Task-Oriented Pain Management: A Patient's Perspective

Abstract

"I'll tell your nurse." The wall speaker beeped off before I could respond to the person at the nurses' station. Frustrated, I yelled out my hospital room door, "You said that 20 minutes ago!" Having just had bilateral knee replacement surgery, my only access to the world beyond my hospital bed was the call button, but I expected this. During the preoperative patient education class that my family and I attended, we were told that the most important thing a postoperative patient could do would be to ask for help. Use a call button for even the slightest need, use ice packs as oft en as possible, and do not under any circumstances get up without help. Only a few days into rehabilitation I learned that if I needed something, it was going to take more than one push of the call button. Desperate for ice packs and a trip to the bathroom, I decided it was time to take matters into my own hands. There was a walker about three feet from my bed, just close enough for me to grab with the reaching stick provided by the occupational therapist. The question at this point wasn't whether or not I could make it to the bathroom. This wasn't the first time I had broken the rules and ventured past the confines of my bed alone, so I knew I could do it. The question was whether or not I'd make it to the bathroom in time. A nurse entered my room-the first response aft er four calls in 40 minutes- and helped me back into bed. "You know, you're not supposed to be walking around by yourself," the nurse advised as though I didn't know. On her way out, she asked if there was anything else I needed. Exhausted from a strenuous exodus to the restroom, I didn't remember until aft er she was gone: ice packs. My recent inpatient experience left me with a sense of inner conflict. As the daughter of a nurse, I had to try to reconcile what my mother taught me about nursing with what I experienced. "Nurses are a patient's number one advocate," Mom always said. "They are your eyes, ears, and voice when you are at your most vulnerable." The staff at the rehabilitation center ran a very tight ship. They had to; with few nurses on the unit and more than 30 patients screaming for pain medication, ice packs, and all the other needs, they were well trained to methodically provide care to the highest standards of a Magnet hospital. What I observed, however, is that when care is provided in the form of a regimented task list, stretching nurses far too thin, the patients suffer from the lack of compassion that comes from being treated like a checklist of responsibilities rather than a human being. Every day I awoke at five to the sound the curtain being drawn around my bed. A nurse had to take my vitals and draw my blood to check my Coumadin level. It was difficult to get back to sleep-the discomfort of two prosthetic joints made sleeping at all nearly impossible. The sound of clean towels and a water-filled basin dropping on my bed table roused me out of a lucid nap 2 hours later. To me, this was the first physical therapy session of the day. Getting myself up, bathing from a basin without spilling onto my sheets and reaching for my clothing was physically strenuous enough that by the time I was done, I needed a nap. My breakfast frequently got cold as it waited for me to finish my morning rituals. I wondered if my age had anything to do with the absence of assistance. I oft en heard the nursing staff comment on how unusually young 746B was, that 746B would probably recover faster than the other patients. They wondered what 746B did to need double knee replacement surgery before age 30. I wanted to scream, "746B has a name and needs help getting dressed!" Two different pain medications were administered every day: a controlledrelease drug given every 12 hours and a fast-acting narcotic given every 3 to 6 hours as needed. …