Posts Tagged ‘Forensic Nursing Pain Assessment’

Effective Measures Toward Pain Management, comment

July 12, 2010

Nursing assessment plays a significant role in the management of pain in caring for a patient.  Pain being a very subjective area to measure you can not only take the subjective level of pain you must also take into account the objective level of pain observed.  The level of pain is a grey area; it is not as simple as being in pain or not being in pain.  There are different levels to the pain and this varies from patient to patient.  Each patient has their own level of pain tolerance.  For example; in the practice I work in now we use a NIBP to measure the patients’ blood pressure in which most patients are not affected by this instrument.  However there are some patients that cannot tolerate the NIBP, it is too painful for them to use to measure their blood pressure; these patients have a lower threshold for pain.  They experience pain in a different way, however their pain is real.  As a nurse you need to be alert and conscious of each patient’s pain threshold.

An accurate pain assessment holds such an imperative function of a nurses advanced health assessment when caring for their patients.  When a nurse is functioning in the role of some area of forensic nursing their experience and knowledge of pain assessment may be called upon to use in their responsibility as a forensic nurse.  For example; if a forensic nurse is being called upon in the court of law to provide testimony in a legal matter they may have to incorporate this experience and knowledge of assessing pain to give an honest and accurate testimony.  Another example of pain assessment being incorporated into forensic nursing would be when a forensic nurse is assessing a possible victim of abuse; the victim may downplay their pain.  As a victim they may try to hide their pain and the forensic nurse will be required to be able to observe accurately any objective signs of pain to give the victim the care they need.

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.

Online Forensic Nursing introduction course
Online Forensic Nursing certificate program
Online Nursing Assessment undergraduate education
Online Nursing Assessment graduate class

Advertisements

Drug abuse co-occurring with chronic pain, comment

January 11, 2009

I do agree that physicians are obligated to try to relieve the pain to there fullest power, however, one person may continue to experience pain and the physician should not always be held liable. It is the responsibility of the physician to do all that is in their power, but sometimes despite attempts at pain relief, some patients who have been addicted to drugs in the past end up with chronic pain. I do not think that one should be judged by their past experiences with drugs nor do I think this is a reason to keep pain medications from them. They have the right to treatment. Sometimes one of the barriers is that when a person has done drugs in the past, they have a higher threshold, meaning that they may require more of a substance than the physician who is treating them is willing to prescribe. Some past drug addicts require mega doses of morphine for pain, and some doctors do not feel safe in prescribing this. As an overdose could end fatal. One of the things that Naturopaths can do is to help the patient focus on other things instead of the pain. Try relaxation techniques and try to help the patient focus on healing instead of feeling the pain. While this will not work for all patients, this will work for some.

Original Post:
October 16, 2008
Drug abuse co-occurring with chronic pain
Physicians are obligated to relieve chronic pain. What should the professional do when chronic pain is present, but substance abuse is a concealed co-occurring disorder? When addicted patients experience any type of pain, the goal is to treat the pain; the addiction treatment in not the priority while patient is in pain. If drug abuse is unknown in the patient it’s the nurse’s job to suspect abuse when normal doses of analgesics do not relive the patient’s pain. If the nurse can determine the drug that is being abused and the amount being used, it is best to avoid exposing that drug to the patient and have an alternative drug.

tags





Drug abuse co-occurring with chronic pain, comment

November 12, 2008

I too believe that just giving these people pain meds is irresponsible. Giving them resources is all we can do in the emergency department setting. They get mad when they become a repeat customer and are finally refused pain meds. We give them alternatives and resources to providers who can get them help or long term treatment. The problem is these patients have to want the help. There are patients out there that work the system. They travel in an “ED circle” to get what drug it is they need. They might not even be the abuser of the drug. They may be looking for meds for their spouse or to sell, so they can get the drugs they do want. I offer resources to patients repeatedly. But, after numerous attempts I stop. Patients do need to take charge of their own health. And unfortunately, there are those people out there that just don’t want to and no matter what approach you use, you’re not going to change them. They have to change themselves.

