okay, this could be a stupid question/story, but my degree is not in nursing - i start this summer
so, when i was in the hospital after a c-section (with my 2nd child) and my son was in NICU - i was prescribed to lortabs (2 every four hours). since i was staying in the hospital, i didn't have to go out and get a prescription - the nurse brought it to me...while i was there.
when i had my first child, i was released from the hospital the next day after my c-section - went to the pharmacy, and took MAYBE 5 or 6 pills once i was home. the rest stayed in my med. cabinet.
but with my 2nd child being in NICU and me being stuck at the hospital without being able to breastfeed, hold him, and do all the things new mothers usually do - i was a nervous wreck and stir crazy - wanting to walk to see him, wanting to walk to the ice machine, wanting to put on make up, wanting to go develop pictures - wanting to do ANYTHING besides sit in the hospital bed without my baby!
point being - since i was doing so much running around, i actually needed the pain meds this time. so, after about 6-7 hours without, i asked the nurse if i could have some and she was nice and brought them to me. i suspected that she'd bring me some 4-5 hours later. when she didn't, i asked again. she brought them to me. i asked if they could just bring them to me when they had the chance (around the time i was prescribed) because i would be needing them and i didn't want to bother them - and she said no, and that i had to ask for them. i felt like a drug addict begging for meds every 4-5 hours! i hated it. and after a few times of asking, i felt like THEY were treating me like one!
why do you have to ASK for pain meds in the hospital when they're prescribed after surgery? i'm sure there's a reason - it just made no sense at the time.
If you weren't being assessed for pain on an ongoing basis post-op you should have been. When being assessed if you stated you were still in pain the PRN drugs should have been given as long as they were within the proper timeframe. It seems the pain the OP experienced was on par with her surgery and how most patients in similiar situations respond.
maybe she thought by coming in the room to see what i was doing, i was being "assessed" but as far as asking me, "are you in pain" or anything of the sort - no, she didn't. the only thing that happened that i would consider an assessment is when i wanted to take a shower. the nurse had me go from the bed to a chair and said she'd come back in an hour and if i was able to get to the chair, sit there with no problem, etc. then i could shower when she came back. i had to have help to the shower and help putting on some funky underwear, but afterward i started feeling better and being more active (so long as i had medication). i never got medication in the middle of the night when i was asleep, but i do remember the pain was always bad when i first woke up and tried to move - and i would wake up a lot earlier than normal like 5am. i'm pretty sure i could've gone with very little medication had i stayed in the bed like i did with my first child, but why would i stay in the bed to keep from being in pain/needing meds when i could take them and be productive.
can you cite your source please? i hope you are kidding. pain is what the patient says.
reposted from pg. 14 of the thread:
pain and ethnicity in the united states: a systematic review. journal of palliative medicine; dec2006, vol. 9 issue 6, p1454-1473.
"abstract:
background: evidence suggests that racial and ethnic disparities exist in access to effective pain treatment.
purpose: to review evidence of these disparities and provide recommendations for care and further research.
design: systematic review methods: we conducted a medline search using the mesh terms of ethnic groups, minority groups, pain, analgesia, and analgesics. we included studies describing current practice patterns, utilization of available treatments, treatment outcomes, and patient and provider knowledge, attitudes, and behaviors.
results: our search identified 35 journal articles describing the effect of patient race and ethnicity on pain assessment and management. three studies on pain assessment revealed that minority patients are more likely to have their pain underestimated by providers and less likely to have pain scores documented in the medical record compared to whites. eleven of 17 studies found that african americans and hispanics are less likely to receive opioid analgesics and more likely to have their pain untreated compared to white patients. three studies revealed that minority patients are more likely to have negative pain management index (pmi) scores--undertreated pain--compared to whites. patient-related, provider-related, and pharmacy-related barriers to effective pain management were identified.
conclusion: the majority of studies reveal racial and ethnic disparities in access to effective pain treatment akin to disparities found in other medical services. quality improvement initiatives that improve treatment of pain for all patients according to established guidelines should decrease disparities by race or ethnicity. educational interventions should aim to improve patient-provider communication regarding pain and its treatment and should provide support around substance abuse issues. further research is needed to examine pain treatment outcomes and to determine whether health care system factors lead to these disparities."
I'm confused by the sheer number of posts that state that they never wake a patient for pain management. I thought the current literature was that if you don't medicate at night then the patient can wake up in a lot of pain and you're left chasing your tail? Could you explain a bit more why drawing such a hard and fast line is best-practice? Obviously it is per the patient's situation, and yes, sleep is a rare and crucial thing in a hospital, but here is a thread from a pain specialist talking about how patients need to be woken up for pain management purposes.
I don't wake people up for pain meds because there are better ways to deal with it. When a pt. wakes up after a few hours sleep (or a good night sleep if they were lucky) and is in pain because the therapeutic value of their pain pills is gone/was missed while sleeping.....I consider this acute pain. It is worse than the usual chronic pain the pills are meant to deal with, goes away on its own eventually but at the expense of stoking the fires of the chronic pain.
To deal with acute pain, IV pain meds that act very quickly are preferred. I have no problem giving an IV pain med along with w/e pill they are on for chronic pain. The IV med keeps you from "chasing your tail" and gives them relief, the pill keeps them there. Orders for situational IV pain med administration are very helpful..........."IV morphine in the AM upon awakening if pt reports severe pain"..........."IV Dilaudid prior to dressing changes".................."IV morphine just prior to leaving for PT/OT" ect ect. Doctors love these types of orders along with PO pain management rather than having another PRN IV med that the pt. will often choose over the PO.
