The thought of letting patients succumb to opioids was rejected on my unit . When a patient was to be discharged and the pain was still severe or intolerable , the nurse would initiate a conversation to re-evaluate the patient ’ s reason for pain . The interprofessional conversations I witnessed on this unit were centered around opioid prescription , not as an unchallengeable solution to post-surgical pain , but rather in relation to the patient ’ s pain level as well as the origin and intensity of that pain .
Team Mentality One example of this nurse-initiated team approach to pain management took place after a patient was recovering from a biopsy on his foot . The patient received regional anesthesia but was complaining about intense pain radiating from his foot up his leg in the postop recovery area . The patient was given a dose of moderate pain medication . The nurse paged the physician to update him on the patient ’ s recovery . The patient ’ s pain was reduced from a 9 / 10 to a 6 / 10 after the medication . The nurse checked for pulses bilaterally and reassessed the patient for any signs of adverse effects related to the biopsy ; she found none .
When it came time for the patient to be discharged from day surgery , the patient was worried he wouldn ’ t know when he needed to take opioids versus acetaminophen . At this point , the nurse felt that talking the correct amount of the prescribed oxycodone was crucial to a successful recovery for this patient . The nurse paged the surgeon and called the nurse practitioner to inform them of the situation . They agreed that the patient should be prescribed a low dosage of three pills : enough for his first full day postoperatively . The patient was told that if severe pain at 7 / 10 or higher on the pain scale persists after 3 days , the patient should call the physician for a follow-up appointment .
The physician explained to the patient his reason for the patient ’ s dosage and how to manage his pain without the opioids . The nurse practitioner weighed in after completing her own assessment and asked the physician about his follow up plan and parameters the patient should be aware of , such as pain intensity and duration . The nurse was diligent to ensure the patient ’ s partner was included in the conversation and plan . The multiperson holistic approach provides a checks and balances system for the patient and healthcare team .
Conclusion : My Future is Conversation As I graduate this upcoming spring , I feel confident and well versed in my ability to talk to patients about their pain and initiate a care plan that holds everyone accountable for their choices , both short and long term .
The nurses on the perioperative unit made sure the patients ’ feelings and fears were heard and conveyed those concerns to the rest of the team . The nurses also provided the patients with literature about opioid prescriptions designed to combat the opioid epidemic .
One tool being used by patients and providers is SolveTheCrisis . org ( Makary , n . d .). The site , put together by experts , goes through opioid prescribing guidelines . This and other accessible tools , combined with team conversations , creates a formula that looks at pain management for patients individually based on strong research and evidenced-based practice .
Over the course of my time on the unit , I had heard countless conversations like the one previously mentioned . I remember these conversations so well because they were the embodiment of nursing ethics ; the nurses were aware of the larger systemic issues of the opioid epidemic and kept that in mind when treating their patients . The nurses always felt confident and empowered to consult peers for the betterment of the patient . Nurses hold a unique position in the healthcare field ; they are the liaison between patient wellbeing and healthcare practices . I believe one of the hardest skills to master in nursing is balancing what patients want with what evidence-based practice defines as appropriate . After working on the postop unit , I believe I have improved that skillset . I have greatly valued my time working on the unit and how much I learned about real-world problems and solutions , which I can and will use in my soon-to-be new nursing career . •
References
Makary , M . ( n . d .). Surigcal guidelines : Center for opioid research and education . https :// www . solvethecrisis . org / best-practices .
Makary , M . ( 2021 ). Opioids Like Candy . In The Price We Pay : What Broke American Health CARE--AND how to fix it ( p . 128 ). essay , Bloomsbury Publishing .
Onello
Katherine Onello is a nursing student at Northeastern University in Boston , MA . She is also minoring in Global Health and is expected to graduate Spring 2022 and have a strong interest in Emergency / Trauma nursing .
42 NSNA IMPRINT • SEPTEMBER / OCTOBER 2021 • www . nsna . org