Original Post:
November 10, 2008
This is an interesting post about physician’s obligation to “relieve chronic pain.” As the patient(s) may be coming in for treatment of pain with a concurrent drug abuse situation, the patient is the one who does the healing and the nature of the pain needs to be fully examined. Drug addiction can be recreational, prescribed meds, and common “foods” like sugar, alcohol, caffeine, nicotine, nutritional stimulants, etc. If a patient does not respond to pain meds, there could be many causes that warrant further investigation. If substance abuse is suspected, then blood testing and urinalysis may detect overuse, but how about in people that have been long-term users/abusers? I don’s believe that the solution is to simply use an “alternate drug.” A professionally supervised detox program will usually free up the liver detox pathways to allow the meds to work better – in the even of an emergency situation with debilitating pain. If the pain is chronic in nature than the origin must be detected and dealt with in order for the patient to regain health. In my experience most patients want help with their addictions usually come clean if they trust the practitioner. Our job as health care practitioners is to promote health – neglecting the patient’s habitual abuse and underlying causes for his/her chronic pain is just pain lazy and irresponsible. There is a person sitting in front of us who needs our immediate help and we must understand the situation in to the best of our ability. Giving the patient more meds is no solution, and you can’t promote health by loading people up on drugs -in fact you may kill him/her. They will need education and integrative therapies that will help them piece together their lives. The “chronic pain” is the body’s way of communicating a person that there is a problem or imbalance and using meds to shut off this alarm is not an effective long-term solution.

Original Post: October 16, 2008 Physicians are obligated to relieve chronic pain. What should the professional do when chronic pain is present, but substance abuse is a concealed co-occurring disorder? When addicted patients experience any type of pain, the goal is to treat the pain; the addiction treatment in not the priority while patient is in pain. If drug abuse is unknown in the patient it’s the nurse’s job to suspect abuse when normal doses of analgesics do not relive the patient’s pain. If the nurse can determine the drug that is being abused and the amount being used, it is best to avoid exposing that drug to the patient and have an alternative drug.

Technorati Tags:
, , , , , , ,

Drug abuse co-occurring with chronic pain, comment

November 10, 2008

This is an interesting post about physician’s obligation to “relieve chronic pain.” As the patient(s) may be coming in for treatment of pain with a concurrent drug abuse situation, the patient is the one who does the healing and the nature of the pain needs to be fully examined. Drug addiction can be recreational, prescribed meds, and common “foods” like sugar, alcohol, caffeine, nicotine, nutritional stimulants, etc. If a patient does not respond to pain meds, there could be many causes that warrant further investigation. If substance abuse is suspected, then blood testing and urinalysis may detect overuse, but how about in people that have been long-term users/abusers?

I don’s believe that the solution is to simply use an “alternate drug.” A professionally supervised detox program will usually free up the liver detox pathways to allow the meds to work better – in the even of an emergency situation with debilitating pain. If the pain is chronic in nature than the origin must be detected and dealt with in order for the patient to regain health.

In my experience most patients want help with their addictions usually come clean if they trust the practitioner. Our job as health care practitioners is to promote health – neglecting the patient’s habitual abuse and underlying causes for his/her chronic pain is just pain lazy and irresponsible.

There is a person sitting in front of us who needs our immediate help and we must understand the situation in to the best of our ability. Giving the patient more meds is no solution, and you can’t promote health by loading people up on drugs -in fact you may kill him/her. They will need education and integrative therapies that will help them piece together their lives. The “chronic pain” is the body’s way of communicating a person that there is a problem or imbalance and using meds to shut off this alarm is not an effective long-term solution.

Original Post:
October 16, 2008
Physicians are obligated to relieve chronic pain. What should the professional do when chronic pain is present, but substance abuse is a concealed co-occurring disorder? When addicted patients experience any type of pain, the goal is to treat the pain; the addiction treatment in not the priority while patient is in pain. If drug abuse is unknown in the patient it’s the nurse’s job to suspect abuse when normal doses of analgesics do not relive the patient’s pain. If the nurse can determine the drug that is being abused and the amount being used, it is best to avoid exposing that drug to the patient and have an alternative drug.

