Just came here to blow some steam off. I just put in a three day stretch with a chronic pain patient assigned to me that was a royal pain in the behind to take care of. This patient was on our floor for a ORIF of her knee. She also had a hx of fibermyalgia and was on all kinds of pain meds and narcs and junk to keep her zoned out most of the time. I tried my best for the three days I had her as my patient to take very good care of her and meet her needs, but for the most time she was very rude and nasty to me. It did not matter what I did, I could never do enough nor could I do it right.
Here is the question I would like to put out there: Why do these docs keep ordering all of these highly addictive substances for these folks? I know that when I go see my doc he is very conservative about pain killers and does not want folks to become addicted to them. He will give you something for pain, but he won't keep ordering it over and over again for you. He also looks for alternative medicines to give to you that will do the same thing but are not addictive.
Another question to throw out there: Why are most chronic pain patients "nasty" to deal with? They always have "attitudes" with the nursing staff. Most are downright rude to everyone who takes care of them. Many do not know the words "thank you" and are very demanding and critical of your care to them.
Sorry if I sound like I am not compassionate. I really am. I just came here because this is a safe place to sound off about these issues. If anyone out there has some answers, please, please post them.
I just want to understand better why these people act the way they do. Thanks.
Specializes in icu, er, transplant, case management, ps.
Most of the ones I have cared for are a pain in the behind because they have been labled " a chronic pain person" ie- drug seeker. I cannot tell you how often I have followed a nurse who gave the minimum ordered pain meds to a
post-op patient because they were "a drug seeking chronic pain history patient". It's amazing how much more compliant the patient gets when I max out his meds.
Patients who are being treated for chronic pain with opiate meds have a tollerance for those meds. What would work for your 80y/o grandmother won't help them at all. In addition when a patient has chronic pain issues the nervous system is unable to regulate painful stimuli as effectively. They feel even minor pain more acutely than people who have no history of chronic pain issues. Pain tolerance gets worse with the length of time the patient has had chronic pain not better. For this reason all the "warm fuzzy" interventions mearly annoy the heck out of them- distraction, music therapy, relaxation therapy...all can help non chronic pain sufferers but the mechanism that provides relief with there therapies is broken in this patient population. All you are telling them is that you won't or can't manage thier pain. That will make them a bit panicy and exacerbate thier pain. Even if the patient is drug seeking to feed an addiction, drug withdrawl is painful and additive to other painful health issues that are going on (post-op or the like). Get off your high horse and treat your patients pain. You are not qualified or capable of providing a drug rehab program in the midst of an inpatient stay for another health issue. If they need a referral to an approp detox/rehab program post recovery that is for them and thier doctor to decide. Making them suffer in pain isn't going to make them "see the light" and give up drugs. You are the patients advocate and for this admission the patients complaint includes pain. If the ordered medication is ineffective call the doc-get a change in the order and ask for a referral to the pain management department. Your shift and thier admission will be much better for it.
Good for you. I wish more nurses had your attitude.
In the not too distant past, I parked in a disabled parking space, went into the store, did my shopping and returned to find our local traffic enforcement officer writing me a ticket. I explained that I had forgotten to hand my tag. His response "You don't have a tag, you are getting the ticket. You can plead guilty and pay the $500 fine". I had the tag in my glove box. I got it out and he ignored me, got in his car and drove off. I plead not guilty. Went to trial, having a judge hear me and defending myself. The State Attorney made a motion to dismiss, which was granted. One officer wasted my time, the State Attorney's time, the judge's time. And cost the tax payers of my county several hundred dollars in the process.
Just think, if someone had been in my area, he could have video taped the whole incident, posted it on the net and given the entire world the wrong impression of me.
Woody:balloons:
See I could have been there videoing it also. Just like Jimmie Justice. Put it on you tube. Submit it to Internal Affairs. One of my golfing buds works for IA, he would love that.
Specializes in icu, er, transplant, case management, ps.
See I could have been there videoing it also. Just like Jimmie Justice. Put it on you tube. Submit it to Internal Affairs. One of my golfing buds works for IA, he would love that.
Business have the right to put in video cameras but private people are taking the law into their own hands. And by taping someone whom YOU think is violating the law and posting it, you are doing a disservice to the general public you claim to be protecting. The officer who gave me the ticket, wasted my time, the courts time and the state attorney's time. While my time does not affect my county's budget, the state attorney and the courts do. Time that could have been spent on a more important case.
Business have the right to put in video cameras but private people are taking the law into their own hands. And by taping someone whom YOU think is violating the law and posting it, you are doing a disservice to the general public you claim to be protecting. The officer who gave me the ticket, wasted my time, the courts time and the state attorney's time. While my time does not affect my county's budget, the state attorney and the courts do. Time that could have been spent on a more important case.
Woody:balloons:
Woody, your looking at this wrong. I am not trying to protect anyone. I am attempting to shame someone who feels that the rules dont apply to them. Just because, and this is the last one. I taped. His "poor sainted dead mother" had a disabled license on her car. Well, as he put it. He continues to park in handicapped spaces to remind him of her.Shame on him.
Specializes in icu, er, transplant, case management, ps.
Woody, your looking at this wrong. I am not trying to protect anyone. I am attempting to shame someone who feels that the rules dont apply to them. Just because, and this is the last one. I taped. His "poor sainted dead mother" had a disabled license on her car. Well, as he put it. He continues to park in handicapped spaces to remind him of her.Shame on him.
