Forensic Nursing Chronicles

According to JCAHO guidelines, accountability for pain management is shifted from the individual practitioner to the organization. Nurses are called to examine their own views and cultural beliefs regarding pain management and to rethink them if they are in conflict with their employer’s standard. Often patients complain of having to call frequently for medicine, having to wait unrealistic time frames for medicine and of receiving too little pain medicine or none at all. If pain assessment is truly "the fifth vital sign," then we must assess pain just as we would assess other vital signs – every few hours and prn. If the patient’s blood pressure were elevated, we would act on it. The same holds true for the pain assessment – we must act on it. When the patient becomes anxious and fearful that the pain will return, it complicates pain relief because of that anxiety and fear; therefore, at least initially, it is often necessary to give pain medication on a fixed schedule. Usually by the time the patient calls, they are already hurting and pain is more difficult to control. Two areas of self-assessment are important for the nurse to examine. The first is pain management in the drug addicted individual. Often nurses refer to individuals requiring frequent pain relief as "drug seeking." The patient who has a history of drug use will often require greater amounts of pain medicine. Drug abusers still have the intrinsic right to adequate pain management and the nurse must advocate for the patient, suppressing any personal feelings about drug abuse and knowing that drug abusers feel pain the same as (or sometimes more intensely than) any patient. While we must use discretion in our pain assessments, giving narcotics only when indicated, we are also morally obligated to do no harm, which includes withholding needed medicines. We must believe the subjective report of our patient and not withhold medications because we fear enabling the abuser. The other area needing self-awareness is in the care of the dying patient. Caregivers sometimes withhold opiods near the end of life because they do not want to give "the fatal dose." In the patient whose death is imminent it is inhumane to allow them to end their life in suffering when the nurse has the tools to provide the relaxation and peace experienced through the relief of pain. Death is something we all will face one day, and most of us fear dying. Hospice nurses assess the patient’s expectations of the dying experience upon admission, and most patients desire to be pain free when death occurs. When death is near, many patients cannot communicate the need for pain relief, so the nurse must be especially vigilant in attending to the patient’s needs.

Original Post
November 9, 2009
Title: Effective Measures Towards Pain Management, comment
Being culturally sensitive is paramount in the assessment and treatment of pain. It begins before any contact with the patient. It begins with self awareness of how the nurse views pain and the understanding that the nurse’s beliefs are formed by his/her own culture. By self actualization, a nurse is better prepared to interact more therapeutically in the patient’s behalf. The Joint Commission requires that a patient be assessed and reassessed ongoing to pain relief, taking into account the patient’s cultural, spiritual and ethnic beliefs. According to McCaffery (1999), pain is whatever the experiencing person says it is, existing whenever the experiencing person says it does. It is a combined phenomenon with sensory, emotional, cognitive and physical parameters. Pain assessment and pain relief however, may be different for every patient. Nurses should educate their patients and families to report the pain, and to expect relief. It is far more likely that a patient’s pain will be under treated due to withholding or inappropriate prescribing of opioids. The nurse should very familiar with the pain tools and use them consistently, taking into account cultural differences. The signs and systems of pain should be assessed carefully. The nurse should not second guess the patient or family and should not dismiss what is being said. They should also listen carefully to their patients and look for contributing factors. The nurse will want to ask the patient regarding their belief about pain and satisfaction with the current pain level. This information will direct the actions that the nurse will take, both pharmacologically and in providing comfort measures.

Original Post
September 8, 2009
Title: Effective measures toward pain management, comment
This post reminds us that the measurement of pain is primarily subjective. As providers, we must always remember that people respond to and express pain very differently. We must be culturally sensitive when assessing and treating pain. Pain is the 5th vital sign. Pain affects the physical and psychological well-being of our patients. It is our responsibility to ensure that our patients’ pain is being well managed. We must know our own biases and misconceptions and leave them at the door.

Original Post
September 2, 2009
Title: Effective measures toward Pain Management
Pain is an alteration in ones comfort level, which can significantly impact the physical, emotional, and psychological well-being. Pain is a subjective experience that can only be explained by the patient. Cultural and ethnicity are a few factors that influences patients response to pain, to improve outcomes nurses must be able to understand pain from a cultural perceptive. People respond to and view pain differently. Among various groups for various reasons emotions may or may not accompany pain it is viewed by some as an act of punishment or as a spiritual test. Having knowledge of patient’s views and how they define pain is very valuable in that it can assist the nurse in achieving positive outcomes by incorporating this information in the plan of care. Nurses who ignore or refuse to develop cultural sensitivity not only do they violate patients’ rights but also a chance of having a trustful relationship and without this you can expect poor outcomes. Pain is often poorly assessed and poorly managed due to reasons like misconceptions and nurses lack knowledge. This usually leads to under medications and poor outcomes, such as the post-op abdominal surgery patient that develop pneumonia because is unable to perform cough and deep breath exercises every 2hrs secondary to pain because of the nurses’ misconceptions about administering pain medication to a patient with history substance abuse. To achieve goals of effective pain management nurses must first be aware of their values and personal beliefs concerning pain and the behaviors associated with it, this will assist in developing an awareness and sensitivity to the patient’s need. Nurses must be knowledgeable and skilled in collection of both subjective and objective data (by accepting the patients’ assessment of pain by using pain assessment tools and observation of emotional behaviors such as crying or moaning), which will assist in identifying the intensity of patients’ pain and promote better outcomes. Misconceptions must be explored and addressed because these also impact outcomes, such as administering pain med on regular basis will lead to addiction or those who abuse drugs usually over exaggerate their pain, by acknowledging these misconceptions nurses will be able address patients’ pain related issues more professionally and improve steps toward effective pain management.

Tags: Forensic Nursing, Forensic Nursing Chronicles, Forensic Nursing Theories, Forensic Nursing Pain Management, Patient Rights Pain Management, Medication Error Pain Management, Cultural Sensitivity Pain Management, Ethic Sensitivity Pain Management, Forensic Nursing Pain Assessment

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