Technorati Tags:
, , , , , ,

Drug abuse co-occurring with chronic pain

October 16, 2008

Physicians are obligated to relieve chronic pain. What should the professional do when chronic pain is present, but substance abuse is a concealed co-occurring disorder? When addicted patients experience any type of pain, the goal is to treat the pain; the addiction treatment in not the priority while patient is in pain. If drug abuse is unknown in the patient it’s the nurse’s job to suspect abuse when normal doses of analgesics do not relive the patient’s pain. If the nurse can determine the drug that is being abused and the amount being used, it is best to avoid exposing that drug to the patient and have an alternative drug.

tags





OUCH! – Pain control and nursing related issues

September 26, 2007

The last decade or so the medical field has been placed under greater than normal scrutiny with issues concerning pain control. Now considered the “5th vital sign” nurses are expected to be even more of a patient advocate in assessing and treating pain. I think it’s great that there is a large emphasis placed on the comfort of patients experiencing pain, but there are some problems associated with this extra pressure. For example, a nurse might be afraid of being sued now for not giving a patient enough pain control, when worried about that said nurse might be more apt to giving TOO much pain medicine. I used to work in the post anesthesia care unit of an OR department. This is a unit where pain control is a major issue anyway. I recall being in several situations where a patient was barely conscious but rating pain level 9-10. What is a nurse supposed to do? Of course if I felt like respiratory depressing was becoming an issue I would hold the pain meds, but I could not help but feel I might get in trouble later for doing so. Pain is terrible, but scaring nurses with legal tactics or threats of lawsuits is probably not the answer.

tags






Back pain in the emergency room

September 20, 2007

The health assessment for back pain in the Emergency Room (ER) is an interesting assessment. The assessment usually begins as a visual watching the patient walk into the examination room after observing them get walking in form the parking lot not knowing that the practitioner is watching them. The chronic back pain caused from some sort of an on the job injury (OJI) usually does not pass the test of true and unrelenting pain. The client walks normally from the car but then starts stooping or limping or other symptoms just to make the “pain” look good. On the other hand, the acute injury or true pain is very obvious just by the outward visual exam. The physical exam on the person seeking continued pain medications or work disability shows that almost any suggestion of something hurting produces pain whether it should or not. The conclusion that we are coming to is that OJI for back pain lasts much longer without resolution then it should.

tags








The Passing of Demerol

June 8, 2007

There is plenty of literature stating the cons of Demerol use for pain management but usage still remains high in the hospital setting. I have had little success in my career to change physicians ordering practices except when I can demonstrate the side effects or poor outcomes produced by Demerol on a patient-by-patient basis. It seems not to matter the short duration of action; induced confusion in the elderly or the potential Demerol has to produce nuerotoxicity due to the accumulation of normeperidine.

As nurses it is our duty to be an advocate for our patients. To help ensure patients receive the best possible care we as nurses need to arm ourselves with knowledge. It is important to possess the basic concepts of pain management to accurately assess and document your patient’s pain and to know the classifications of pain. The nurse must understand basic pharmacologic pain management principles including the use of an equianalgesic table. Working with the medical staff to develop pain management protocols can help decrease Demerol usage and provide an effective pain management program in your hospital.

Demerol seems to be dying a slow death but as hospitals and healthcare workers embrace evident based medicine it is only a matter of time when this “lumbering dinosaur” will be come extinct.

tags






Pain assessment in the forensic population

February 14, 2007

I recall one time a Psychiatrist told me; “trust and believe in the psychiatric patient until that trust is broken”. That is very much paraphrased from the actual content of that conversation that occurred oh so many years but that has been a motto that I have used throughout my nursing career. To me this mean to treat the patient with respect, dignity and to value where they are at that moment.
That preamble leads me to pain assessment. JCAHO implemented their pain standards in early 2000 for multiple reasons two of which are; 1. customer satisfaction & 2. healthcare was doing a very bad job at assessing, and providing intervention for pain. My posture is; that in caring for the forensic mental health population we continue to not meet the basic premises of pain management. We judgmentally scoff that the patient is “drug seeking”, we discount that this recovering mentally ill person with co-morbid substance usage issues could ever legitimately have pain. On the flip side of that we dole out acetaminophen without the blink of an eye.
On one hand the “drug-seeking” patient no doubt has not been adequately assessed for acute or chronic pain and the acetaminophen-ingesting patient is probably just trying to obtain some attention.
I have a desire to make change in pain assessment and implementation of interventions at this organization where I work. I am a firm believer that health promotion and health maintenance are vital in the area of pain management and all too often we either ignore the patient or far to readily administer medication. I seek suggestions for the promotion of non-pharmacologic interventions, solid assessment techniques that are tried and proven, and any other insight into being a change agent in this area.

tags





%d bloggers like this: