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

Tallying Losses and Gains of Being a Nurse, and Finding Profit

I was talking with a dear friend who was telling me how she went through a period when she had wondered whether nursing was destroying her. I can’t say what she actually meant by this for her own self, but the comment stood out to me. I found myself chewing on this notion that we can feel slowly worn down by the overall experience of nursing to a point where we feel the losses are not being offset by the gains quickly enough.

A certain loss of innocence.

Given all of the random tragedy, self-sabotage, and violence that nurses may witness in their patients’ stories, nurses can experience the loss of a more innocent, optimistic perspective about people and the world. Nurses often say there are things you cannot “un-see” in this line of work. Those experiences can darken the lens through which we see the world. The loss of faith in the assured wellness in the world can feel disheartening. It can be difficult to know how to process this in a way that does not simply leave us more fearful or cynical people.

The energy drain.

On a less philosophical level, it is no […]

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, […]

What if Our Antibiotic Prescribing Practices are Wrong?

How often have you emphasized to patients, family, and friends that they must finish their prescribed antibiotics, even if they feel better? A provocative new analysis in BMJ takes a close look at why standard antibiotic protocols may promote, rather than prevent, antibiotic resistance.

The authors’ arguments center around two key points:

  • The length of a course of antibiotic therapy is not evidence based, but rather “set by precedent [and] driven by fear of undertreatment.”
  • Typical, prolonged courses of these drugs cause endogenous or colonizing bacteria to become antibiotic resistant. It is these “collateral” organisms, they argue, and not the organism that has actually caused the infection, that drive the spread of antibiotic resistance.

Individualized antibiotic courses.

The BMJ authors present a strong argument for more individualized courses of antibiotic treatment. Unfortunately, when the news media picked up this story, much of what was written and broadcast erroneously suggested that everyone should simply stop their antibiotics when they feel better. […]

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 […]