Isn't pain whatever the patient says it is??? - page 4

Hi, I'm pretty P.O.'d too.... Am a Hospice nurse with a patient who's had a lifelong hx of neurological pain. Each time I see her she c/o pain "all over", is grimacing, moaning, cries out when... Read More

  1. by   tiroka03
    Quote from earle58
    hi momcat,

    what is your pt.'s dx for her to be in hospice? also, neuro pain is one of the more challenging types to treat. as for mcaffrey's "pain is whatever the pt. says it is", i have mixed feelings about. but since your pt. is clearly exhibiting textbook signs of pain, you are 100% correct in trying to get it controlled. it drives me crazy when nurses write in their notes, " no c/o pain" or "denies pain". that is such a crock for there are so many patients that will indeed deny pain for many different reasons. i would pursue any channels you must to get a scheduled regimen started, and document very clearly all pertinent data. you've done good....thumbs up to you.
    I've had people deny pain, and I know for a fact they are having pain. But, I can't force pain pills down their throat. If they refuse to take the pill, what is your suggestion?
  2. by   dhudzinski
    If what the patient is saying does not correlate with the behaviors that you are seeing (ie pt is grimacing, guarding, refusing to move, irritable etc) then I usually have a little sit down with them and ask some more specific questions and share my observations. ex (You say you have no pain, but your body is saying something different to me. You are grimacing and guarding your movements and this says to me that you are in some discomfort. The pain medication that the Doctor ordered will take away some or all of your discomfort, would you like to give it a try.) Sometimes I will even ask them why they need this pain? It is amazing some of the answers you will get.

    We don't want to force pateints to take meds and they do have the right to refuse any intervention without fear of retaliation but we need to be sure that they understand and are making an informed decision based on fact and not some myth or other false information.
  3. by   lawrencenightingale
    Quote from dhudzinski
    The problem with that is... what are you basing yourjudgement on? Pain is so subjective and the only one who can judge how much pain and when it is there is the patient. Pain assessment is absolutely important BUT it must be a thorough systematic assessment if it is to be of any value.

    Judgement is a value statement. Assessing and then using Critical thinking to come up with a plan as to how you might best intervene...I know it is symantics and a bit picky BUT....
    I'm basing my judgement on my nursing assessment. A nursing assessment is critical thinking which leads to judgement. Perhaps judgement is a value statement in your opinion. Judgement in my opinion is an intellectual process. A process that experts(neurologists,e.g.) agree is among the highest of human abilities. CATscans/MRI's show the seat of judgement to be located in the forebrain. Because of our large forebrains with it's capacity to judge, homo sapiens survived(according to anthropologists,zoologists,et al.,). It wasn't our size,strength,numbers,speed,fangs,claws,flying/swimming/camouflaging/envenoming ability but our capacity for cognition which is responsible for our existence today. Judgement is an attribute of cognition. It's a good thing. Viva la judgement!
  4. by   leslie :-D
    Quote from walkmygardenpath
    I've had people deny pain, and I know for a fact they are having pain. But, I can't force pain pills down their throat. If they refuse to take the pill, what is your suggestion?
    i find the most valuable intervention is to establish a very therapeutic and trusting relationship with them, as is what i do w/all my patients. i've had many patients refuse to take narcotics because of unspoken fears/concerns. but it's very helpful if they trust you and what you tell them, and give them complete control over their decisions.

    one lady i recall was in excruciating pain towards the end of her life. she ended up sharing w/me that she deserved this pain because of her perceived past sins. we worked closely together; we experimented via many discussions, trial and error and many md order changes. she died, free of physical and mental anguish. but it was a matter of being committed to the cause...it's not always easy but 90% of the time, it works. peace.

    leslie
  5. by   tiroka03
    Say registered nut, and others who have replied to my question about pt refusing pain meds. I appreciate your replies. This has given me a lot to think about. Your answers are right to the point and I will start to use them right away. THanks
  6. by   lawrencenightingale
    Quote from earle58
    i find the most valuable intervention is to establish a very therapeutic and trusting relationship with them, as is what i do w/all my patients. i've had many patients refuse to take narcotics because of unspoken fears/concerns. but it's very helpful if they trust you and what you tell them, and give them complete control over their decisions.

    one lady i recall was in excruciating pain towards the end of her life. she ended up sharing w/me that she deserved this pain because of her perceived past sins. we worked closely together; we experimented via many discussions, trial and error and many md order changes. she died, free of physical and mental anguish. but it was a matter of being committed to the cause...it's not always easy but 90% of the time, it works. peace.

