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 […]

2018-01-17T10:04:37-05:00January 17th, 2018|Nursing|0 Comments
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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.

2017-12-13T15:23:52-05:00November 17th, 2017|Nursing, pain management, patient experience|8 Comments
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Managing Your Patients’ Pain: It’s Not Just about the Opioids

Before Pain Assessment Was the Norm

Some of the most difficult times I experienced as a nurse involved patients in pain. This was before the days of patient-controlled analgesia, when patients in acute pain were mostly managed with “Demerol IM q4h.”

I recall many incidents of paging and telephoning and beeping physicians and residents to get orders for pain medications and trying whatever non-pharma methods I could think of to allay pain. It was awful to see patients suffer needlessly.

Progress, But with a Cost

Then pain became a key part of assessment, as well as of patient satisfaction scoring, and clinicians heeded the need for managing pain. However, there has been too much reliance on the quick fix of strong opioids. A friend who recently had surgery was asked by a nurse to rate his pain. When he replied “eight,” she asked him if he wanted one or two oxycodone pills. His reply, “Well, what do people usually take?”

Revising the Approach to Pain Management

Thankfully, pain management is being revisited, and along with a renewed focus on not prescribing by the numbers (a patient’s pain rating should only be one factor in deciding the intervention), there is a greater understanding of pain and how it can become chronic, and there are more modalities at our disposal to manage it.

To […]

2017-04-05T10:34:01-04:00April 5th, 2017|Nursing, pain management|0 Comments
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The Primary Care Confessions of Traumatized Patients

drawing of patient in waiting room Illustration by Hana Cisarova. All rights reserved.

In this month’s Reflections essay, “The Traumatized Patient,” family nurse practitioner Margaret Adams delves with sympathy into what she calls the “primary care confessions” of a challenging subset of patients. Writes Adams:

I’ve come to recognize patients like you—sometimes by your disturbingly long and detailed allergy lists, but more often by the frequency with which you come in for the same constellation of symptoms: fatigue, headaches, dizziness, general malaise. Something happened to you— maybe years ago, maybe recently—and it left its mark on you in irredeemable ways, . . .

While symptoms often do have underlying physiological causes, Adams is likewise attuned to the emotional subtext behind certain seemingly fruitless patient encounters. And with many specific examples, she makes the case here that the life of trauma plays itself out over time in the body and mind. […]

2016-11-21T13:00:53-05:00October 18th, 2016|Nursing, nursing stories, patient engagement, Patients|0 Comments
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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 […]

2016-11-21T13:01:12-05:00May 26th, 2016|health care policy, Nursing, nursing perspective, pain management, patient experience, patient safety, Patients|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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