Pain is subjective?

[lena130]

I have been a nurse for only one year and I am already questioning the idea/assumption that pain is subjective. I work in the LTC ward where we have subacute patients (including acute rehab and extended care) and hospice patients. I administer vicodin, morphine, oxycodone, tramadol, tylenol #3, etc. at least 8-10 per shift and I work an 8-hour shift. I do have patients that I know without a doubt are really in pain, but 75% of my patients ask for PRN pain medication right on the hour everytime it is due not knowing that I am outside their door and I can hear them laughing and/or carry on an entertaining conversation with another person. Yes, I do believe that pain can be subjective but how am I suppose to assess pain for my drug-seeking/addicted patients? I find it hard to believe that they are telling me that their pain level is 8/10 every single time. Lately, I have been feeling less like a nurse and more like a street drug pusher in a hospital setting. Can anyone relate to what I am saying? Do anybody have any article that suggests I can objectively assess pain?

[leslie :-D]

I didn't say anything about wanting to withhold. Neither did the OP. Did you not read my entire post?

yes, i read and reread your post.

as i did, the op's.

the op states she feels like a drug pusher.

your post questions the nurse's role in perceivably inappropriate pain mgmt.

and no, no one literally said they wanted to withhold.

but when nurses question the motives behind a pt's request for pain meds, the inference (to want to withhold) is there.

while some regimens are clearly over the top, i'm not seeing how nurses are in a position to question their pts.

again, our evals are not based on objective data, but purely speculative, subjective notion.

and that, is what makes many of us "judgmental".

again, barring obviously stuporous pts or med orders that clearly could snow a pt, i just don't see why we feel the need to intervene.

leslie

[Virgo_RN, BSN, RN]

Again, I wasn't talking about intervening, but rather, about the OP's question as to whether or not there is an objective way to measure pain, and the ensuing finger wagging simply for asking the question.

[icunurse42066]

yes, i read and reread your post.

as i did, the op's.

the op states she feels like a drug pusher.

your post questions the nurse's role in perceivably inappropriate pain mgmt.

and no, no one literally said they wanted to withhold.

but when nurses question the motives behind a pt's request for pain meds, the inference (to want to withhold) is there.

while some regimens are clearly over the top, i'm not seeing how nurses are in a position to question their pts.

again, our evals are not based on objective data, but purely speculative, subjective notion.

and that, is what makes many of us "judgmental".

again, barring obviously stuporous pts or med orders that clearly could snow a pt, i just don't see why we feel the need to intervene.

leslie

So, when you say "but when nurses question the motives behind a pt's request for pain meds, the inference (to want to withhold) is there." aren't you being as judgemental as you say the nurses that question the pt's motives for pain meds are? That is a double standard in my book. A NEW nurse has a question regarding pain being subjective and comes on this forum to ask it, and she is belittled and berated for asking a question? I'm very dissapointed in those that have jumped down her throat! Yes pain is subjective and it IS what the pt says it is and should be treated as ordered and promptly, but that doesn't mean that a nurse who questions the motive is going to withhold the med and to assume so is utterly ridicilous!!

[leslie :-D]

So, when you say "but when nurses question the motives behind a pt's request for pain meds, the inference (to want to withhold) is there." aren't you being as judgemental as you say the nurses that question the pt's motives for pain meds are? That is a double standard in my book. A NEW nurse has a question regarding pain being subjective and comes on this forum to ask it, and she is belittled and berated for asking a question? I'm very dissapointed in those that have jumped down her throat! Yes pain is subjective and it IS what the pt says it is and should be treated as ordered and promptly, but that doesn't mean that a nurse who questions the motive is going to withhold the med and to assume so is utterly ridicilous!!

w/o a doubt, i do feel judgmental towards those who suspect med seeking pts.

guilty....yet not feeling a bit of guilt.

ftr, i wasn't addressing the op.

if i was, i would have responded specifically to her post.

a very gen'l statement.

and no, it's not ridiculous to think there are nurses who don't withhold.

that's a bunch of bunk..

i'm quite confident that most nurses do not.

but are there some?

oh yes.

leslie

[Virgo_RN, BSN, RN]

I'm sorry, Leslie, you've lost me. You're not making any sense.

If you're implying that I arbitrarily withhold pain medications or even consider doing so, then I resent that implication.

[leslie :-D]

I'm sorry, Leslie, you've lost me. You're not making any sense.