Now, the Nurse Ratchet types will sabotage this formula for the pt. right off the bat. "Sorry, I have to wait an hour between administering the two narcotics" is their favorite line. Again, its passive aggressive behavior, not nursing. You'll NEVER find it in any hospital procedure/policy manual that a pt. must wait an hour between their IV and PO pain meds or their pain meds and sleep pill..........but N. Ratchet somehow decided to enforce this rule written in invisible ink.
Finally, to end, the reason I choose this way of dealing with things and draw the hard fast line of not waking people up is............sleep is harder to come by than pain meds are. Sleep is every bit as much a part of the healing equation as pain management, but I can't go to the Pixis and give them "5 hours of uninterupted sleep IV". So, when I see a pt. getting said sleep, I let'em get it all, then manage the pain upon awakening.
i think there is alot of misunderstanding here based on different work environments. PRN q4 in long term care is gonna be alot different than PRN q4 post op. Pain will be anticipated postop and it should be of no issue for a patient to request timely dosage of pain meds, PRN or not. In a hospital, a doc is gonna be rude if you call to change an order when there is already a PRN ordered that is sufficient in pain control, but im just a student so i might be wrong.
i think there is alot of misunderstanding here based on different work environments. PRN q4 in long term care is gonna be alot different than PRN q4 post op. Pain will be anticipated postop and it should be of no issue for a patient to request timely dosage of pain meds, PRN or not. In a hospital, a doc is gonna be rude if you call to change an order when there is already a PRN ordered that is sufficient in pain control, but im just a student so i might be wrong.
"Experience is the best teacher." My favorite proverb!:)
Specializes in Oncology; medical specialty website.
I don't know any experience nurse who would awaken a pt to ask them they needed a prn. We do NOT give prns w/o a pain scale assessment, so it isnt as though we could even admin something IV. I also do not ask pts if they want a prn, nor would I honor such a request as the OP. I would routinely visit the pt and inquire about pain. If at hour 4 he doesn't want anything he may actually have to make the effort at hour 5 to (gasp) press call bell. The OP struck me as unreasonable, entitled and likely abusing narcotics. At the very least, she completely misunderstands medication ores and the role of the professional nurse.
I completely agree.
I am a strong advocate for pain control, but I am not just going to give someone carte blanche pain meds just because they demand them that way. I need to assess the patient and the effectiveness of the pain control. Certainly, if the patient needs pain medication, the patient will get it. But I will not routinely bring meds on the q 4h mark ATC just because the patient wants them that way.
OCN gets it. I note that she has 25 years experience, and I suspect this is why we are on the same page. We have been there, done that, know better.
Any patient that requests prns in advance, without even knowing if they are going to need them, is demonstrating ineffective coping, at best. And yes, it is a red flag. It raises eyebrows. Reasonable people, after being informed that they misunderstood the meaning of prn, and the role of their nurse, would say "Oh, I wish I had known that. I wish they had communicated that to me more clearly, but thanks for clearing it up." Asking learned, experienced people for their perspective and then telling these same people that they are somehow at fault for failing to agree with her, is a tell tale sign that the individual has an agenda. I made a guess as to what it is (justifying misuse of narcotics) but it certainly could be any number of other things.
Something to note, interventions are not intended to make one pain free, they are intended to make the pain bearable. Only the patient can determine what is bearable, but I think that is oft misunderstood point that needs to be acknowledged I can tolerate at least an 8/10 before taking pain meds, but it neither shocks nor offends me when people with 5-6/10 require intervention. Less than that, well yeah, I start thinking you are just a *ussy, lol, but if it is ordered, and you ask for it, you still get it. All you have to do is call. It isn't that strenuous, and I think c/o that you are required to actually voice your own needs is laughable. But actually, it is the indignation that is the give away.
I've had that same surgery, and I know what it feels like. It is uncomfortable, I took motrin for several days afterward, and that is sayig something because I am loathe to take drugs of any kind. It isn't excruciating. It is odd to me that someone could be certain that they would be in pain four hours from now -severe enough to require narcotics before even trying other measures. Very very odd. Frankly, after 20 years of dealing with patients, I know the difference b/w drug seeking and relief seeking behavior when I see it. But I didn't see the OP, so I can only go by her very odd behavior in this thread. IME, most patients whom are not drug seeking want to take as little medication as necessary, and welcome the assessment and advice of a seasoned nurse to help them achieve optimum comfort with the least amount of chemical intervention and the associated risks and SE profile. Patients who decline to try any other measures, who insist they are entitled to narcotics just because there is a "as needed" order in place, and whom try to justify this behavior by blaming nursing staff for failing to anticipate or meet their perceived needs are a breed that experienced nurses like OCN and myself know how to spot. They cannot be reasoned with, and are usually best handled by being explicitly clear about the orders, and their own responsibility for their needs. I gather from the OP that this is where the staff failed here. They were not clear with the patient about her own responsibility. They should have been.
A patient demonstrating the behavior described in the OP requires intervention to be sure, but I can't say without laying eyes and hands on that they require opiates, and four hours in advance neither can they, lol. Unless of course the primary objective is to be taking narcotics, and not to achieve a measure of comfort. MY goal is the latter. If the pts goal is the former, there is going to be a disconnect. FWIW, I medicate my patients, when it is time even when I know they are seeking. You see, it doesn't matter to me. I'm a big believer in natural selection, and I just don't care if they are addicts or not. I'm going home to my happy, non substance abusing life either way. They are stuck in their own hell, and if they want to get out they will have to ask for help. IF they ask for help, I am going to fall all over myself trying to provide it, because you see, that is why I chose this profession. IF all they want is to be enabled, and they have a valid order, I will do that too. But they still have to ask.
agldragonRN
1,547 Posts
can you cite your source please? i hope you are kidding. pain is what the patient says.