Today I got called into my DON's office, where our executive director--who is not a nurse--yelled at my for charting "Pt. states pain is an "8/10". I listed my interventions, what her response was, etc. ED told me that "If her pain was really that bad, we should be sending her to the hospital. You need to do a full assessment then to see if that corelates to what she's saying." I asked her if she was concerned about drug seeking....
This pt. is A&O x4, has an infection in her hip incision, AND has fibromyalgia, for which she takes methadone 5mg BID. "You need to use the faces scale then if the objective assessment does not agree with what she's saying."
And then what? Only give her 1 pain pill instead of the two that I did that reduced her pain to a "3/10"???? She had previously stated "7/10" and the day nurse gave her one vicodin and vistaril, she was asking for more within 3 hours...
What ever happened to pain is subjective?
And I wonder why I can't get anyone to believe me about MY pain issues.
Thanks for letting me vent. I WILL continue to document what the pt. says, doing an objective assessment as well because that is what is required. ALL of our documention is narrative style, which I'll step up. One of the computer systems I learned on had the objective information in one area, with pain assessment in another area, thus it was easy to cross reference without having to question what the pt. stated like this.
I'm still shaking my head...why on earth would I use a faces scale (she was referring to the dementia pain scale we use) on someone who is A&O?
When I am a patient, I have the opposite problem. Apparently, I have a fairly high pain threshold. So, I don't report pain as being very severe and I don't request "enough" pain relief for people to take me seriously as a patient.
I frequently find myself saying things like, "It doesn't hurt all that much, but I do thinK there is something wrong here. Could you please take a closer look at this?" The doctor and/or nurses brushes me off because I don't seem to be suffering much ... and then we all have to deal with a more serious problem later because my little problem was not sufficiently treated and it grows to become a big problem.
Even when I was a child, my father (who was also my doctor) would say things like, "She's not a complainer. If she says something's wrong, there probably is." whenever he had to refer me to someone else for treatment.
I drives me crazy. I am often tempted to "over-dramatize" my report of pain just to get taken seriously.
OH, do i hear you, i have a fairly high tolerance for pain, and i have been treated similiarly......i have taken to informing practioners that i can tolerate having my teeth drilled without novacaine, please include that in your judgement when i complain of pain......
I went to the ER once with food poisoning. I was hurting. But, I knew what it was and was willing to just "wait it out". I only went to make sure it wouldnt get worse.
I got a lot of "oh yeah, your here with abd. pain, OK" sort of pat answers. I hadnt told them I was a nurse. Next thing I knew, the nurse was bringing 2mg of dilaudid to me. I was like "hecks no, I dont want that. I never asked for that." The doctor hadnt even seen me yet. I guess they thought they were just going to feed the beast and let me lay in the ER for awhile until I felt I had gotten my fix. Funny. They didnt know what to do with me when I said I wasnt interested in dilaudid and was just there to make sure things didnt get worse.
Specializes in Hospice, Palliative Care, OB/GYN, Peds,.
It is so easy for some people to be judgemental (?SP) about another person's pain. Everyone reacts differently to pain and we function at different levels. So someone could be smiling at an 8 while another person cries at an 8. Our tolerance levels are different and our ability to carry on ADLs with pain vary. If this is not subjective, then I would like your boss to explain to me how she or he perceives pain. I ask my patients at what level are they able to perform usual ADLs and what is a comfortable level for them, that sounds subjective to me. And yes, pain is very subjective.
That's why I like pain scales that illustrate the patient's functional ability instead of the patient's "perception" of what their pain should rate (look under "Activity Tolerance Scale") :
While all the advocacy literature states we should completely believe the patient's report of their pain, we need to have some way to verify what we are being told. If the patient can walk and talk without any distress, then they aren't a "12 out of 10".
Based on this, then she was an 8. While she didn't have the facial characteristics, she still couldn't get out of bed and repositioning caused her pain as well.
Dont forget the drug companies. How many companies are offering their drugs to those with Fibromyalgia on TV. I do take exception to a lot of these medicine commercials on TV. They affect everyone who sees them also
Yep, I can't even count how many times I have seen commercials for Lyrica on TV the last couple of months. And I don't even watch TV that often...The drug reps definitely do make an impression on the public whether they realize it or not.
Yep, I can't even count how many times I have seen commercials for Lyrica on TV the last couple of months. And I don't even watch TV that often...The drug reps definitely do make an impression on the public whether they realize it or not.
They realize it, thats why they do it. I loved that episode on Boston Legal where Bill Shatner dropped dead. Of course revived. Then they found out he was taking every med they advertised on TV because he believed them. That was a good episode
They realize it, thats why they do it. I loved that episode on Boston Legal where Bill Shatner dropped dead. Of course revived. Then they found out he was taking every med they advertised on TV because he believed them. That was a good episode
Sorry, I meant to say that the public sometimes may not realize how much "Big Pharma" plays a role in influencing their medical decisions. Of course the drug companies know that they have an influence on the public. If this was not the case then the drug companies would be out of a job.
Specializes in education, Peds ICU, cardiac, LNC, psych.
I totally agree with Shrinky:
It is so easy for some people to be judgemental (?SP) about another person's pain. Everyone reacts differently to pain and we function at different levels. So someone could be smiling at an 8 while another person cries at an 8. Our tolerance levels are different and our ability to carry on ADLs with pain vary. If this is not subjective, then I would like your boss to explain to me how she or he perceives pain. I ask my patients at what level are they able to perform usual ADLs and what is a comfortable level for them, that sounds subjective to me. And yes, pain is very subjective.
I hurt myself when I worked in an ICU. I've had 3 back surgeries (all spinal fusions) and I have pain everyday. My pain goes from a 7 to a 10. I am never below a 7 for my pain. I go to a pain doctor and he gives me motrin and neurontin!! Of course, they do not work, but physicians are hesitant to give anything stronger. I think because I am a nurse they think I am exaggerating my pain or something. I can do alot of things when my pain is an 8. I have a very high tolerance for it because it built up over the years.
I went to a wonderful nursing school where I was taught "pain is what the patient says it is." Pain is always subjective.
I get very heated about this topic because of my own personal experience.
I don't really have much to add except that you are right, pain IS subjective and that your boss is a moron.
The real problem is that while pain is subjective, a few people will lie about their pain level in order to get meds, and we have no accurate way to ascertain who is lying and who isn't. It sure seems to me that less harm will result from getting suckered by a few drug seekers than leaving many more to suffer from undertreated pain.
The drug seekers are ultimately responsible for the harm they do themselves, but we as nursing professionals are at least partly responsible for the harm done by withholding adequate pain relief.
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SunnyAndrsn
561 Posts
Thanks for letting me vent. I WILL continue to document what the pt. says, doing an objective assessment as well because that is what is required. ALL of our documention is narrative style, which I'll step up. One of the computer systems I learned on had the objective information in one area, with pain assessment in another area, thus it was easy to cross reference without having to question what the pt. stated like this.
I'm still shaking my head...why on earth would I use a faces scale (she was referring to the dementia pain scale we use) on someone who is A&O?
UGH!!