Mom Needs a Pain Pill

demylenated, BSN, RN · Jul 20, 2012

I am speaking from a pt perspective. I spent 32 days in the hospital. I also have a chronic d/o that has pain associated with it. Some of the nurses were less than kind (that is another story in itself. One story where I still cry when I think of what happened. And, yes, I complained all the way up the chain. It was a military facility, so I know she didn't lose her job).

They all knew I was a nurse AND in nursing school. I think it intimidated some of them. I never played the "nurse card." NEVER. (My husband mentioned I was in nursing school and the Dr. knew I have been a nurse for 10+ years.) My husband would notice I was in pain. He knows my signals... he also knows I don't like to take too much pain medication. I was on a pain pump, and I could get 2 different PRNs (yes, it was a pretty significant hospital stay). I was afraid of getting labeled, and I was just afraid of taking too much. Being a nurse, I think it actually hurt me. My pain "wasn't significant enough" to take them away from what they were doing. That is what I would always say... LOL. There was times HE would point out I needed some pain medication. HE was MY advocate. I thank God he was there almost every hour of every day... He was amazing.

Families know their family members. Please take them a little more serious. I know sometimes they are not right... but when it comes to things like pain and sleep... they have important input.

Been there,done that, ASN, RN · Jul 20, 2012

I spent two years from paid nursing.. to take care of my family members.

Especially my father. He had a chronic pain issue.. that he hid with a big smile and a big heart.

As he weakened in his old age.. he gave up trying to explain his pain to the '"SYSTEM"

#1 Rate your pain on a scale of 1 to 10

#2 Where exactly is your pain

# 3 You have already received the prescribed dose.. you can't get anymore.

He turned to me .. to communicate his pain and pain control requirements. At one point .. he required 80 milligrams of morphine an hour. I had to get anesthesia and pharmacy to change the PCA settings to deliver the required dose.

Every case deserves our utmost assessment. Don't assume ANYTHING when it comes to pain control.. listen to All parties involved.

Pain is NOT about the nurses perception.

Pain is what the patient. and sometimes the family.. says it is.

cherryames1949 · Jul 20, 2012

I have seen patients left to suffer for all kinds of explainable reasons. My only hope is that if I ever need relief the person in charge of my care is proactive for me.

jasnms · Jul 20, 2012

If the patient is cognitive, then it doesn't matter what the family wants. Our job is to provide care for the patient. I have worked in many nursing disciplines; peds and geriatrics can be the most difficult. But if a child is crying and you know it's because of pain, then administer the medication the MD has ordered. If the patient is elderly but not cognitive enough to say yes or no, use your own nursing judgement by facial grimacing, crying, how the patient is behaving. Remember documentation is everything. Document that the family is requesting pain medication and why you did or did not administer it. Documentation will save you from disciplanary actions.

Been there,done that, ASN, RN · Jul 20, 2012

If the patient is cognitive, then it doesn't matter what the family wants. Our job is to provide care for the patient. I have worked in many nursing disciplines; peds and geriatrics can be the most difficult. But if a child is crying and you know it's because of pain, then administer the medication the MD has ordered. If the patient is elderly but not cognitive enough to say yes or no, use your own nursing judgement by facial grimacing, crying, how the patient is behaving. Remember documentation is everything. Document that the family is requesting pain medication and why you did or did not administer it. Documentation will save you from disciplanary actions.

It doesn't matter what the family wants?

Snort** giggle** wheeze.. and coffee on the monitor. The FAMILIES and the PATIENTS have been running the show for a long time now.

Patient care is now a business ran within the customer service model.

The family knows the patient better than any nurse could. You could assess pain and anxiety with our little nursie tricks until the cows come home.. without getting the real picture.

The patient and family is everything, not documentation.

Treating them with concern and respect will save me from disciplinary actions.

CoffeeRTC, BSN, RN · Jul 20, 2012

I dunno, I tend to listen to the families. If they say mom needs xyz, I would go in and assess the resident. I will then use nursing judgment and educate family as needed. A lot of times they might not have complained to the nurse or the family might just want mom to be very comofortable and didn't know that we might have already done xyx for the resident.

I think the OP might be talking about the situations where daughter doesn't want to leave until mom is sleeping or relaxed. If they have dementia, you might need to creat a diversion so that the daughter can leave. Maybe the daughter feels powerless? I've shoo'd many a family member home and reminded them to call when they get home and check up on mom or dad. Talk to them, show them you really do care and are on their side.

BelgianRN · Jul 20, 2012

It doesn't matter what the family wants?
Snort** giggle** wheeze.. and coffee on the monitor. The FAMILIES and the PATIENTS have been running the show for a long time now.
Patient care is now a business ran within the customer service model.
The family knows the patient better than any nurse could. You could assess pain and anxiety with our little nursie tricks until the cows come home.. without getting the real picture.
The patient and family is everything, not documentation.
Treating them with concern and respect will save me from disciplinary actions.

I interpreted the message of jasnms that he/she meant to follow the patient's wishes over that of the family if the patient is fully capable of making their own decisions. And I agree that we can't force something upon/into a patient just because the family wishes it so. In the end it's the patient that gets the final say. And if a fully capable patient decides he doesn't want pain meds even though he is in pain all we can do is educate, talk and convince them of the benefit of pain meds. But no is no.

And yes you are absolutely right the family knows their family member best. But they also have emotional ties to them and sometimes fail to see things in the proper perspective. Been there, done that you are a capable nurse even when caring for family members and you are blessed with an in depth knowledge and understanding of the family members you cared for... But not all family members mean well, have the best interest of the patient at heart or know as much about pain and medicating it.

I like Ashley's suggestion of asking the family members what led them to believing the patient is in pain. There could be important clues there to find out that we would be missing when they are not around to advocate for the patient.

JZ_RN · Jul 29, 2012

When a family member wants pain meds or other PRN meds, I go through FLACC, ask the patient if the patient is able to communicate pain, etc., then go off the patient's wishes or my own assessment. I often will tell people, it doesn't appear Mrs. S is in pain, she is calm, breathing normally, legs and arms still, doesn't seem to be hurting. She says she only wants a tylenol, etc. That makes it focused on the patient, not the requesting person. If all else fails I just will say that the doctor doesn't want me to drug someone unnecessarily.