Unmotivated patients VS pain?


I just don't know if I'm being too hard on myself...or too easy on patients. Here's the thing....of course we all know how important movement and breathing are when it comes to patient care. But, patients who won't try aggravate me. I can't argue the pain issue because I know that I DON'T feel what patients feel...but I can use my eyes.

One gentleman came in with back pain....has been there for 9!!! days. numerous steroid injections, point nerve blocks, you name it, he's had it. Currently, he was on percoset for pain...just PO meds. Without the meds, he rates pain at 7/10...but only has a slight guarding and no problem breathing, talking, no spasms in bed, etc.....With em, it's only a 4...but he can put hands above head, turn to go on/off bedpan, wipe self if he is on bedpan(not well), etc....He's lying there having his wife feed him..and he's 43. When I try to encourage him to get up with PT, and warned him what was going on that day, he said "great, I wanna get up and get out of here." PT is firm, believe me. And he sat up and refused to try to stand up. Standing helps get pressure off the back...but he didn't want to hear it. Pain hurts at first, but without trying you can't say it won't get better. I guess I just don't see that without the physical to back me up, I don't agree with your pain scale....just me.

2nd fella was having bad pain...as he had a MVA...lots of abrasions/staples, couple of rib fx, etc. From start of day on, he had morphine q1hr prn. I gave him some at start of day when I pulled his foley, and he rated pain high. every time you wake him he wants something, but when you go in 15 mins later, he's asleep. I gave him some about 30 mins before he got up to a chair....but between me and CNA, getting him from lying to standing was rough....he kept saying "I can't, I can't" but I wouldn't take no for a answer. Once we got him standing, he was better. got him in a big recliner, and told him I would bring him something for pain....came back, he's asleep. He woke up off and on, and I gave morphine more like every 4-5 hrs today...finally got some oral meds for him. He refused to get washed up with help, wouldn't get up to go to bathroom, wouldn't work with PT, walked 5 ft and refused to move more. I mean, I understand it hurts...but if you KNOW you have 3 rib fx, a busted head, a busted clavicle....and I've explained to you that the more you move the better your outcome will be but IT WILL HURT "AT first!"....wouldn't you try to move? I guess I just don't know what is low motivation and what is pain.....so go figure.

Specializes in ER; HBOT- lots others. Has 27 years experience.

sorry to hear about your troubles. that is crud when you dont really know the pt's thoughts. that sure would help. i think i am jaded that most ppl are unmotivated becuz i worked with and MD for yrs that gave narc's for everything and then would refill the day after when they said they "lost" the 360 pills they got.

my mind is changing with being on the floor, but man oh man..


as they say (dunno who "they" is) Patience Grass-hoppa





278 Posts

Specializes in LTC, wound care. Has 4 years experience.

You might be fighting fear here for the second patient. The first one, well, I don't know why he'd need his wife to feed him... guess he just wanted to be spoiled.

Yeah, if people are konked out and sleeping then it might seem that they are getting adequate if not more than adequate pain relief. They also might like the more than adequate pain relief as a way to "get away from the pain". They also might be fearful of more pain that might result from ambulating. Hard to know.

I know after the major surgeries that I have had that my reaction to pain is to try to hold as still as I can, and that includes trying to breathe as little as possible. (Stupid, I know!) But lots of pain just gets overwhelming and is very exhausting.


520 Posts

Specializes in Med Surg, LTC, Home Health. Has 31 years experience.
I can't argue the pain issue because I know that I DON'T feel what patients feel...but I can use my eyes.

I guess I just don't see that without the physical to back me up, I don't agree with your pain scale....2nd fella was having bad pain...as he had a MVA...lots of abrasions/staples, couple of rib fx, etc.

Use your eyes all you want to and you will still fail to adequately gauge another human being's pain. You may think that because your pt "only has a slight guarding" then he must be in less pain than the MVA with the abrasions and staples. The fact is however, people tolerate pain at different levels. Nursing 101, and what should be elementary to you, is that "pain is what the patient says it is", PERIOD. You are not a detective nor a psychic and thus you should never pass judgement on something so subjective. One man may scream in agony with the same pain that another may lie quietly still through. If they both say their pain is an 8, then both of them have a pain level of 8. It is as simple as that. Good luck in nursing school, and never forget this fundamental concept.:)

al7139, ASN, RN

1 Article; 618 Posts

Specializes in Emergency. Has 5 years experience.

OK, Here is my 2 cents from both the nursing and the patient view.

First the patient view (from my own experiemce): When I was 15 years old (waaay back when!!!), I was diagnosed with an ovarian cyst that was first drained via lap surgery, but quickly returned and grew to the size of a grapefruit. I had to have major pelvic surgery to remove the whole encapsulated cyst, which meant cutting through some major support muscles for my abdomen and pelvis. When I woke up (on the way to recovery), I was in excrutiating pain, and was crying and guarding my abdomen from any exploration by the nurses. I asked for pain meds, which I got, but when I fully recovered from the anesthesia, only really needed percs every so often. The next day they told me I had to walk, and that I could not be discharged until I could have a BM. Yes at first it hurt like hell, and the nurses would premedicate me when I wanted to walk or go to the bathroom, but it was not debilitating. In my first few days, I would sleep when I felt horrible pain, for an escape. It does not mean that I was drug seeking, or did not feel the pain.

Every person is different. It's hard, but there is an obvious difference to the drug seekers and those who have real pain issues.

I recently had a pt who supposedly had a pyleonephritis. She insisted that 1mg of Dilaudid q4hrs was not relieving her pain, yet she would walk up to the closest store and panhandle for change.

I brought this to the MD's attention, and she was quickly discharged...Found out later, she had been to several hospitals to try to get admitted...and knew when each dose of dilaudid and phenergan (told us she was vomiting, but never saw it) was due. When the MD D/C'd her was so mad, she cussed out the nurse, and ripped her own IV out.

You will learn...



1 Article; 1,350 Posts

A sleeping patient isn't always a pain-free patient. Sometimes they are so exhausted from dealing with the pain that sleeping is a way to escape the pain. It is so hard to know for certain what a patient is experiencing. But until we can make a gadget that can accurately measure pain, the best we can do is treat it, whether it's 'real' or not.

locolorenzo22, BSN, RN

1 Article; 2,396 Posts

Specializes in Ortho, Neuro, Detox, Tele.

ok...I appreciate all responses..thanks.

However, I am a RN currently...and I did NOT say I was NOT treating the pain....Pt. 1 was getting his percoset q4h prn, and his scheduled pain meds....I was not withholding anything at all. I was just thinking in terms of what is seen and how the verbal/physical didn't match up....just saying.

perhaps it was a bad day. pt. 2 WAS dealing with fear issue, because today simple vicodin was holding pain, and he confessed he was embarrassed about having others take care of him, and he hadn't had a shower/bath in 3 days, etc....once he got to the shower chair, and I cleaned him up and he got around, he did MUCH better today.

Pt. 1, however, was up and down today, rolling, etc....and right after he rolling...the facial/guarding/etc did NOT match up with what he was saying in terms of describing....I did NOT give him prn pain meds unless requested today...but he was comfortable enough NOT to request them. just scheduled meds, and also I did go in and make sure he was AWARE that to get the percs he had to ask....only did so once today after a PT treatment that I was part of and he WAS severely limited....

I understand the pain is pain argument...but you do have to gauge on who is NOT matching up with assessments that you're doing....thank you all for the advice and I respectively disagree with some of it. But thanks anyways. Good posts!

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