[mustangsheba]

This is indeed a very difficult subject. However, with all due respect to the pain of those whose families have drug problems, there are so many patients who suffer excruciating pain unnecessarily because of those who abuse medications. My own mother who was dying of bone cancer could not get a one-time injection to transport her 200 miles because the doctor thought she was seeking attention. And I can cite you hundreds of similar cases. We can deal with addiction after the acute pain is alleviated. It is not okay to allow the majority of nonabusers suffer for the transgressions of the abusers. Huganurse: I know this is painful, but if intervention hasn't worked for your family, the rest of us should not have to suffer. It is frustrating and sad - but, bottom line, unrealistic for you to expect ER personnel to police these respectable drug seekers. ER is acute, emergency intervention and followup is usually PCP. If you have family members whose safety concerns you, seek intervention with a treatment center for substance abuse. They can advise you about what steps to take. I wish you well.

[HotSpam]

While we are of course curious to know if someone is "drug seeking" it is ultimately the doc's decision what they get, and if they get.

Basically, with the exception of the ARNP, we aren't going to be ordering any meds for these patients anyway.

But I do get the point. I think we take law inforcement a little too serious. I would rather participate in accidently dosing a seeker than denying a sufferer. I don't think the illegal use of legalized drugs is nearly the problem some make it out to be.

HotSpam

[Huganurse]

I don't know what the answer is here. As a nurse would definatly give an ordered med to a patient for pain management and in the ER or acute care setting would not hesitate to give the doses as prescribed.

As a newly licensed nurse, many years ago, I remember a young woman that was admitted to the hospital I was working at. This young lady(in her 20's) had Lupus and multiple other health concerns. She watched the clock and timed it perfectly for when she could have her pain meds. I remember the RN on duty always making nasty comments. (I'm not picking on RN's, but she was the only one that could give the injections at that time) This nurse would always say something like, "She can wait, she's not in that much pain." This young lady died within a week or so of admission. Yes she was a frequent admit and she did call for her meds as soon as they were available to her, but from the fact that this little lady had so many problems, and remembering the uncaring remarks I heard said, I always consider pain to be what is stated, as I cannot see inside their mind or feel what they feel. I remember this nurse being very upset once this young woman died and it DID make a difference in how she cared for others from that point on.( she was a very good nurse from the beginning it's just that she made a judgement in her mind) I have had residents that I felt called for pain meds, not because they were in pain but for the fear of pain, but since the meds were ordered, I gave them as ordered but when I have had true concern, I have asked the MD to evaluate for another medication that could be more effective. It's hard not to have human thoughts but I will never forget this young girl, and she influences the way I react.

[mustangsheba]

This will continue to be a problem long after we have joined Flo on the other side. It is especially hard if we have loved ones that suffer from addiction or untreated pain. Drug abusers tend to be treated punitively at times when it is appropriate to treat their pain aggressively just because they have a history. Every patient needs to be evaluated and treated based on their immediate needs with followup in the care plan for aberrant behaviors. At least that is my fantasy.

[jamistlc]

Originally posted by fergus51:
<STRONG>I think we are horribly arrogant to think that if we (the medical professionals) can not find a reason for someone's pain than it doesn't exist. Just think of all the different conditions that didn't even exist 20 years ago. Diseases like chronic fatigue and fibromyalgia are still mostly mysteries. </STRONG>

Greetings All Nurses,

I get mad with that term as a person who has migraine HA's I have heard that said of me and my wife she too has migraines. It took many years of going from Chiropractors, nuerologists and such to discover I have TMJ. There were many times I would go to the hospital after days of a HA with no relief from OTC analgesics and anti inflamintory frugs! I would go and what would they give methergine and a script fot Motin. Yea like it was effective. It was my dentist who finally figured it out and confirmed with a pana xray! He treated my HA's and now I am painfree with episodes down to once twice a year. He treated it with a night gaurd and manipulation of the bite! It works I highly recomend it!

As far as the term "Drug Seeking Behavior" it is one of those buzz words that really **** me off! Pain is subjective and I thought I was taught All Pain is real regardless of it's origin! To me that means even the person who is addicted is having pain when they say they are having pain! It does not mean only if you can find a physical cause! Even Psychosomatic pain is real ask any amputee about phantom pain!

