Pain: The underestimated Vital Sign.
As a Nurse Practitioner, I meet and care for quite a wide range of individuals, coming from all socioeconomic, racial, religious, and age groups that it would be too many to count! This is just one of the reasons why I love being a healthcare professional; it exposes me to more types of people, and I can learn a lot! While the environment I see patients is a bit more non-conventional, I am still caring for individuals facing various physical challenges, new health concerns, and new diagnoses, and they are in an environment that is not what they would consider ideal. But being on the other side of caring for patients, where now I am the ordering provider, I have seen an unfortunate side to patient care that I always knew existed, but was never the person ordering what a patient needed. What I am referring to is pain. Pain as in physical pain. While I am not going to provide education on the many different types of physical pain, some individuals care for people closely, who do not understand it. They may not wish to help alleviate it and perhaps carry biases with them or do not want to be responsible for the administration of pain medications, because they erroneously believe it places their license at risk by simply following an order. Whatever the reason, the patient ultimately suffers the consequences and I don’t feel as if this is talked about enough.
I cannot share specific details about the two instances I experienced this week but I felt compelled enough to write about this, because part of my job is to ensure people can heal, and eventually go home. Pain is a HUGE obstacle that has been greatly misunderstood because we cannot measure it like we can a blood pressure, test for it in our blood or see it because it is something each person experiences and feels differently. My 10/10 pain, may be someone else’s 3/10 pain. It is a seriously overlooked vital sign that can tell us if someone is healing or not, or if they will be able to go home and be independent again. Pain is something that many functional people live with every day, who you would never know, do. It tells us what could be wrong with a part of their body. It allows us to correct an underlying cause or drives treatment plans. Does every treatment plan mean they need narcotics? Absolutely not. It may just mean they need to learn how to move properly. But it is most certainly one of THE most underestimated and underused measurements.
On two separate occasions last week, I had patients tell me their nurses were not supportive in adhering to their pain medication schedule and felt like they were being judged when asking for their pain medication. These are elderly patients. They are post-operative patients. As a prescriber, I need to know whether what I prescribe is helping or not. This is not just with pain medication of course but with pain there is no other way to measure a medication's effectiveness other than what a patient tells you. Perhaps I was very fortunate to have attended nursing school with instructors who took this very seriously. Nurses are responsible for assessing and documenting pain, medication effectiveness and reporting any adverse or undesired effects of medications they give to patients. If a patient’s pain is escalating despite an intervention, there could be a potential underlying problem. It was very evident to me that those caring for these two patients missed this part of their education. Does this mean I am haphazard in my pain management prescribing? No, as I do believe many non-pharmacological pain relief measures are also greatly underutilized because they do not work as quickly as medications do. But it does mean that I consider an entire clinical picture of my patients to formulate a pain management plan that will allow people to be more mobile and individualized.
If you stayed with me this long, I am not asking you to give out more narcotics to your patients or go right for the strongest medication possible to manage the pain of your patients. But let us remember something called compassion. I was going to say empathy but empathy is the incorrect term because pain is what each person feels. You can put yourself in someone else’s shoes but we all experience pain differently and most likely can’t imagine what someone else feels. I can’t. I have no idea what bone surgery feels like because I’ve never had it, so how can I put myself into the shoes of my patients? I can be compassionate towards them. Meaning, I can talk to them, figure out where they are in experiencing their pain, how it feels to them and act based on this. Unfortunately, we live in a world riddled with addiction, and many medications used to treat pain are habit-forming mainly because of what they do in the body. Honest and open communication with patients can lead to developing an individual plan to appropriately taper them off. But compassion has to be at the forefront of this. However, if you are not the prescriber of these medications, professionally it is not your job to do this based upon your personal belief that people should not be taking narcotics. Read that again. Nurses who hold a personal belief that narcotics should not be given should seek employment in an area of nursing where this does not occur. Many providers do not prescribe narcotics, which is acceptable and understandable.
Being on the other side of nursing has served as an eye-opening situation especially after being a nurse for 12 years before being an NP. Building relationships with my patients as their Nurse Practitioner has led many of them to confide in me which has led me to question the integrity of some individuals out there. This is not a bragging right; this is something that needs to be fixed in our nursing programs, through our precepting, and in leadership. Patients are human beings. They are not shelf merchandise or inanimate objects. They are living, breathing, individual humans with emotions and fears and need to be treated as such. Most of this post comes from a place of utter sadness. I hope that if these medical professionals ever experience a life-changing medical procedure requiring pain control, their caretaker has enough compassion to take them more seriously. Working in healthcare is an absolute gift. I am lucky to be here. It is not perfect, and roses and wonderful. It is difficult, it is challenging and by far one of the hardest career paths one could take. But one of the best parts of this field is the ability to make a difference in the life of another human being that you’d otherwise never cross paths with. Every day is a new day to make a difference! Be the difference. Be the one who goes above and beyond for your patients. Be the one who actually wants to know your patients. They will tell you things that will help you treat them, more than any tests will ever tell you.
