[BabyRN2Be]

KK2000,

From what you are describing, the teaching that's taking place in your school is not in step with current thinking or methods for that matter.

Please don't leave nursing because of it. Once you graduate from school you'll learn the difference between the "ideal" and "real life." I have found that some programs are not in step with real life.

I believe that nursing needs more people like you. People who will take the laments of a patient seriously and not be ready to judge. People exhibit pain in different ways, and not everything goes by the textbook.

Wow, I remember when I went in for a T&A in '74. I was a kid and was not told that it would hurt. They had all these books out for kids "glamorizing" T&A's. That you'd be put out to sleep, but when you woke up you'd get all the ice cream you could ever want!! You'd spend a night or two in the hospital, you'd go home and return to your normal life! WRONG!! Wrong on the "all the ice cream you want" bit and returning to normal life. And they didn't mention the pain. This was at a time in which they didn't have the wong scales and they didn't even ask kids if they were in pain. I was not offered anything the whole stay. I remember laying in bed, thinking I was going to die. I was having very morbid thoughts for a 7yo.

I'm thankful for kids today that this is changing. Some people may say that we are "babying" kids for giving pain meds, because this wasn't done previously. After having gone through what I did at 7, and remember thinking "Where did I want to be buried? What do I want on my grave marker? What will the cemetery look like?" and having thoughts and actually crying because I'd miss mom and dad so much... this at 7 for a T&A! I'm so glad that there are better methods out there now, and I do hope that they continue to address pain issues.

Please don't quit nursing...

[sjb2005]

Education is the key in changing this "drug seeker label" trend. The drug reps for MS Contin as well as many pain clinics will teach a valuable inservice on pain and pain control. Ask your employer to set up an inservice.
Pain is subjective. I believe what the patient tells me. I am not a nurse so I can pass judgement. I find that patients are frequently in pain and it is not being controlled. I do everything in my power to get the patient pain control.
I worked with people suffering from quadraplegia, paraplegia or amputations. Phantom pain is a frequent complaint. "My legs hurt", the pt would say. The nurse would reply, "But you have no legs. How could you have pain in your legs when you don't have any?" Or "How can your have pain in you legs...You can't feel anything from the chest down ?"
In these cases, nurses often do not understand the neuro response to stimuli and interpretation of the stimuli via the neuropathways. Sometimes, people cannot express that they are in pain and act out instead, as in the the pt who suffers from alzheimer's.
I would speculate, from my 14 years experience, that 95% of the patients I have cared for are suffering from uncontrolled pain.
I can only recall 2 patients that may have been drug seekers. They were able to convince their physician to prescribe high doses of morphine and narcotics for their pain. This did not seem to adversely affect them. What ended up adversely affecting them: the poorly diluted cocaine or street drug that they shot up in their PICC lines supplied by a friend or family member. I was the one who found them unconscious, barely breathing and administering High doses of narcan and assisting with intubation to bring them out of it. They survived and denied the situation but their drug tests proved otherwise.

[bethin]

I feel that if a physician ordered the med, it should be given when requested within the time constraints. If you feel that a pt. may have a "problem" then I think it should be discussed with the physician. Everyone's tolerance is different. We should be objective. Last time I checked no one can crawl into a pts. head and detemine their tolerance.

I too have chronic pain(Crohn's) and a year ago admitted to the med/surg floor where I work. Of course I got stuck with the nurse who is known to not give pain meds easily. She would lecture me for 30 mins. when I would tell her that a pt. needed pain med. Anyway, while a pt. I requested my prescribed pain med. She went to go get it and when she came back she told me bluntly "I hope you're not going to be one of those patients where we never see them in pain or throwing up." Those were her exact words. I worked with her and she treats me like this? I can only imagine how she treats others.

And another thing, I hate when we generalize pain based on the procedure. You know the "my last post op bowel obstruction wasn't on a PCA". I know I'm guilty of it and I'm sure there's others out there.

[kk2000]

Originally Posted by BabyRN2Be

KK2000,

From what you are describing, the teaching that's taking place in your school is not in step with current thinking or methods for that matter.

Please don't leave nursing because of it. Once you graduate from school you'll learn the difference between the "ideal" and "real life." I have found that some programs are not in step with real life.

