Pull Out the Pain with a Needle
How many of us became nurses because we like shots? We never liked getting them as kids, and we probably don't continue to enjoy receiving them. Learning to give them was probably no less stressful than receiving them. I can remember being in the skills lab with my clinical group and instructor when we learned to give IM injections. We were all very nervous and wondered if we could ever inject a patient. After graduation, and with a half dozen shots under my belt, I felt no less anxious about giving shots. With a bit of help from my preceptors, I got the hang of it, but I didn't go out of my way to seek opportunities to inject. Then I took a course on therapeutic touch, and the instructor asked us how many of us really enjoyed giving shots. Of course, we all groaned and moaned. "Why?” she asked. "Because we don't like to cause pain," we all replied. She then proceeded to explain to us how we were missing the point (pardon the pun!). The shots we gave were not causing pain, but were relieving pain. She talked us through a guided imagery to use when we gave pain shots. It went something like this: As you walk down the hall with the syringe of Demerol (or other pain medications), imagine yourself heading to your patients room to take away his or her pain. As you prepare to give the injection, close your eyes for a moment and see the syringe in your hand not as an instrument for injection of a medication, but as an instrument for withdrawing pain from the patient. Then inject the needle and medication into the patient, but as you withdraw the needle, create an image in your mind of withdrawing the patient's pain from his or her body with the needle. Well, after that exercise, I began to like giving shots! I used to go into my patient's rooms and talk them into their prn meds, rather than trying to avoid them as I had in the past. It was then that I began to realize that it is our attitudes as nurses that can keep patients from the pain relief that they need and deserve. Our preconceived notions about addiction seeking behavior by those in pain, of weakness of character of those who "needed" pain medicine, etc. enter into how we see our patient who is in pain. It is practically impossible for someone who is in pain to become addicted to pain medication. Yet by withholding a prn dose and allowing too much time to pass between injections, we can allow the blood concentration of the drug to fall enough that pain control is absent, and the next dose needs to "start over" with achieving pain relief, instead of just maintaining comfort. Recent directives by the JCAHO, and education of providers, have made pain management more of a priority. Pain assessment is now described as the fifth vital sign, to be assessed as frequently as we check temperature, pulse, respiration, and blood pressure of our patients. New drug delivery systems, such as transdermal patches, have made medication delivery so much easier, and give the medication a steadier blood level over a longer period of time. But these new systems bring with them challenges for drug control and diversion protection. As Nurses, and other providers of health care, it is imperative that we seek effective pain relief for our patients. It is not only our professional and moral responsibility as nurses to assess and relieve pain, but as case managers it is a critical step to moving along the process of recovery. For example, the patient who has had knee replacement surgery will most likely do more in the therapy gym if he is pre-medicated for pain before he even goes there. If a patient has a dressing change of a skin ulcer, pre-medication thirty minutes before the procedure may ensure that it is performed without causing tremendous discomfort. As long term care facilities are providing care for more complex patients for short-stays, it is critical that an effective pain management program be employed, including these elements:
- Assessment of all patients on admission and periodically for pain
- Education of nurses and other health providers on the basics of pain control, and how to be aware of our potential internal blocks to providing pain relief
- Readily accessible pain medications with medical staff will to prescribe them, pharmacy able to deliver them when needed, and nurses able to administer them
- Education of staff in non-pharmacological pain control modalities such as music therapy, massage, imagery, etc.
As with any initiative, there needs to be a commitment to pain control starting with the very top of the organization and extending down to the front lines. In your organization, focus on taking the pain out of relieving pain, just as my preceptor did for me when she taught me not to think of causing pain with injections. If so, patients will be more comfortable and the facility will be more successful.
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