The control of pain could be one of the most subjective and complex assessments that a nurse has to complete. JHACO has put the patient's right to have their pain controlled on the forefront of nursing assessments. What is a nurse to do with all that subjective information?
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There's all sorts of pain. There's physical, emotional or a combination of both (and probably a lot more descriptive words that can be used). The most difficult part of pain for a nurse is to put aside some of their own thoughts, and focus on patients as a whole.
Pain control is complex. So one doesn't have to go it alone. Yes, there are "drug seeker, push it fast, give me more" kinds of patients. Those are the patients who need a few more disciplines involved than a nurse with a vial. And one should not hesitate to use them, especially when it becomes apparent that your interventions are not working.
So how does a nurse do all this with a "straight face"? Like a number of things in nursing, a nurse needs to have the ability to leave out judgement. Which is difficult when on the one hand we have to educate patients on care, on the other do it without a tone that suggests distaste.
We need to remember that for the patient the pain is real. And the loss of control real. And there is real fear. This is the patient's perception, for some their reality. If pain has the ability to raise one's RR, one's blood pressure, would it also make sense that it is a real symptom that requires intervention?
I have noticed that, especially in a rehab setting, that there's a huge push for pre-medicating. For a patient to receive a PRN prior to the pain "getting out of control". Using key words like "out of control" can backfire. Then you have a patient that is fearful, edgy and in constant anticipation for the other shoe to drop. And that does nothing to help a patient advance in function.
Then you have the "well, patient x was chatting and laughing and rated the pain at a 10. SERIOUSLY????". Again, needs more disciplines involved than you can provide, however, don't be so quick to judge pain on what the patient is doing just to not feel the anxiety that uncontrolled pain or perceived and/or real withdrawal can give.
Take the personality out of the equation, and follow the orders for control of pain. If you are thinking that multiple mg of dilaudid pushed every hour is excessive, then you need to speak to the MD about the plan.
Some patients do not realize there's viable options. There are patients who do realize there's viable options but choose not to take them. It is when we take the judgement out of the equation, do what we can to give a patient access to services that they may or may not take us up on, then can we be mindful of a paients needs.
Such as those in acute pain are mindful of the need to not let the pain get "too bad", chronic pain suffers are intimately aware of this idea, and both need to be medicated per order when indicated. If a patient is over-medicated, a nurse needs to respond to that. And if a patient is under-medicated the same holds true.
JHACO is very clear on the needs of a patient and the right of a patient to receive control of pain. This is when a personal judgement needs to be pushed to the side, and a nursing process be put into play. We should never be in a position to assume that all patients at the end of the day want to be medicated into oblivion, nor every patient who experiences pain and asks to be medicated are seeking some sort of high. We are not feeding addicitons. An addict is an addict. We are contolling pain.