I believe that nursing needs more people like you. People who will take the laments of a patient seriously and not be ready to judge. People exhibit pain in different ways, and not everything goes by the textbook.

Wow, I remember when I went in for a T&A in '74. I was a kid and was not told that it would hurt. They had all these books out for kids "glamorizing" T&A's. That you'd be put out to sleep, but when you woke up you'd get all the ice cream you could ever want!! You'd spend a night or two in the hospital, you'd go home and return to your normal life! WRONG!! Wrong on the "all the ice cream you want" bit and returning to normal life. And they didn't mention the pain. This was at a time in which they didn't have the wong scales and they didn't even ask kids if they were in pain. I was not offered anything the whole stay. I remember laying in bed, thinking I was going to die. I was having very morbid thoughts for a 7yo.

I'm thankful for kids today that this is changing. Some people may say that we are "babying" kids for giving pain meds, because this wasn't done previously. After having gone through what I did at 7, and remember thinking "Where did I want to be buried? What do I want on my grave marker? What will the cemetery look like?" and having thoughts and actually crying because I'd miss mom and dad so much... this at 7 for a T&A! I'm so glad that there are better methods out there now, and I do hope that they continue to address pain issues.

Please don't quit nursing...

Thank you for your reply.
Your post reminded me of a good article I read on pain in infants and children and how science is finding out how much kids really do feel pain.(think circumsion!)
i will try to post the link if anyone's interested.
Sorry about your t&A trauma, must have been awful!
K-

[sjb2005]

Originally Posted by bethin

I feel that if a physician ordered the med, it should be given when requested within the time constraints. If you feel that a pt. may have a "problem" then I think it should be discussed with the physician. Everyone's tolerance is different. We should be objective. Last time I checked no one can crawl into a pts. head and detemine their tolerance.

I too have chronic pain(Crohn's) and a year ago admitted to the med/surg floor where I work. Of course I got stuck with the nurse who is known to not give pain meds easily. She would lecture me for 30 mins. when I would tell her that a pt. needed pain med. Anyway, while a pt. I requested my prescribed pain med. She went to go get it and when she came back she told me bluntly "I hope you're not going to be one of those patients where we never see them in pain or throwing up." Those were her exact words. I worked with her and she treats me like this? I can only imagine how she treats others.

And another thing, I hate when we generalize pain based on the procedure. You know the "my last post op bowel obstruction wasn't on a PCA". I know I'm guilty of it and I'm sure there's others out there.

Please tell me more about what types of symptoms you suffer from with Crohns. My friend suffered for years..frequent hospitalizations, TPN, fistulas....she ended up with an ileostomy and has basically been cured.

[hjmcenti]

It really hurts me to hear this! I would like to know what school you are going to!! I work on a med/surg unit and at least 5 out of my 6 patients receive a narcotic pain med at least once in a day. If someone is laughing that does not mean that they are not in pain, it simply means that they are finding ways to deal with it until relief comes. You will always get your "drug seekers", but for every 1 drug seeker you will have 10 that are in true pain. For the sake of your patients, PLEASE do not judge them. Everyone has their own way of dealing with pain. Put yourself in their shoes and think of how it must feel to have to ask for Morphine every 3 hours. Of course they're watching the clock, they are in PAIN!

[BlocDoc]

Like Diabetes, HTN, Throid disease, CAD, Hypercholesterolemia, etc, chronic pain is a disease- In terms of the treatment ramifications, there is no "fix" for the disease, therefore, varied treatments, to include medications, are used to manage the disease prgression, to minimize symptoms and optimize quality of life- If the B/p doesn't respond to the current medication dose, then we raise it and add other meds until the number falls into line- If the blood sugar is too high, we adjust dietary restrictions, increase the oral meds or increase the insulin dosage- In thyroid we go up to .5, .75, .88, 1.0 and in some case, above 1.5 ! Nobody gaives this a second thought - This is perfectly fine from a societal standpoint- You don't find 2 healthcare workers in the hall or 2 people on the street whispering "Do you believe the dose of Cardizem Mrs. Johnson is taking!? She looks fine to me!"

