Not staying on top of pain - confusing orders - myths?

[Biogirl4]

I am a first year nursing student who just finished a class about pain management. We were taught, that everyone has an individual pain tolerance and it should be treated if the patient expresses their pain. Fine. I was afraid when I was going into my lady partsl hysterectomy, cystecele repair, rectocele repair combo surgery about pain managment. Everyone assurred me that the hospital would take care of it. The morning after my late afternoon surgery, I was told that I 'shouldn't be in so much pain', "I must have a low pain tolerance", the nurses told me there were no orders for anything but advil and oral diladid. I begged for pain medicine. The 'doctors' (who I found out later were 4th year residents) told me "some women have different pain thresholds and that mine must be low". Every single one of these people looked for my incisions on my abdomen when they did their brief assessment. By the end of that day, the residents and nurses finally realized that I had a lady partsl hysterectomy with as one put it 'wow you had a lot of extra work done - we must have gotten behind on your pain medicine'. Finally they put me back on IV diladid. But wait - the nurses were so busy that they didn't stay up on my pain schedule. I waited three hours past the time for my meds and I was sobbing when my husband came in.

Can ANYONE explain to me how this can happen? Apparently my surgeon wasn't able to follow up with me that morning because of a snow storm. Not one nurse assessed my pain, not one nurse asked where I hurt, what the pain was like. Everyone just kept looking at me like I had a third head. And get this, when I asked the nurses and the resident to check my catheter because it hurt really bad - no one did. Finally, I lost my mind and yelled and insisted. The resident literally came over and said something about 'pain tolerance' and jerked on my catheter - which sent me through the roof and he said 'see that shouldn't have hurt - you must have a low pain tolerance'.

It has now been three weeks since surgery and guess what - I still can not void on my own. That's right. I have severe pain down my left leg, and left perineal area. And I still can't pee. I am in nursing school and I can think of many things a nurse could have done for intervention. Much of what happened can also be placed on the ridiculous actions of the residents, but couldn't the nurses have been more proactive????? Any comments?

[General E. Speaking, RN, RN]

Please report this by writing a detailed letter to the Administrator or CNO. I would be very specific and would name names if you can remember them. Give the exact dates of your hospitalization and which shifts were responsible so the perpetrators can be identified. Give as much detail as you can remember.

This is totally unacceptable and makes me ashamed of my fellow nurses. This hospital needs some serious education in Pain Management and I would suggest so in my letter. Maybe you should write a letter to your local newspaper as well. You could be anonymous.

I am very sorry this happened to you. :hug:

[Biogirl4]

I agree that everyone needs someone to be their advocate. In most cases, this means it is best if they stay with the patient the entire time. Even with good nursing care, things can get missed and nowdays, if you are sick enough to be in the hospital, you are almost surely too sick to advocate for yourself.

Thanks for this thought. You are absolutely right about the advocate. I am getting my degree in nursing and I pre-planned all I could - even the medication orders. Even though I am 'in training' for this, I really was down out out after surgery and really couldn't get my 'mind together'. No matter how I tried to explain my concerns, no one seemed to 'get it'. As a futer nurse I will definitely encourage a patient to have an advocate through their stay - expecially if I know that some health care personnel on my unit may not be astute to paitent needs.

Thanks for all of your support, and I agree that I need to write a letter.

[smily nurse, BSN, RN]

I also am sorry that you had to go through this. I had a fx hip and walked on it for 5 wks..... I have a high threshold.... I taught prenatal classes and tend to breath throught things..... after my hip was pinned they offered pain med..... well I had no pain then.... it was before!!!!

I agree with reporting everyone... whatever that pt says their pain is, is what their pain is.

good luck!!! XO

[caliotter3]

I had basically the same issues and agree that having an advocate can help. I also agree that you should write the letter. More letter writing to the right people might bring about some change in the behavior of some individuals.

[Biogirl4]

Thanks everyone for your advice and well wishes. Just an update. I found out that one big part of my pain was damage to the perineal branch of my sciatic nerve which can happen if someone inadvertantly leans on your leg during surgery (while it is strung up oddly in the stirrups for a lady partsl hysterectomy). I am still taking Tramadol because that pain is still hanging around, but I have recovered ok since then. Finally after week 5 I started to be able to void on my own - around the time the sciatic pain began to decrease. My surgeon said that he must have deinnervated my bladder.

I now have some great nursing insight about having to self-cath for long periods of time. I also have a good idea of what it is like to go home with a catheter leg bag too. I am taking my time to write letters to make sure they are well written. My hope in all of this is NOT to get anyone in trouble, but to bring AWARENESS that nobody at the hospital was truely invested in my care and that their was lack of patient ownership. I just feel so much better hearing from you all that I really did have every right to ask for pain medications and that it WAS bizarre that they told me I shouldn't be asking.

[tewdles, RN]

It is okay to get people in trouble...especially when they are harming patients!

[llerkl, ADN]

I am SO SORRY this happened to you!!! A few things I am thinking, based on the information you have provided.......Sounds like the nursing staff did not understand that you had MORE than a lady partsl hyst and were basing their administration of pain medication on that alone. You certainly would require more pain meds with the surgery you had!!! The other thing I wonder about.....do you have a chronic condition (I mean pre-op) that causes pain or changes your normal pain response? Such as fibromyalgia, some type of neuropathic pain or the like?? Were you on any medications pre-op?? If so, what medications??

I am a Pain Management Nurse and when I have trouble managing a patients pain after surgery on the current meds ordered, I ALWAYS go to the patient's history. I look for other diagnoses or currently prescribed medications.

Were you taking the ibuprofen and oral dilaudid, as often as they were ordered and the maximum dose ??? If you were and you were still having uncontrolled pain, the nurse had an obligation to notify the surgeon of your unrelieved pain and obtain further orders to assist in managing it.

Again, I am so sorry for you and hope you will recover from this awful ordeal.