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| No. 60 | 
Dec 24, 2003, 02:30 AM
Originally posted by gwenith
Once again I will ask all posters to show respect for each other. As health professionals we do not like to contribute to addictive behaviour that is deleterious to the person - on the other hand pain is what a person says it is - hence the dichotomy.
We are torn between wanting to help and to act in an efficient and timely manner to relieve pain and not contributing to an addiction that will cause more problems for the patient
Gwenith! We need nurses like you in Detroit! 
My posts, while I have "taken to task", somewhat, the advanced practice folks, it is solely because they seem to forget that others have valid experience which is appropriate to draw upon. Certainly we are, most of us, in this to make a difference in whatever way we can. Don't throw your (not you, Gwenith) credentials in my face and attempt to denigrate my experience and compassion.
Yes, we need not to be TOO judgemental with our patients. And, true, with chronic pain, we may mistake some tolerance of the pain as a lack, thereof. But, I feel, as you, that we all truly care about pain control.
But, there are the junkies that come in and need an EJ or central line placed 'cuz they've used up everything else. And they slip out for a smoke after getting doesed or complain that our turkey sandwiches are too dry, or "why can't I get a meal, rather than a snack?", etc... The abusers....
No, don't be too judgemental, but open the eyes and see what is there, yes?
PS: Just took my wife to the local ED tonight for bad tooth pain... Very slow to deal with her, but they ultimately DID give her the appropriate relief. 
ERKev
 | | Advertisement Sponsored Links | | | | No. 61 |
Dec 24, 2003, 08:41 AM
Originally posted by ERKev Gwenith! We need nurses like you in Detroit!
My posts, while I have "taken to task", somewhat, the advanced practice folks, it is solely because they seem to forget that others have valid experience which is appropriate to draw upon. Certainly we are, most of us, in this to make a difference in whatever way we can. Don't throw your (not you, Gwenith) credentials in my face and attempt to denigrate my experience and compassion.
Yes, we need not to be TOO judgemental with our patients. And, true, with chronic pain, we may mistake some tolerance of the pain as a lack, thereof. But, I feel, as you, that we all truly care about pain control.
But, there are the junkies that come in and need an EJ or central line placed 'cuz they've used up everything else. And they slip out for a smoke after getting doesed or complain that our turkey sandwiches are too dry, or "why can't I get a meal, rather than a snack?", etc... The abusers....
No, don't be too judgemental, but open the eyes and see what is there, yes?
PS: Just took my wife to the local ED tonight for bad tooth pain... Very slow to deal with her, but they ultimately DID give her the appropriate relief.
ERKev hi erkev!
i am glad your wife was given relief. hi gwenith!
none of my posts were meant to be taken personally by any one on this bb.
we as humans are lucky to have been builtwith our very own bb inside. it is our sence of humor. truley, if we did what we did day in and day out and couldn't joke about it in some aspect, we would explode. so please take my posts for what they were intended...intended for venting (and never being judgmental)! thanks to all of you! you have made my world more fun! 
magik girl
| | No. 63 |
Dec 24, 2003, 09:45 AM
i actually think that we all have very good points - on both sides - and it is primarily attributed to what we see/ what we do.....
i truly think we - in a way- we are arguing two sides of the same coin
yes the majority of er patients c/o of pain are in pain
yes - we see those who are lying just for the narc's
so - i think perhaps discussing how nursing as a profession should deal w/ this is a better avenue
- should we just medicate everyone until they rate pain 0/10?
- even to the point of intubation?
- is it wrong to feed addictions?
- how do these things affect our views, our empathy?
- how do return visits, etc effect insurance premiums or
hospital bills?
- who is responsible for health?
i think that these questions stimulate so many answers, yet so many other questions that perhaps our focus should be health promotion - and what we need to do to encourage those promoting strategies.
| | No. 64 |
Dec 24, 2003, 11:20 AM
Originally posted by athomas91
i actually think that we all have very good points - on both sides - and it is primarily attributed to what we see/ what we do.....
i truly think we - in a way- we are arguing two sides of the same coin
yes the majority of er patients c/o of pain are in pain
yes - we see those who are lying just for the narc's
so - i think perhaps discussing how nursing as a profession should deal w/ this is a better avenue
- should we just medicate everyone until they rate pain 0/10?
- even to the point of intubation?
- is it wrong to feed addictions?
- how do these things affect our views, our empathy?
- how do return visits, etc effect insurance premiums or
hospital bills?
- who is responsible for health?
i think that these questions stimulate so many answers, yet so many other questions that perhaps our focus should be health promotion - and what we need to do to encourage those promoting strategies. BRAVA!!!!!!!  | | No. 65 |
Dec 24, 2003, 11:48 AM
 Re: pain...... Originally posted by Rapheal
I just have to say it. Sorry but I have to say it.