If you really wanted to be effective, try calling your local police department's section of traffic enforcement and giving them his license plate number and where he is parked. Here in Florida, such a call gets an immediate response from our traffic enforcement officers, who issue all illegal parking tickets. In the case of a handicapped tag, the person who is handicapped has to be physically present when the officer makes the inquiry. Some go so far as to go into the store and have the tag paged over the store's loudspeaker. It is much more effective then video taping someone and then posting it on the net. All that does is give you your own private satisfaction of attempting to embarrass someone. A $500 has a much bigger impact.
If you really wanted to be effective, try calling your local police department's section of traffic enforcement and giving them his license plate number and where he is parked. Here in Florida, such a call gets an immediate response from our traffic enforcement officers, who issue all illegal parking tickets. In the case of a handicapped tag, the person who is handicapped has to be physically present when the officer makes the inquiry. Some go so far as to go into the store and have the tag paged over the store's loudspeaker. It is much more effective then video taping someone and then posting it on the net. All that does is give you your own private satisfaction of attempting to embarrass someone. A $500 has a much bigger impact.
Woody:balloons:
Here in Texas, most officers don't care. After all this is Bush country
I always give pain meds when asked to, as long as I have an order, if the pt isn't in distress. I encourage my pts to ask for their meds before the pain get bad because it is harder to control if we don't stay on top of it. even if my pt is in deep sleep when I walk back in with the med, i will still give it (as long as they wake up easily) If I have someone with chronic pain, I give what is ordered, I advocate what is needed to control the pain. an acute care facility is not a rehab, it is not the place to get drug addicts off of drugs, that can wait til after they are no longer acute. pain is whatever they say it is. It is not my place to try to get someone off of drugs they may have been taking a lifetime. I could care less if they are a drug seeker or not. if its ordered I'll give it so long as it won't kill em!
Most of the ones I have cared for are a pain in the behind because they have been labled " a chronic pain person" ie- drug seeker. I cannot tell you how often I have followed a nurse who gave the minimum ordered pain meds to a
post-op patient because they were "a drug seeking chronic pain history patient". It's amazing how much more compliant the patient gets when I max out his meds.
Patients who are being treated for chronic pain with opiate meds have a tollerance for those meds. What would work for your 80y/o grandmother won't help them at all. In addition when a patient has chronic pain issues the nervous system is unable to regulate painful stimuli as effectively. They feel even minor pain more acutely than people who have no history of chronic pain issues. Pain tolerance gets worse with the length of time the patient has had chronic pain not better. For this reason all the "warm fuzzy" interventions mearly annoy the heck out of them- distraction, music therapy, relaxation therapy...all can help non chronic pain sufferers but the mechanism that provides relief with there therapies is broken in this patient population. All you are telling them is that you won't or can't manage thier pain. That will make them a bit panicy and exacerbate thier pain. Even if the patient is drug seeking to feed an addiction, drug withdrawl is painful and additive to other painful health issues that are going on (post-op or the like). Get off your high horse and treat your patients pain. You are not qualified or capable of providing a drug rehab program in the midst of an inpatient stay for another health issue. If they need a referral to an approp detox/rehab program post recovery that is for them and thier doctor to decide. Making them suffer in pain isn't going to make them "see the light" and give up drugs. You are the patients advocate and for this admission the patients complaint includes pain. If the ordered medication is ineffective call the doc-get a change in the order and ask for a referral to the pain management department. Your shift and thier admission will be much better for it.
This is the school of thought that I subscribe to as well. Just a student, but I always wondered why people are so concerned about "addiction" while the patient is in the hospital. You aren't going to cure a drug addict over a 3 day stay. Treat the pain and refer them to a treatment program, when appropriate, after the acute event has been dealt with.
I've got to ask... have YOU dealt, personally, with having/sufferting with chronic pain??? Until you do... you really have NO idea of what we go through. I try really hard not to let my pain define me as a person/nurse. If anything, I go too far the other way since I don't want to bother the nursing staff as I know how busy they are. I think the issue of patients being "nasty" doesn't have to do with chronic pain... they're just nasty in the first place and they use the pain as an excuse for their behavior. I've dealt with patients that I know must have been going through hell and they've smiled and tried to put up a brave front... I've had other patients who were experiencing "as expected post-op pain/discomfort" and you'd think they were being tortured to the nth degree. It has to do with the person and their personality. Please... don't blame the pain. They do that enough.
PattycakeRN... I AM in Canada. To let you know how screwed up we are... my doctor has been visited by the RCMP investigating the amount of pain killers he prescribed to me. Because of that, he wouldn't write me a prescription and I was lucky because I was admited to a pain clinic where the doctors have more leeway in writing scrpts for pain medication. Still... I'm happy.... after "the accident" (a patient became violent and kicked me repeatedly), almost a year and a half later I woke up paralyzed from the waist down. They didn't give me much of a chance of walking again as I went into surgery, but I fooled them and even had two kids. Granted... I broke my fusion in three places with my last kid and the docs told me I was "making up" the pain before they finally (after 15 months of sending my to a psychiatrist and having Children's Aid try and take our kids away from us) did the CT scan that showed the three breaks.
I'm not complaining, per se, I'm just trying to educate the other medical professionals that I know that there's often a long, sometimes complicated, story behind chronic pain. Too often, persons in pain are accused of exagerating the pain, of making it up to get out of something, etc. We get frustrated, and yes... sometimes we get angry. Maybe the patient doesn't always take it out appropriately. My wish is that nurses, doctors, etc. take a moment and find out their side of the story before labelling the patient as a "nasty", "bitchy", "difficult" patient... Sorry that I'm ranting, but having been on both sides of the issue... sometimes I need to remind people that pain is something we've all heard about and think we know about... but, until you've personally dealt with it, you can't really understand. Anyways... thanks for listening.
woody62, RN
928 Posts
Good for you. I wish more nurses had your attitude.
Woody:balloons: