Diane Goodman is an Advanced Practice RN with special certifications in critical care & neuroscience nursing. She is a clinical educator at Advocate Condell Medical Center in suburban Chicago – part of the Advocate Health Care System, which employs more than 9,000 nursing professionals. This article, reproduced from the ADVANCE for Nurses blog and reproduced here with kind permission,* was first published Jul 19, 2012.
Pain Waits for No One
In providing care to patients on their ‘watch’, nurses have developed a few bad habits in repeating phrases that have become second-nature to the profession. One of these phrases has been utilized so frequently the words are spoken benignly by nurses, although the words and their suggested agenda can be detrimental to patients.
The phrase "it isn’t time for your pain medication" should be erased from nursing vocabulary ASAP, for what does this imply?
It implies pain should arrive on a schedule, one that happily coincides with the physician’s orders, so no one is inconvenienced by pain that is refractory, arrives early, or refuses to respond as intended to what is on the patient’s MAR [Medication Administration Record].
What should nurses learn to say instead of the phrase "it isn’t time for your pain medication”?
Words designed to provide comfort and validation to the patient in pain!
Here are a few examples of how this can be achieved.
• Start with compassion, saying "I’m so sorry your pain has returned."
• Add an assessment feature, such as "tell me more about where the pain is, and how it feels. Is the pain similar to what you were experiencing earlier, or is this a new pain?"
• Add a component of empathy, such as pulling up a chair at eye level to the patient, holding their hand, and asking them to describe what they “usually do for pain at home."
Here is an opportunity to explore how often the patient self-medicates, and when they may have ‘gaps’ in controlling their pain.
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All of these features can be accomplished in minutes, and the words "it isn’t time for your medication" haven’t been expressed by the nurse.
The next step is to engage in dialogue about the patient’s plan of care for pain.
The nurse can begin by stating that:
• Pain management orders, left by the physician, are "fluid" and designed to be adapted to the patient’s response.
• Patients are closely assessed to gauge their reaction to analgesics.
• Pain management orders are written for a majority of patients whose pain might be safely and effectively controlled on a schedule.
• However, this particular patient is "special." Their pain hasn’t read the workbook, and doesn’t know it should wait until the medication is due to be repeated. Their pain waits for no one.
What is said to the patient in the next few moments makes all the difference to someone in pain.
• "What can I do to make you more comfortable while I am getting new orders?" reminds the nurse and the patient to utilize non-pharmacological methods of pain relief, a forgotten art of bedside nursing care.
• Integrating ice, heat, distraction, touch, and repositioning are all effective components of pain relief, and never are they more appropriate than for the patient whose pain proves harder to suppress and control.
Utilizing the above techniques validates the patient’s complaint of pain, while providing the nurse with time to follow up on the need for more flexible analgesic orders, including the possible addition of adjunctive therapy.
• At no time was the patient allowed to feel "bad" that their pain returned earlier than expected,
• And at no time did the nurse imply the patient should tough it out and wait until their medication was "due."
By exposing one of the bad habits nurses have utilized over time, nurses can learn to re-purpose time spent at the bedside into a "win-win" scenario for everyone involved.
[See also Diane Goodman’s article "Pain Bias Toward Patients," on providers’ invalidating attitudes about patients who request help for unrelenting pain, posted by ADVANCE for Nurses on Mar 25, 2011.
* This article is reproduced from the ADVANCE for Nurses blog (http://nursing.advanceweb.com) with kind permission of the author and Merion Matters©2012 All Rights Reserved.