I feel sorry for my patients who are in pain. Pain is subjective and I will administer the patients pain meds based on what they say it is.
BUT-
In healthcare their is an allocation of resources. My TIME is a scarce resource. So when a person who has chronic pain issues and has PRN narcotics ordered starts DEMANDING that they need their pain medication NOW, and will cause such a ruckus if it is not delivered within minutes of their request it may become a problem. The problem may be that the little old lady down the hall has developed a heart arythmia or pulmonary congestion. She may not be screaming for help- in fact she may just lay there getting worse until you the nurse intervene.
That poor little old lady needs help now. She may not have the ability to call the NM and start screaming for help NOW. So then I have a decision to make. Sometimes my decision is not a popular one. Sometimes the person who can scream, can be demanding will do so at the expense of another, more fragile, more vulnerable patient. Hence- this nurse, or anothe nurse in the same position may feel frustrated. Resources should not be doled out based on the aggressiveness of a patients' demands.
There I have said it. I hope to not appear unsympathetic to our patients who are in pain. And although pain is the 5th vital sign, it may cause a life altering condition and not a life threatening condition. And I as a nurse will put a life threatening concern first. So some patients may have to be in pain a little longer than we both would like. We both end up frustrated, but sometimes that is just the way it is.
Claps hands vigorously and then jumps to feet in encore!!!!!!!!!!
| | No. 66 |
Dec 24, 2003, 11:56 AM
Originally posted by Erin RN
Couple of things to think about:
1. Although pain is not "life threatening" in itself it can be indicative that something life threatening is going on..hence the 5th VITAL SIGN.
True Story: We had a guy some in to the ER that was a "frequent flyer" complaining of abdominal pain. Of course we all rolled our eyes, saying, "whats new". We gave him Donnatol and Lido..of course the pain was still 10/10 again rolling of the eyes..we knew he wanted the "good stuff". The staff taking care of him put him on the low priority list due to his past history and our predjudice against him..Finally after sitting in a room for several hours the MD scanned his belly just in case. He was perforated and had to go and have an emergency appy. The surgeon screamed at us when she came in over the amount of time we had basically let him stew. He ended up in the ICU for over a week with a systemic infection and brought a suit against the hospital maintaining that IF the ER staff would have taken him seriously then he would not have become septic. Would he hve? It is unknown BUT try to defend your actions in depostition on that one..."Um well he is usually full of crap so I figured this time was no different...A plantiff atty would tear you a new one for that. Now I know I am going to hear variations of the little boy that cried wolf here but a BIG part of nursing and critical thinking is based on remaining OBJECTIVE to the patient at hand. That is part of our responsibility as healthcare providers. By not doing so, the staff in our ER put a patient at high risk..not something any of us were proud of.
2. As far as the patients that come in over and over for narcs and the fact that we as nurses think it is bull..the MD is ordering these. If the supply dried up they would no longer come. Maybe rather than complain and complain about the patients go speak to your MD group or refuse to give them. I have seen more than one nurse say, "NO". I told an MD "No" once since the pt was so completely gorked and her resp were so slow in my judgement it would not have been safe to give her anymore. After I told the MD her vitals etc he agreed.
I no longer work ER and am glad when I read these types of theads. I used to be the same very judgemental and the pt basically had to "prove" to me that he/she was really deserving of that pain medication. It is sad really. Bottom line is the seekers are not going to go away so I agree with the NM "give em what they want and get em out"..wasting emotion and time on being "mad" at the pt only serves to take away from the nurse.
Erin
Basics assess the Pt not the chart but I can see how in an ER as you described that exact situation must occur (the seeking not the Appy) thousands of times a day across the United states.
| | No. 67 |
Dec 24, 2003, 12:22 PM
Ok State Forum
Well my two previous posts were just spur of the mooment barvos as it were. When this subject gets rollong there are really some very masterful ways to make a point. There are ways that are sort of finesse. They are both creative and offered from the perspective of the author. I finally read the entire thread. Things really get heated and then one person is offended and the ball starts rolling and MAN!
What I see here is the total lack of Unity that we as a profession should endeavor to promte, nurture, and pray for!
We are all individuals most assuredly. We are all providing care in a manner that we personally deem appropriate. We all have some things that we would love to change about our porfession. We all obviously work in a HIGH stress environment. We should all try to undesrstand and support our brothers and sisters in our chosen field. We should discuss with an eye toward education and temperence. We should LEARN to get along.
wiping the tears from my eye as the screen blurs
| | No. 68 |
Dec 28, 2003, 12:21 AM
you may have been taught that pain is what ever the patient says............but. having been a nurse for umpteem years, my ******** detector is fine tuned. If a patient is moaning when I'm in the room, and laughing on the phone, when I'm standing outside the room, then I'm not sympathetic at all. for all of you who have never worked er.... get off your soap box, it ain't flying here.
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