Tuesday, August 13, 2002

Today was the first of four classes I am taking on oncology nursing. It is fascinating, and totally relevant to my practice. I can go from class to work, and actually use the information I've learned. A lot of times, that doesn't happen. I found that my learning enhanced because I brought my knitting with me. At first I thought people would be offended that I knit during their lectures, but I sat in the back and one lady actually complimented the scarf. The knitting occupies one side of my brain, it keeps me from being antsy, and I catch more out of the lectures because I am listening harder.

Today the highlight had to been the lecture given by Pat Coyne, our nurse practitioner and pain management guru. Pat has worked his ass off trying to implement a decent pain management education program for the staff at MCV. His 8 hour class on the subject is now required for all nurses and most MDs at MCV to take. Pat's very very passionate about his pain management beliefs and offers some staggering facts about how much better we can make pain management. One of those ways is through patient and family education. So...I figure I'll use The Corner for good use now and tell you what I learned:
Staggering facts:
Percentage of family members of a deceased patient who believed that their loved one died in excrutiating pain: 68%
Specialities of physicians who are required to take pain management to pass their medical boards: 2- oncologists and anesthesiologists.
Percentage of nurses and doctors who cannot calculate correct and adequate opiate doses, thus prohibiting their patient's chances of adequate pain management: 70-80%
Percentage that nurses and doctors underestimate their patient's pain: 50%
Number of pharmacies in the area that do not fill perscriptions for opiates out of fear that they are targets for robbery: 2 in 5.
Number of different types or locations of pain on an average cancer patient: 3 sites

Pain can lead to:
anxiety and depression
decreased REM cycle sleep, which makes patients more tired
slower wound healing and a weaker immune system

What will a good nurse do for a patient in pain?

1) Pain scale. Nurses should review the pain scale with the patient at least once a shift (usually every 8-12 hours). The pain scale usually involves rating the pain on a 0-10 scale. 0 means no pain. 10 means the most excrutiating pain imaginable. A good nurse understands that pain is different for different people. The nurse will take the patient's pain scale rating and based on it, does an intervention.
2) Pain meds...usually the most common intervention. Opiates are used for pain in oncology. Opiates include morphine, percocet, oxycontin, vicodan. A lot of these drugs have come under fire recently because they have addictive properties. A lot of patients fear that if they use these drugs for pain, they will become addicted. The latest research states that, chances are, if you use these drugs for pain, you run a very very very low risk of becoming addicted. Most nurses who want to control pain are not concerned with addiction. They want you to have the medicine that can make you feel better.
3) Other bits of TLC...Relaxation techniques, massage, ice packs, warm compresses, distraction, and prayer have been proven effective in reducing pain.

Also, a good nurse will follow up with her patient within an hour after intervention.

So, any questions? :)

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