How do you feel about pain med refusal

shygirl · Jul 13, 2002

I feel that if a patient refuses pain meds, then the patient is not in pain. Simple as that.

If I have pain, I will use pain relievers-believe me!

ceecel.dee, MSN, RN · Jul 13, 2002

Individual right to choose.

Refusal of pain med is not seen too often if there is really pain (above a 3 on a 0-10 scale) in my experience. Of course, I'm a believer in treating pain and say to all my patients "There is no need for you to be in pain rated above slightly uncomfortable (2) in this hospital. If you need more than what is ordered, just tell me and I'll get you more." Many of our docs undertreat pain, but most are receptive to requests.

nursedawn67, LPN · Jul 13, 2002

I feel it is the patients right to refuse, but i offer alternative methods of pain relief (warm compress, cool compress, massage, darkened room ...depending on the type and location of the pain).

Sleepyeyes · Jul 13, 2002

I've dealt with a lot of pts who were in a lot of pain but were afraid of "becoming addicted." If I see a pt. who is postop and who is making the faces of someone in pain, I explain to them the difference between addicts (using pain med for high) and postops (using pain meds to relieve pain, which will increase mobility, which will get them up on their feet faster, and which will get them home sooner.)

I explain that getting OOB is most important to mobilize secretions and prevent DVT's, and if the pt feels less pain, they're more apt to move.

Then I explain the diff between an ATC and a prn med, and tell them we expect them to rate their pain.

You would not believe how many oldsters literally cry with relief that someone understands.....

Tiiki · Jul 14, 2002

I have found that if a patient is concerned about addiction, they will queery their meds. I think the most impotant thing with pts is eduation, what they are getting, why they are getting it, how often they can get it, and all possible side effects. I find that once they are knowledgable they can make an informed decision, and if that decision is to refuse the med, then I respect it.

As for myself, I'm no hero. I'm a migraine sufferer. The first sign of headach I hit the analgesics in hope of abatting it. :)

JO-ANNE

fab4fan · Jul 14, 2002

This makes me think of a hospice pt I had. He was in excruciating pain, but nothing would make him take his meds. I think part of this was cultural, but it was so frustrating, because I know he suffered and died in terrible pain. I would talk to him, the family, and they'd all nod their heads that yes, he should take his meds, the pt would agree...and then nothing. Of course, this would come to a crisis on the wk. end, then the on-call nurse would make multiple trips to the home...still, he refused.

We had his doc talk to him, the social worker, we networked with a pain mgmt. nurse in NY who was familiar with this culture...nothing worked. I really felt helpless and felt like I didn't do anything for him.

What really threw me off, was that after he died, his family sent me a lovely card saying how much they appreciated all I'd done for him. I really didn't feel like I'd done anything, and it was heartwrenching...he had tons of pain meds right by his recliner that went untouched.

Just because someone refuses pain meds doesn't mean that he/she isn't in pain. All we can do is try to find out the pt's concerns, educate, and the rest is really up to the pt.

BadBird, BSN, RN · Jul 14, 2002

I think that we need to listen to our patients, many are well aware that certain medications work or don't work for them. I personally won't take Darvocet because I puke my guts out, I will take motrin instead because that works for me. I definately offer pain medications to my patients but if they refuse I let them know I am only a call bell away should the need arise for medication. I don't worry about the drug seekers either, the day or two that they are in ICU isn't going to change their habit, I figure if the Dr ordered it and they request it I will medicate them, they will have to deal with the Demon of addiction once they are out of ICU.

CATHYW · Jul 14, 2002

I absolutely believe in the patient's right to refuse. This does NOT mean that they are not in pain. It means that they have pain, but either feel that the pain is not severe enough to warrant pain medication or, that they want to "save" the pain med for when the pain "gets really bad." This is the way I was raised, and my parents are that way, till this day. If pain is bad, yes, I will take something for it. My parents (and other older folks I've cared for) are afraid they will become "immune" to the effects of the med, and may need the med worse at some later date.

Palliative aids, as mentioned earlier, are what I always offer if they refuse meds.

adrienurse, LPN · Jul 14, 2002

I agree with the above statement badbird. Usually there is much more to it then whether pain is present or not. There is personal pride. Some people are unable to show "weakness" to others. There are also tons of misconceptions about pain medications, and not everyone believes in them, and some people fear them. There are also cultures in which stoicism is a virtue. Even if these people are feeling severe pain, they may continue to refuse pain control. It is the nurse's responsibility to find out what's up with these people and go from there. The bottom line is you can't force analgesia on people, but you can enable them to take it.

live4today, RN · Jul 14, 2002

If any patient of mine is in pain and refusing his/her pain meds......it's their right to refuse. I offer what support I can in ways that may help them to be more comfortable. I let them know that if they change their mind, use the callbell...call light...and I'll come running with a shot to knock 'em into the next planet. :rotfl: :rotfl: :lol2: Night ya'll! :kiss

KarafromPhilly · Jul 14, 2002

I think it is important to educate people that they will not become "immune" to pain medication, so there is no need to "save" it for later. I had one patient who refused pain meds, and then refused to get OOB, wouldn't cough, etc. because it hurt. Well, duh.

Are there any nurses here who reassess pt.'s pain after pain med given, pain still 7 or 8 on 1-10 scale, then say, "Well, you're not allowed to have your pain med again for another four hours." ? These nurses always mystify me. If you had no intention of fixing the problem, why did you bother to take a stab at it?