If you're implying that I arbitrarily withhold pain medications or even consider doing so, then I resent that implication.

wow.

just wow.

nevermind.

leslie

[PeaceonearthRN]

Three years ago I had a chole as well. It ended up being a full incision and a lovely j peg. The pain became excrutiating after I was off the morphine for a few hours. The day nurse was awful and sent a student or CNA in to see what I needed. I simply asked for a combo tylenol/motrin to stay on top of the pain. I know now this is an issue with bleeding; however, the answer I got was 'that is what your doctor wants you to have'. I was being given tylenol with codiene. I was upset and called the surgeon's office. Of course this set off a chain of 'attitude' events and I suffered more. The day nurse was ticked but had NEVER come in to assess my pain. I was not and never have been a drug user and the pain was worse than labor. It took all day and all night to get rid of the pain. I had a horrible reaction to dilauded, I waited thirty minutes at a time for pain managment AND the next day after things had calmed down I was treated to overhearing the 3 - ll p and the ll p - 7 a shift 'discussing' me. It was unbelievable and I was totally 'mortified'. Not only was I desperately sick as I had let the gallbladder issue go on for too long but I was in beyond comprehensible pain. I have made a pledge to remain objective, not judge a patient and by all means make sure they are not in pain post operatively or during a treatment. I am currently working as a GN and have already observed this process. I am scheduled Wednesday to take my NCLEX exam. I have horrible test anxiety, have a focusing issue and have made accomodations. I am also getting a hotel the night before with a jacuzzi. I am determined to pass the first time and try to be the best nurse I can. When i see signs of 'burn out' or 'everything looking the same', it will be time for me to work for a drug company hotline or just get out of the profession. God speed and God Bless!:smiley_ab

[Virgo_RN, BSN, RN]

wow.

just wow.

nevermind.

leslie

Now I am completely confused.

[lena130]

Wow!! I came here hoping that I would get a good insight (I did by the way) about a concern I had. I did not expect to be stoned to death and have others get caught in the crossfire. I think some of you nurses are getting a little too personally. Who am I to judge a patient and who are you to judge other nurses? To those who gave me good, professional advices on how to differently view pain management, THANK YOU. And to those who crucified me for asking an honest comment, THANK YOU ANYWAY. You guys confirmed one of my theories about nursing. There are nurses who are happy and willing to teach and there are nurses that are, well, like some of you guys.

I am kind of disappointed and flabbergasted at the same time.

[chenoaspirit, ASN, RN]

I had a patient the other day who is dying of lung cancer with mets to brain. He is on a Dilaudid PCA with a continuous drip. His family (nephew to be exact) was caught burning a hole in the tubing and draining the medication out of the bag into a cup.

Ive had a patient (previous nurse, btw who lost license due to drug abuse) who I caught crushing a percocet and injecting into her port-a-cath.

Ive also had elderly patients dying of cancer who refused to take a narcotic because they knew they would eventually NEED it more than they did at that time and didnt want to build up a tolerance. I felt so bad for that person because I knew she was in pain.

I had a patient who was caught sneaking and taking home meds (narcotics) on top of what I was administering. I questioned (to myself) if she was in true pain, but I administered it...until I caught her taking her own stash because I was then fearful of an overdose. I had to discuss this with her doctor. Later, her husband called and begged us to rehab her, stated that her drug problem had almost bankrupted him and she is getting out of control.

Ive seen many things and I do administer pain medications whenever requested, I chart it and re-assess afterward. But when I suspect drug abusive behavior, I discuss it with the physician.

Now, I never said that I am the pill police, neither did I say that I dont medicate when asked. But no one can say that they have never suspected drug abuse behavior....and its irritating because of the stress of the job and having to call the doc multiple times to increase dose or run into room every hour when I have patients who are truely in distress and NEED me.

Some are truely in pain, some are not, thats just a fact. I dont have time to rehab someone who doesnt want it. I also dont have time to entertain drug abusive behavior when I have patients who are truely in pain or dying. Ive been told "I should just get myself a n*gg*r to take care of me" when I didnt go DIRECTLY to his room to medicate because I was busy with another patient whose O2 sat was in the 70's. That irritated me for multiple reasons...one because of the word n*gg*r (I find that offensive) and secondly because I tried to explain why I was 10 minutes getting to him, he didnt care...he just wanted his meds. THAT behavior is what disturbs me. I dont care how bad I hurt, if someone elses life depends on my waiting for 10 minutes for my medication, then I would be totally ok with that because I have a heart...and I have a VERY LOW pain threshold.

I dont want anyone to slam me for my comments like I was slammed for my previous posts. We all here should be on the same side and supportive and try to understand each other.

[chenoaspirit, ASN, RN]

Now to the OP, asses using the skills you have learned. I do understand how you feel, as I have felt it many times. When/if you have concerns, discuss it with the physician. I have also discussed the risk of addiction to my patients to make them aware. When one is receiving dilaudid each hour, I think the docs need to stop that and start the patient on oral pain medication to prepare them for discharge since they cant take an IV with them. KWIM? Ive seen docs stop a PCA and discharge the patient, the patient then comes back because of the massive withdrawal symptoms and uncontrolled pain...and I dont blame them, I blame the docs.

[PeaceonearthRN]

I guess every situation is different and we just need to remain objective. My unit is very busy and it would be easy for someone to experience tunnel vision; however, I just hope personally that our ratios are decreased from l: 6 to l:4 soon. Good patient care is difficult when nurses are overwhelmed; however, it should be the nurse assessing the pain and not sending in a CNA to deliver the message. It would be nice if 'one day post ops' and 'dying patients' had a better way to be cared for and not mixed with other issues; however, that is not the case in most places. :)