Ouch! Safely treating patients without pain

A number of weeks ago, my husband got here to the emergency room with a broken rib resulting from a fall. The nurse was very attentive to his need for pain management. Having never taken morphine before or after his second dose, he asked the nurse, “How much of this will you give me?” Her response was, “As much as needed to safely control the pain.” What an incredible answer!

When it involves treating pain, it is not at all times that straightforward. I’ve previously told the story of a patient in our ICU whose member of the family, himself a nurse, would not allow us to treat his sister’s pain. This was a difficult case and ultimately our hospital’s ethics committee was consulted.

The position of the American Society of Pain Management Nursing (ASPMN) and the International Nurses Association for Addiction (IntNSA) is that “every patient experiencing pain, including patients with substance use disorders, has the best to be treated with dignity, respect and top quality pain assessment and treatment.” As nurses, we’ve a responsibility to make ethically sound decisions regarding pain management. But find out how to do it?

Please review related ethical standards

• there’s an obligation to do good for the patient, considering his wishes. it’s the duty to not harm patients. The challenge here is to realize pain control while ensuring patient safety.
• means treating everyone fairly. This could be difficult because pain can’t be measured objectively and we must depend on the patient’s self-assessment.
• requires us to respect, support and advocate for patients, even when it goes against our own beliefs.

Be aware of barriers to effective pain management

• Sometimes patients are unable to speak about their pain. Whether the patient is noncommunicative, has a language barrier, or has difficulty describing the pain she or he is experiencing, use your knowledge and skills to conduct an intensive history and physical assessment.
• Time constraints could make it difficult to evaluate and manage a patient’s pain. Try to actively take heed to the patient, plan and cooperate with other team members.
• Sometimes cost is a difficulty and a few procedures will not be covered by the patient’s insurance. If this is just not inside your expertise, seek the advice of with a colleague who knows the financial points of pain management.

Set goals and prepare a pain management plan

1. Evaluate your personal beliefs and take into consideration your past experiences.
2. Remember that every patient is exclusive.
3. Tailor patient and family education appropriately.
4. Encourage patients to develop into energetic partners in pain management. Remind them that pain control helps with recovery.
5. Actively take heed to the patient’s report of pain.
6. Be sensitive to concerns about reporting pain. For example, patients may not report pain for fear of getting to undergo more treatments.
7. Consider asking about burning, pain, pressure, discomfort or throbbing. Research shows that to reduce pain, older people cannot use the word “pain.”
8. Take cultural differences under consideration.
9. Pain scales appropriate to the patient ought to be used.
10. Ask the patient what level of pain can be satisfactory.
11. Explain the difference between pain elimination and pain control; Completely eliminating pain while maintaining safety is just not at all times realistic.
12. Work with the patient to set “functional goals” – for instance, having the ability to walk down the hall and back.
13. Consider non-pharmacological methods corresponding to lighting, positioning, distraction techniques (music, guided imagery), leisure techniques (respiration, progressive muscle leisure), and advanced complementary modalities (massage, biofeedback).
14. Monitor the patient for negative effects, contraindications, and drug interactions.

As nurses, we’re in an excellent position to advocate for protected pain management. Remember to listen, collaborate, plan and evaluate!

Bibliography

Diallo, B., and Kautx, D. (2014). Better pain management for older people within the intensive care unit. , 316-319.
Oliver, J., Coggins, C., Compton, P., Hagan, S., Matteliano, D., Stanton, M., . . . Turner, H. (2012). American Pain Management Association Statement: Pain Management in Patients with Substance Use Disorders. , 210-222.
Quinlan-Colwell, A. (2013). Developing an ethical treatment plan for patients affected by pain. , 64-68.