I think that if someone comes into your ER and is drug seeking you should think about what I just said and it is better than them self medicating it themselves!

Drug seeking is a label that we healthcare providers use to label someone and labels lead to discrimination, are judgemental, and do not help the client. It gives us a sense of wellbeing, a supierority complex, and an out for not treating the pain or person how holistic is that?

[fergus51]

Originally posted by moonshadeau:
If you reread my post again you will see I did not say that "ALL nurses cold cruel and uncaring". I said I have seen patients pain being ignored by nurses who are cold cruel and uncaring. I am a nurse so please do not lecture me about perpetuating the bad rap that I myself have. (I am not trying to be snotty or anything, I just think you didn't read what I wrote).
ps
It wasn't only one particular nurse. I have seen many and I will not apologize for calling them (not you and every other nurse) what they are.

And Fergus, not all nurses are cruel, cold and uncaring and that is an unjust remark. You should have said that PARTICULAR nurse was uncaring. I take offense to your remark and you are only further perpetuating the bad rap that nurse have by your generalization![/QB]

[fergus51]

If you reread my post again you will see I did not say that "ALL nurses cold cruel and uncaring". I said I have seen patients pain being ignored by nurses who are cold cruel and uncaring. I am a nurse so please do not lecture me about perpetuating the bad rap that I myself have. (I am not trying to be snotty or anything, I just think you didn't read what I wrote).
ps
It wasn't only one particular nurse. I have seen many and I will not apologize for calling them (not you and every other nurse) what they are.

Originally posted by moonshadeau
And Fergus, not all nurses are cruel, cold and uncaring and that is an unjust remark. You should have said that PARTICULAR nurse was uncaring. I take offense to your remark and you are only further perpetuating the bad rap that nurse have by your generalization![/QB][/quote]

[Kris10lnC]

HI butter,
I've never worked anywhere except LTC, but there are nurses who have that "she can wait" attitude, Or other nurses say "it's all in her head". I find that medicating patients promptly cuts down on anxiety, and you'll find they don't hang on the bell an hour before they're due. My feeling is that if they're 90 and they say they have pain, they have pain PERIOD. But of course that's LTC.Maybe try offering Tylenol first? or watching them swallow meds? or see if your hospital would institute a policy for crushing those meds that can be crushed . (nother nurse posted that patients were taking their drugs to the street for sale)

[MollyJ]

I wanted to post once more before this topic dies a natural death.

It is as important for a nurse to have an index of suspicion for addiction as a patient problem as it is for him/her to have an index of suspicion for atypical presentation of MI, aortic aneurysm, brain bleeds, ectopic pregnancy and all of those other problems that sometimes present subtly and look like many other things.

That does not mean that we respond to bell lights and point the finger of suspicion and say things like, "You don't need/deserve this drug."

Clearly, the first thing someone with an acute or chronic pain process needs when they are starting to make too many people uncomfortable about their pain med usage is a reevaluation of their pain management regimen THAT INCLUDES THEM. Are the right tools being used? Do we need to look at adjuncts? are their co-factors?

How many of us would know how to differently manage our client's pain IF they DID tell us they had had a narcotics abuse/addiction in the past and wanted good pain relief but didn't want to go "back there"? Would it be "Toradol for you" or would we talk options with the client.

We live in a very pro-pharmacological intervention environment in our world and in our practice environments. I am appalled when I see so many CHILDREN on 2, 3 and 4 psychotropic drug therapy regimens. Do not fool yourself into thinking that use of controlled substances without careful thought around the issues is always going to be cost-free. That is counter-intuitive to all we know.

Let's be really fundamental about this. HOw many of you have worked with impaired nurses and been the case finder? I have worked with more than one and was never the case finder. I never even had a suspicion. That's wrong folks. We've got to get better at thinking about these issues or we will miss a problem that destroys lives and benefits from treatment as surely as early case finding of MI and those other phenomena I listed earlier.

I believe (as do many in the addictions field) that our nursing ed in this area is relatively incomplete. I witness an awful lot of black and white thinking in the area. ie, ALL drug seekers are addicts. If a person says they have pain, I should give the prescribed regimen, no questions asked. Those are both polar statements and bound to "miss something" over time.

Again, nurses need to learn more about the PROCESS of intervention in order to thoughtfully examine some of the issues that this thread has addressed.