Unmotivated patients VS pain?

[locolorenzo22, BSN, RN]

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.

[ayla2004, ASN, RN]

i'm a student nurse ona spinal ward

lack of motivation is a biggie for some of these patients

seems younger patients are more lacking motvation and i'm talking 18 year old having congentive scolorsis they won't move due to pain, we do try to work with PT to give prn meds before movement however its not due we can't give. however i've never seen so much opiates adminstered anywhere in this hospital. what seems to get rn is that when a patient ask when its due and then there roomate also asks for the med.

[DreamingTree]

To truly understand motivation, you have to learn what makes the person tick. Not an easy thing to do when you are a busy nurse. My former career was in psychology, and I draw upon that background daily. If someone tells me that they are in pain, and I see them tense up, I jump right into a soothing speech (short & sweet w/a demo) about relaxation techniques. I also ask them about what makes the pain worse, what helps, and work off of what I learn. Basically, I use a mix of "I care....," "here's how to take control.....," and "I'll let you rest after...." approaches. I also try not to doubt their pain rating -- it is what they say it is. Obviously, there are those who we just won't reach no matter what approach we try.

Side story about pain ratings: Many years back (before I became a nurse) I had the worst headache of my life for several days. It became so bad that it was hard to lift my head. My husband finally had me go to the ER (b/c it was a weekend.....). I have always been a stoic around strangers, so when I was examined, I simply gave the facts -- no moaning or groaning, calm approach. Big mistake. They must have doubted my pain report because insurance would not cover the visit -- even though a visit to the ER w/o dr approval fell under my plan. Lesson: you never truly know the person you are caring for, so don't be quick to pass judgment.

[Pretty in Ink]

I am in a similar situation w/ a particular pt. at my rehab facility. Hx of MI, CHF, Arthritis etc, etc etc u name it, he has it...came in to rehab post hip fx. and has been on heavy doses of pain meds for years. He actually went through withdrawals at the hospital he came from prior to arrival in our facility. Him and his wife are so nasty with the staff and the dr. that I can't believe they made our own dr. break down and write an order for something we all know is contraindicated with another med he is on all b/c of his "pain." I am sure he is in some pain but then again who am I to know what he is going through, and its so hard trying to find the line between med addiction and real pain relief with him. He refuses to get up for PT during the day then cries to me at night for 30 minutes about how he feels bad for acting the way he did and he really does want to get better and function as before but then during the day he is a totally different person and blames the staff for withholding pain meds and "torturing" him so on and so forth. Its hard to help people who won't help themselves and he is in rehab and part of him being able to stay at my facility is cooperating with the PT staff and getting back to a level of stable functionality. All I can say is try to be as compassionate as possible and just document document document on the pt's noncompliance so it doesnt fall back on your shoulders.