    leslie
    Couldn't agree with you more. Interesting that so many nurses,I'm one of them, feel dutybound and actually honored to persuade their patients to take a pain med because signs(physical criteria) indicate the patient needs a pain med - eventhough the patients repeatedly refuse a pain med. It is the judgement of these nurses that the pain is not being accurately reported(that the patient is wrong). The subjective patient accounts of pain in these cases are overridden by the objective assessment of their nurses. Rah! This is what we're supposed to be doing - in my view - provide objectivity(because we care). It also works the other way,folks. Patients err in reporting pain. Sometimes they exaggerate - just like they sometimes deny or minimize pain. Why is it okay to disagree with our patients when we sense they are denying or minimizing their pain but many of us,if this website is any indication, won't countenance the possibility of our patients exaggerating or inventing their pain? Our clinical skills are good enough for the former but not the latter? Doubt it. Does giving meds turn us on?
  7. by   leslie :-D
    and NOTHING gets my blood boiling more is when nurses chart "denies pain"...it is so NOT a one question assessment, i.e., are you in pain?

    i've seen nurses chart, "pt. moaning and grimacing when repo'd. denies pain". :angryfire :angryfire :angryfire

    just a little pet peeve of mine.

    leslie
  8. by   Angela Mac
    I have posted this remark in regards to drug seekers.
    Luckily- some medical centers and emrgency rooms have a system to fall back on when they are suspicious of "drug seeking personalities"- I worked at a medical center that had a RED BOOK. It listed the names of patients who frequently came in with PAIN. Other MD offices, the ER, and local pharmacies kept a record of those patients seen for PAIN. You would not believe how many RED FLAGS went up with the local pharmacists- who, in turn, called the MD back when prescriptions were called in.
    ex: Joe Doe was seen in four different MD offices for knee pain & prescribed- percocet, demerol, & Lortab......all within a two week period.
    This is handy. Most of the DSP patients paid in cash, with hopes that no records were being kept.
  9. by   teeituptom
    Quote from Angela Mac
    I have posted this remark in regards to drug seekers.
    Luckily- some medical centers and emrgency rooms have a system to fall back on when they are suspicious of "drug seeking personalities"- I worked at a medical center that had a RED BOOK. It listed the names of patients who frequently came in with PAIN. Other MD offices, the ER, and local pharmacies kept a record of those patients seen for PAIN. You would not believe how many RED FLAGS went up with the local pharmacists- who, in turn, called the MD back when prescriptions were called in.
    ex: Joe Doe was seen in four different MD offices for knee pain & prescribed- percocet, demerol, & Lortab......all within a two week period.
    This is handy. Most of the DSP patients paid in cash, with hopes that no records were being kept.

    Trouble is it violates HIPPA
  10. by   momcats3
    Not sure if I made it clear, I'm a Hospice nurse, work in LTC, and my original post was related to a Hospice patient. Pain management in Hospice is a unique specialty (yup, it really is). I've had many nurses who've stated to me "Well, they look comfortable, it's only when you move them that it hurts"..... I've seen patients who deny pain constantly. Then, when the family isn't there, they admit it to me. They don't want their families to be worried, or be perceived as a "baby". I had one patient who'd told me "No, I don't hurt" and "No, I'm not having any pain". I'd ask her in many different ways during my assessment, and she always denied it. Yet when I asked her how her knee is feeling today, she told me "Oh, it really aches today" and confirms she'd like some medicine. Staff are unable or unwilling to take the time to really ask the right questions, and listen, and use proper assessment skills. I've had patients actively dying, with HR 120, RR48 & labored, whose NP's refuse to schedule MSIR, instead leaving in PRN's because they're afraid of snowing the patient. Sorry, but using PRN's in LTC with Hospice patients is a joke. It just doesn't get utilized despite our best efforts at teaching. The staff, usually agency, don't want to deal with it. Call it simplistic, but what it comes down to me when I see my patients in such distress is "Would I want this for my mother? (or father, friend, etc").
    Last edit by momcats3 on Aug 14, '04
  11. by   leslie :-D
    i agree with you 100% momcat....

    prn's are a joke, unless it's prescribed for breakthrough pain but you still need a scheduled pain regimen.

    but prns don't mean a darned thing if nurses are not going to properly assess pain rather than just stating "patient denies".

    SO much more education in pain mgmt. is needed for the mds and many nurses. it is so infuriating.

    leslie
  12. by   lawrencenightingale
    You sound like a good nurse - one that realizes that asking a patient one, simple question about pain is not a pain assessment.
  13. by   teeituptom
    Im a firm believer

    just give them a menu to choose from

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