minutes to go over them with whoever is taking the patient home. And in many cases, that person is not even the one who will be caring for the patient, so instructions for medications and treatments are given second-hand. And we wonder why there are so many readmissions within 30 days!

Forty million plus unpaid caregivers in the United States.

As I note in this month’s editorial, there are over 40 million unpaid caregivers in this country who are administering complex medical and nursing interventions such as ostomy and wound care,  tube feedings, injections, and tracheostomy care, in addition to taking on bathing, toileting, and other necessary care. Many of these caregivers do so without any real training. Aside from the real danger that they may cause harm to the patient or to themselves, they often live in fear that they are not providing what […]