Quote from Hospice Nurse LPN
I just want to add that a pts pain is what they say it is. It's not up to me to decide if they have pain or not and what the intensity of the pain is.
Why? In what other regards do we ignore objective information, and only go with the pt's report? Wouldn't you give narcan to an obvious overdose, despite the pt having denied using narcs? Or would you say, "the pt's drug use is what he says it is. It's not up to me to decide."
Or- regarding pain- an elderly pt has an obvious mechanism for pain. He is wincing, grimacing, tachy. He denies pain. You know he has had a bad experience with narcs- maybe somebody pushed some Dilaudid too fast. Woupdn't you push the issue a bit to encourage effecive pain relief? Or would you base your actions on the "pain is what the patient says"? IE disbelieve the p's pain claim.
Stoic LOL in obvious severe pain rates it 3/10. A guy takes a break from eating his pizza and texting his GF o tell you his pain is still 10/10 even after the Dilaudid. Who gets treated first?
From your signature, I see you are a hospice nurse. I support your aggressive treatment of pain in hospice patients, and understand that pain is an individualized experience, impossible for another to fully assess.
But..... I disagree with "the pain is what the pt says it is". Where does this come from? People lie all the time about all kinds of things. Drug addicts- or people who just like getting high- lie about drug use and pain.
My assessment includes subjective (what they say) and objective (what I see/feel/hear etc.) data. This goes for ortho, respiratory, pain, whatever.
I do my assessmnet, communicate it to the provider, and follow my orders. If a pt is ordered PRN, and complains of pain, i give the med. If I have a dose range, and I think they are in pain, I will start low, and titrate to maximize pain relief, and minimize side effects. This is the LOL with the broken hip. The guy who is on his call bell at the exact time of his prn, who always rates his pain 10/10? The guy who is eating and holding a normal conversation when you are outside the room, but all of a sudden is wincing and can barely speak when I come in? He gets the full ordered dose. Save both of us a bunch of time and effort, allows me to move on with my moe important tasks.
And to the OP: You did the right thing.