The perception regarding the treatment od chronic pain isn't a patient perceptual problem. It is one of misguided societal mores.

If you believe that a patient has pain, then it deserves the very same aggressive treatment consideration their blood pressure requires.
We are in the business of caring for people- Lets keep our eye on the ball.

[khine2mn80]

Originally Posted by kk2000

Hi.
First let me say that I don't want this to end up as a debate over real pain or drug seeking. What I am looking for is reasons why there is such a suspicion of pain patients.
I am in nursing school, and am discouraged, disgusted and quite frankly angry at what I am seeing as the judgemental attitudes of some nurses. How dare a nurses try to decide who is in pain, or to what severity they are feeling pain.
Mind you,I am a chronic pain patient myself. You would never know it most of the time because I live with it all the time. This is a personal issue with me and I just don't get it. Heres the clincher, we are actually being taught how to recognize a drug seeker, and guess what...i have all the red flags of a drug seeker. My kidney stone patient also exhibited all the red flags, too...should I deny him pain meds as I am seeing some nurses do? Not actually denying, just being so busy it takes 2-3 hours to get him the meds.
So, could you tell me what constitutes a 'seeker" in some nurses minds/
I am seriously considering leaving the profession because of this. I am seeing this across the board, from the ED to a med surg floor, to PACU, for goodness sakes!
please help me understand this!
Please understand I am NOT trying to start a heated debate, I am just very, very stunned at what I am seeing.
K-

hi

i dont like the idea that it takes 2-3 hours to get pain meds to a patient who is in pain. Thats poor nursing care in my opinion. whoever is in pain should be assessed properly and yes pain is a subjective thing. always remember the theory of pain threshold. each ppl have different threshold so why should u cALL them seekers?

[kk2000]

Originally Posted by khine2mn80

hi

i dont like the idea that it takes 2-3 hours to get pain meds to a patient who is in pain. Thats poor nursing care in my opinion. whoever is in pain should be assessed properly and yes pain is a subjective thing. always remember the theory of pain threshold. each ppl have different threshold so why should u cALL them seekers?

Yes, yes, yes...I totally agree. I am the original poster. Just need to point out that I am a huge advocate for people in pain getting timely and effective meds.
I am a pain patient myself and have been really disappointed, sickened, disgusted etc ec, with the way I have seen patiets being treated in the hospital I was doing clinicals at.(from med surg to the er)
Actually I came very close to quitting school altogether.
Thank you to all that replied-good to know there are nurse that give a darn l out there.
I know what it is like to ask for pain meds and be given the runaround. I know what it is like to be at the ER in pain and be sent home being told the "pain was all in my head".(actual quote from the er doctor, only to have an MRI at my expense and find out had 3 herniated discs in addition to the 3 I already have).
Why are students not being taught enough about pain management???
Maybe it is just the hospital I was at, or the classes I was in, but I feel that the general lessons learned in school were to be wary of thoses c/o pain, no matter what the situation.
I find it very discouraging.

[sharann]

Wow, I am impressed with you as a nursing student...you will be one dynamite nurse!
Unless you are an addictions nurse in a specific facility where it is appropriate, I strongly feel that you(or me) should NOT be labeling ,judging, preventing or treating drug seeking. I work in PACU and I give meds out fairly freely. Most of the time my pts are in acute pain and its obvious. Sometimes though, after being medicated with enough drug to kill a Rhinocerous, some of my pts still claim 10/10(even though I can't in good conscience agree).It doen't matter what I think or believe though, it is about what they feel and believe. I refuse to undermediate ONE, just ONE patient because I have a power trip or are playing know it all nurse. I want to sleep at night. I would feel like cutting my arm off at the though of intentionally withholding meds because I was judging incorrectly.
BabyRN2BE and BLOCDOC, I loved your replies, you are right on.
Bethin, I too have Crohn's and have been lucky to have very few times I was in that much pain EXCEPT once. I went to ER 3 yrs ago with severe pains in my left chest area(mimicked angina). I was 34. The ER doc gave me a knowing look and the a cocktail of stuff to "settle" my "heartburn".
He came back an hour later with his tail between his legs and said "You have acute Pancreatitis, that really hurts". No crap Einstein
Please remain a fierce pain advocate