I first started working as a nurse in a busy medical/surgical unit where patients had a range of pain management issues. At the time, I thought I knew a lot about managing pain. I realized I was wrong when I experienced a significant orthopedic trauma. Then I learned firsthand that the nurses managed my pain, not the physicians, and that they were having trouble doing so for various reasons: They were limited in the drugs they could administer, their understanding of pain assessment was incomplete, and their expectations about how patients should recover from orthopedic surgery colored their interventions. After that eye-opening experience, I dedicated my master's program to learning about pain and how to manage it.
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From teaching nurses about pain management over the years, I've learned some important lessons. One of the most rewarding is that nurses truly care about their patients and want to give them the best care possible. But I've also concluded that nurses' attitudes and biases are still barriers to effective pain management.
The Nursing2008 Pain Management Survey featured in this issue (see page 42) was designed to explore the knowledge and biases of nurses at the bedside. Nearly 3,000 nurses took time from their busy schedules to respond. I'm encouraged by many of the results: Saying no to placebos and intramuscular injections and yes to standardized pain intensity rating scales, most respondents demonstrated keen awareness of many important pain management principles. But I was also discouraged to see that fears and misunderstanding about opioid addiction are still prevalent.
Although most nurses chose the right answers to questions about addiction, the comment section contained many remarks about "frequent flyers," "clock-watchers," and "drug seekers." For these patients, I prefer the term "relief seekers." If the nurse can find out why these patients are making frequent requests for analgesics, she may be able to help them find relief. It takes those special nursing skills we all have-listening, patience, empathy, and caring-to work with the patient to find the right medication, right dose, and right approach to pain relief.
I'm grateful to all the nurses who took time to complete this important survey. The results prove we're on the right track for improving patient care. I'm proud of the way that nurses keep stepping up to seek the best possible pain relief for patients under their care.
Yvonne D'Arcy CRNP, CNS, MS
Pain Management and Palliative Care Nurse Practitioner Suburban Hospital Bethesda, Md.